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Is bipolar a hereditary disease


Bipolar disorder: MedlinePlus Genetics

Description

Bipolar disorder is a mental health condition that causes extreme shifts in mood, energy, and behavior. This disorder most often appears in late adolescence or early adulthood, although symptoms can begin at any time of life.

People with bipolar disorder experience both dramatic "highs," called manic episodes, and "lows," called depressive episodes. These episodes can last from hours to weeks, and many people have no symptoms between episodes.

Manic episodes are characterized by increased energy and activity, irritability, restlessness, an inability to sleep, and reckless behavior. Some people with bipolar disorder experience hypomanic episodes, which are similar to but less extreme than manic episodes.

Depressive episodes are marked by low energy and activity, a feeling of hopelessness, and an inability to perform everyday tasks. People with bipolar disorder often have repeated thoughts of death and suicide, and they have a much greater risk of dying by suicide than the general population.

Manic and depressive episodes can include psychotic symptoms, such as false perceptions (hallucinations) or strongly held false beliefs (delusions). Mixed episodes, which have features of manic and depressive episodes at the same time, also occur in some affected individuals.

Bipolar disorder is classified into several types based on the mood changes that occur. Bipolar I involves manic episodes, which can be accompanied by psychotic symptoms, and hypomanic or depressive episodes. Bipolar II involves hypomanic episodes and depressive episodes. Cyclothymic disorder involves hypomanic episodes and depressive episodes that are typically less severe than those in bipolar I or bipolar II.

Bipolar disorder often occurs with other mental health conditions, including anxiety disorders (such as panic attacks), behavioral disorders (such as attention-deficit/hyperactivity disorder), and substance abuse.

Frequency

Bipolar disorder is a common form of mental illness. At some point during their lifetime, 2.4 percent of people worldwide and 4.4 percent of people in the United States are diagnosed with this condition.

Causes

Very little is known for certain about the genetics of bipolar disorder. Studies suggest that variations in many genes, each with a small effect, may combine to increase the risk of developing the condition. However, most of these genetic variations have been identified in single studies, and subsequent research has not verified them. It is unclear what contribution each of these changes makes to disease risk. Some of the genetic changes associated with bipolar disorder have also been found in people with other common mental health disorders, such as schizophrenia. Understanding the genetics of bipolar disorder and other forms of mental illness is an active area of research.

Studies suggest that nongenetic (environmental) factors also contribute to a person's risk of developing bipolar disorder. Stressful events in a person's life, such as a death in the family, can trigger disease symptoms. Substance abuse and traumatic head injuries have also been associated with bipolar disorder. It seems likely that environmental conditions interact with genetic factors to determine the overall risk of developing this disease.

Inheritance

The inheritance pattern of bipolar disorder is unclear. Overall, the risk of developing this condition is greater for first-degree relatives of affected individuals (such as siblings or children) as compared to the general public. For unknown reasons, the risk of inheriting the disorder appears to be higher in some families than in others. However, most people who have a close relative with bipolar disorder will not develop the condition themselves.

Many individuals with bipolar disorder have relatives with other mood, anxiety, and psychotic disorders (such as depression or schizophrenia). These disorders may run in families in part because they share some genetic risk factors with bipolar disorder. However, these conditions are relatively common in the general population, and so it would not be surprising to see more than one case in a family just by chance.

Other Names for This Condition

  • Bipolar affective disorder
  • Bipolar affective psychosis
  • Bipolar spectrum disorder
  • Depression, bipolar
  • Manic depressive illness

Additional Information & Resources

Genetic Testing Information

  • Genetic Testing Registry: Major affective disorder 1
  • Genetic Testing Registry: Major affective disorder 7

Genetic and Rare Diseases Information Center

  • Bipolar disorder

Patient Support and Advocacy Resources

  • Disease InfoSearch
  • National Organization for Rare Disorders (NORD)

