We All Have Our Ups and Downs

How are you doing? No, really, how are you doing? This can be a deceptively difficult question to answer, especially for those with certain mental illnesses like bipolar disorder. This disorder causes drastic and unpredictable changes in one’s mood and energy levels that can make normal, daily activities impossible. The magnitude of these mood changes varies greatly from person to person, and there is often no clear indication as to when a change is about to take place. This can lead to dangerous situations in which an individual is not receiving proper medical attention because the change in their condition has gone unnoticed.

A diagnosis is most commonly made in a clinical setting through an interview conducted by a physician, or via a questionnaire. Not only are these activities time consuming, but they are also highly subjective — one person’s “4” is another person’s “10.” Moreover, a patient needs to actually get to their doctor’s office for a visit for an opportunity to be diagnosed. That can lead to delays in the delivery of sorely needed treatments, and all too often, serious consequences.

The subjectivity and delays that cause many people with bipolar disorder to fall through the cracks may soon be a thing of the past, thanks to the work of a team of psychiatrists and data scientists in Barcelona and Edinburgh. They have developed a wearable device that can continually track important physiological biomarkers that can indicate when a bipolar mood swing is beginning to take place. It can also indicate the state that the individual is experiencing, whether manic, depressive, or normal. This information can be leveraged by clinicians to intervene immediately, and in a highly personalized manner.

The researchers utilized the existing, commercially available wrist-worn Empatica E4 bracelet. This device monitors electrodermal activity to recognize changes in the skin’s electrical conductivity. The skin’s electrical conductivity is altered by changes occurring in the nervous system, so it can reveal things like one’s stress level, or as the team found, changes associated with bipolar mood swings.

A study of 38 individuals with bipolar disorder, and 19 healthy controls, was conducted to assess how well the bracelet could detect bipolar disorder-related mood changes. After 48 hours of continuous monitoring, it was discovered that patients experiencing depression exhibited significantly less electrical activity in their skin, as compared with the other groups. It was also noted that as a person transitioned from, for example, a manic state to a depressive state, a corresponding change could be seen in the electrical activity in their skin.

It is hoped that one day this information might be able to alert doctors when a patient may be at a high risk for committing suicide so that action can be taken swiftly. The same sort of data could be used to directly alert the patient when certain activities, like driving, may not be advisable.

However, the research is still in a preliminary phase. So while the work has shown a lot of promise, there is much yet to be done before we arrive at this future. Looking ahead, the team plans to conduct much larger-scale studies to see if their findings still hold true. They also intend to explore the use of machine learning algorithms to help them interpret the complexities of the electrical signals that they observe, and to assist in identifying important patterns. These patterns could signify the presence of a particular mental state, and help in creating an optimal treatment plan.