Academic Biography

Dr. Erin Michalak is Assistant Professor in the Department of Psychiatry at the University of British Columbia.  Her research interests focus on bipolar disorder, community-based research, seasonal and non-seasonal depression, quality of life, and developing methods to reliably measure mood in bipolar disorder.  Dr. Michalak is also interested in developing non-pharmacological treatment methods to improve the long-term outcome for people diagnosed with bipolar disorder. 

What is Bipolar Disorder?

Bipolar disorder, formerly known as manic depression, is a complex and debilitating mood disorder characterized by repeated episodes of depression, abnormally elevated mood (mania or hypomania), and mixed episodes when symptoms of depression and mania occur simultaneously.  15% of patients suffering from bipolar disorder commit suicide.  There are several pharmacological methods to treat bipolar disorder; however, even the best medications do not prevent future episodes of depression and mania in all people, and the rate of relapse is high.

Project Summary

Dr. Michalak and her team are investigating whether daily monitoring mood by wireless handheld computer is effective in managing bipolar disorder and reducing the relapse rate of depressive and manic episodes.  In addition they will assess whether adding more questions to the standard mood monitoring form garners any additional benefit.  Over the course of this study 70 participants diagnosed with bipolar disorder will be randomly assigned to three mood monitoring groups. 

To determine the relative efficacy of each of the three mood monitoring methods, Dr. Michalak’s team will compare the average quality of life, and depressive and manic mood level ratings between the three groups.  Because adherence to a mood monitoring program affects a patient’s outcome, Dr. Michalak’s team will also compare the average drop-out rates and rates of missing daily entries between the three groups.

Background and Rationale

Bipolar disorder can be treated by several pharmacological methods.  Doctors usually prescribe one of many mood stabilizing drugs, and may sometimes add a prescription for an antidepressant.  However, even with the ideal mix of medications, patients diagnosed with bipolar disorder are still vulnerable to relapse of depressive and manic episodes.  Relapse of a full-blown episode of depression or mania is preceded by moods and thoughts that indicate the onset a depressive or manic episode (prodromal symptoms).  Prodromal symptoms vary between patients, but they are identifiable and consistent for each patient.

Mood monitoring is suggested as a part of the treatment and management of bipolar disorder to reduce the risk of relapse.  Patients are encouraged to record their moods and answer questions pertaining to their well-being on a daily chart.  Long-term mood monitoring helps patients identify their prodromal symptoms and allows them to seek intervention to help minimize the negative effects of a full-blown depressive or manic episode.  Patients who monitor their moods along with their sleep patterns may help stabilize their sleep patterns and better understand the relationship between sleep and mood.  In addition, mood monitoring may increase adherence to psychological medication treatment.

Dr. Michalak’s team is testing how daily mood monitoring using a new wireless handheld computer compares to traditional paper-based method.  Electronic mood monitoring methods have several practical advantages over paper-based methods: information collection is much easier and less prone to error because once the patient fills out their daily form they can send it directly to the clinical database; the information can be date- and time-stamped to prevent the patient from making retrospective entries or revisions; alarms can be added to remind the patient to fill out their form; and the information can be monitored in real-time by the doctor. 

Outcome

At the end of the study, the emotional trends observed for each group will determine which mood monitoring method was most effective in reducing the symptoms of bipolar disorder and the relapse of depressive and manic episodes.  Dr. Michalak hopes to repeat this study with a larger group of participants to gain more data on mood monitoring in managing bipolar disorder.