Research Studies from ClinicalTrials.gov

  • ClinicalTrials.gov

Catalog of Genes and Diseases from OMIM

  • MAJOR AFFECTIVE DISORDER 1
  • MAJOR AFFECTIVE DISORDER 2
  • MAJOR AFFECTIVE DISORDER 3
  • MAJOR AFFECTIVE DISORDER 4
  • MAJOR AFFECTIVE DISORDER 5
  • MAJOR AFFECTIVE DISORDER 6
  • MAJOR AFFECTIVE DISORDER 7
  • MAJOR AFFECTIVE DISORDER 8
  • MAJOR AFFECTIVE DISORDER 9

Scientific Articles on PubMed

  • PubMed

References

  • Craddock N, Sklar P. Genetics of bipolar disorder. Lancet. 2013 May 11;381(9878):1654-62. doi: 10.1016/S0140-6736(13)60855-7. Citation on PubMed
  • Goes FS. Genetics of Bipolar Disorder: Recent Update and Future Directions. Psychiatr Clin North Am. 2016 Mar;39(1):139-55. doi: 10.1016/j.psc.2015.10.004. Citation on PubMed
  • Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Ladea M, Medina-Mora ME, Ono Y, Posada-Villa J, Sagar R, Wells JE, Zarkov Z. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011 Mar;68(3):241-51. doi: 10.1001/archgenpsychiatry.2011.12. Citation on PubMed or Free article on PubMed Central
  • Shinozaki G, Potash JB. New developments in the genetics of bipolar disorder. Curr Psychiatry Rep. 2014 Nov;16(11):493. doi: 10.1007/s11920-014-0493-5. Citation on PubMed
  • Szczepankiewicz A. Evidence for single nucleotide polymorphisms and their association with bipolar disorder. Neuropsychiatr Dis Treat. 2013;9:1573-82. doi: 10.2147/NDT.S28117. Epub 2013 Oct 11. Citation on PubMed or Free article on PubMed Central

Is There a Hereditary Connection?

What is bipolar disorder?

Bipolar disorder is a mental health condition. People with bipolar disorder can alternate between periods of positive moods, called mania, and negative moods, called depression. These mood shifts can occur suddenly. About 2.8 percent of the adolescent and adult U.S. population have bipolar disorder, according to the National Institute of Mental Health.

Bipolar disorder and its causes aren’t well-understood. That said, researchers have noted a possible connection between family history and bipolar disorder. This suggests there may be a genetic component to the disorder.

Keep reading to learn more about this connection and about bipolar disorder.

While researchers don’t fully understand the causes of bipolar disorder, they have identified some risk factors. One of the strongest risk factors is a family history of the disorder. This connection may be due to certain genes.

Adults who have relatives with the disorder have an average tenfold increase in risk of developing the disorder, according to a 2009 review. Your risk further increases if the family member with the condition is a close relative. That means if your parent has bipolar disorder, you have a greater chance of developing it than someone whose great aunt has the condition.

Genetic factors account for about 60 to 80 percent of the cause of bipolar disorder. That means that heredity isn’t the only cause of bipolar disorder. It also means that if you have a family history of the disorder, you won’t definitely develop it. Most family members of someone with bipolar disorder won’t develop the condition.

In addition to heredity, researchers believe there are other risk factors for bipolar disorder.

Brain structure

There may be subtle differences in brain size and activity in people with bipolar disorder. Concussions and traumatic head injuries may also increase a person’s risk of developing bipolar disorder.

Environmental factors

A stressful event often triggers the onset, or start, of bipolar disorder. This event could be a high-stress occurrence related to work or personal life. A sudden, major life change, such as the death of a loved one or a physical injury, could also trigger the onset. People who have bipolar disorder typically find it helpful to control stress in their lives.

Seasonal factors may trigger the onset of bipolar disorder episodes. The change from winter to spring, in particular, is a strong trigger. This is because the quick increase in the number of hours of bright sunshine during the day affects the pineal gland. This, in turn, may influence development of depression and mania.

Other triggers can include heavy drug or alcohol use and a lack of sleep. And in certain cases, bipolar disorder in women can be triggered during the period after giving birth. This generally occurs in women who are biologically inclined to developing it in the first place. Pregnancy itself, however, isn’t usually the underlying cause of bipolar disorder.

