Pharmacotherapy and psychotherapy for bipolar disorder in the context of early childhood trauma

Abstract

The current pathogenic paradigm of mood disorders proposes a model of gene-environment interaction, linking genetic predisposition, epigenetic regulation and effects of the environment. Among multiple environmental factors, the experience of childhood trauma can be connected with the pathogenesis and course of bipolar disorder (BD) as well as play a role in its pharmacological and psychotherapeutic treatment. Genetic predisposition and epigenetic factors are significant factors that shape the mechanisms of the influence of childhood trauma on the occurrence and course of BD in adulthood. By examining the influence of a number of genes on genetic predisposition, evidence was obtained that the most important genes in this respect are the serotonin transporter gene and the FKBP5 gene. Neurobiological effects can also involve epigenetic mechanisms such as DNA methylation, which can exert an effect on brain function over long-term periods. Moreover, the paper discusses the significance of early childhood trauma in therapeutic management of bipolar disorder. Negative childhood experiences can be connected with difficulties in pharmacological treatment, such as resistance to treatment with antidepressants and mood-stabilisers. Psychotherapeutic methods that directly or indirectly address early childhood trauma play an important role in the treatment of patients suffering from bipolar disorder, who have experienced such events. Among these methods, the most promising data were obtained for psychoeducation and cognitive-behavioural therapy. It appears that psychotherapy should be considered in every patient with the experience of early childhood trauma. Psychotherapeutic management combined with pharmacotherapy significantly improves the results of pharmacological treatment.