Q:

If my parent has bipolar disorder, should I have my doctor regularly screen me for the disorder?

Anonymous patient

A:

Screening for bipolar disorder by your family doctor can be a good idea. More importantly, you should talk to people you trust who seem to know you the best, such as family members or friends. Loved ones generally notice the symptoms of bipolar disorder before they’re out of control and hospitalization is necessary. If your family members or trusted friends are telling you that your behavior is strange and not how you usually act, this might be a good time to make an appointment with your doctor. Consider taking along a family member or trusted friend who can share their observations with your doctor.

Timothy J. Legg, PhD, PsyD, PMHNP-BCAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

If you think you or someone in your family may have bipolar disorder, it’s helpful to know what symptoms to look for. The type of bipolar disorder a person has determines the symptoms they will experience. In general, the main symptoms of the different types of bipolar disorder are mania and depression.

The symptoms of bipolar mania include:

  • restless and impulsive behavior
  • poor judgement
  • an unrealistic perception of abilities
  • happiness, even to the point of euphoria
  • agitation
  • jumpiness
  • participating in risky behavior, such as gambling, drunk driving, or impulsive sex
  • talking quickly
  • thinking quickly

The symptoms of bipolar depression are similar to the symptoms of regular depression. They include:

  • intense fatigue
  • prolonged, extreme sadness
  • talking slowly
  • issues with proper decision-making and focus
  • a poor appetite
  • hopelessness
  • thoughts of self-harm, including suicide
  • withdrawal from friends and families
  • a loss of interest in activities and hobbies

The average age when bipolar disorder develops is about 25 years. Bipolar disorder can start at any age, though. Some people experience their first symptoms as a child. Others have the first symptoms later in their adult life.

Getting a proper diagnosis can take years. This is because people may mistake it for another disorder, or may not report their symptoms.

Your doctor may use several methods to diagnose bipolar disorder:

  • Examine your medical history and symptoms.
  • Complete a comprehensive mental health evaluation. This may include giving you a questionnaire or asking you to keep a record of your mood patterns
  • Interview family members, close friends, and other people you frequently see, with your permission.
  • Physically examine you to rule out other causes of symptoms, such as hyperthyroidism, or an overactive thyroid.

Treatment typically involves medication, behavioral therapy, or a combination of the two.

Medication

Several drugs effectively treat bipolar disorder. The one with the strongest evidence is lithium. It’s particularly effective in preventing relapses and treating bipolar depression and manic episodes. Lithium has also been associated with a decrease in suicides.

Doctors may also prescribe any of the following anticonvulsants:

  • divalproex sodium (Depakote, Depakote ER)
  • carbamazepine (Tegretol, Tegretol XR, Carbatrol, Equetro)
  • lamotrigine (Lamictal)
  • topiramate (Topamax)
  • gabapentin (Neurontin, Gralise, Horizant)

Therapy

Effective forms of counseling include psychotherapy, cognitive behavioral therapy, and peer support. Other potential treatments include:

  • electroconvulsive therapy
  • omega-3 fatty acid supplements
  • meditation

However, more research is needed for these potential treatments.

If you or a loved one receives a diagnosis of any form of bipolar disorder, consider exploring different therapies. Your doctor may recommend combining medication and therapy, too. These treatments together may better manage your symptoms.

Bipolar disorder isn’t well-understood, but we do know that there’s a hereditary connection. If someone in your family has bipolar disorder, your risk of developing the condition is higher than for people without a family history of it. This doesn’t mean that you’ll definitely develop it, though.

If you think you or a loved one may have bipolar disorder, talk to your doctor. They can help you understand your personal risk factors and help determine if you need testing and further evaluation.

Bipolar affective disorder and everything you need to know about it

More than 60 million people in the world suffer from bipolar affective disorder (BAD). The essence of the disease is that a person has alternating periods of altered mood throughout his life: from a state with a minus sign to a state with a plus sign. How and why is this happening?

Marina KINKULKINA, psychiatrist of the highest category, head of the department of psychiatry and narcology, director of the Institute of Electronic Medical Education, First Moscow State Medical University. I. M. Sechenova, Corresponding Member of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences

Moreover, it is often not just about sadness or fun, as is often the case with emotional people, but about extreme degrees of either despair or euphoria. The change in these moods can take place both gradually and suddenly, and often for no apparent reason. This disease is attributed to Byron and Hemingway, Virginia Woolf and Edgar Poe, Van Gogh, Schumann, Vivien Leigh and many others. There is an assumption that even “our everything” suffered from a mild degree of BAD (contemporaries often mentioned mood swings) A. S. Pushkin. Modern stars - Catherine Zeta-Jones and Mel Gibson - openly admit to having this mental disorder. And rapper Kanye West even put the inscription on the cover of his album: "I hate being bipolar, it's amazing." A very accurate description of the essence of this disease.

Genetics does not solve everything

BAD affects both men and women, but the weaker sex - more often. As for the age of onset of the disease, this disorder can also appear in a teenager (especially if there is an appropriate heredity), and in an adult, and even in an elderly person. Everything is individual. The main risk factor is genetics, but a specific gene that would be responsible for the development of bipolar disorder has not been identified. This is a polygenic disorder, and it makes no sense to take genetic tests to find out how great the risk of getting sick is, because scientists still do not have a consensus on what specific combination of genes can lead to a violation. But even if there is a genetic predisposition, it is not certain that the disease will develop. This was proven by studies on identical twins, one of which developed bipolar disorder over the years, while the other did not. Accordingly, there must be some other predisposing moments. Science knows about some of them: life at the limit of possibilities with constant hands-on work, stress and chronic lack of sleep, as well as night shift work, frequent flights with a significant change in hourly flights and, of course, the use of psychoactive substances contribute to the development of the disease. Therefore, they should be avoided. Scientists have yet to learn about other factors.

But not boring?

The number of people suffering from bipolar disorder among the population, according to various estimates, varies from fractions of one percent to several percent. Recently, psychiatrists note, the proportion of affective disorders has increased significantly, which can be explained by improved diagnostics. At first glance, the BAR does not look like something scary and dangerous. To ignorant people, this disorder even seems attractive - sometimes sad, sometimes fun, in general, you won’t get bored. In addition, being different from everyone else is now fashionable. And then, there is an opinion that people with BAD have higher intelligence and creative abilities than the “gray masses”. But even if this is so, then none of those who suffer from it will definitely call BAD a pleasant thing. It is especially difficult for those patients who do not seek medical help on time. Without treatment, both phases of bipolar disorder can last for months (although sometimes the disorder occurs with frequently alternating phases). Moreover, it is impossible to say which of the periods of the disease is more difficult, manic or depressive.

Bad when very bad

Those who have experienced real depression say that this is the worst thing that can happen in life. In this state, the whole world is seen in black, the mood is depressed, self-esteem drops, life loses its meaning. A person suffering from BAD in the depressive phase perceives his very existence as a chain of tragic mistakes, constantly blaming himself for all the troubles and sins, even those that do not even exist. In addition to mental suffering, physical ones also arise: a person even moves with difficulty, as if swimming against the current, it is difficult for him to perform the most familiar actions. In addition, he can feel tension throughout the body, experience various pain sensations. With an average degree of depression, people often complain of debilitating pain in the abdomen and other parts of the body. On this occasion, they turn to doctors, but the diagnosis cannot be made. And the daily pain continues to harass. Psychiatrists call this somatoform symptomatology. With severe depression, many have the so-called atrial depression. Patients complain of pain and heaviness in the chest, they say that "a stone lies on the heart." But even an in-depth examination does not reveal cardiac causes.

Often, with depression, patients (especially the elderly) complain of difficulty in thinking, memory impairment, they say that they have become stupid, they believe that they are developing dementia, they are afraid of “losing their mind”. In fact, affective disorders do not destroy the intellect. When treated with antidepressants, when the mood stabilizes, abilities are restored.

But the worst consequence of depression is suicide. Most suicide attempts are made in this state. Sometimes people in a very pronounced depression, believing that they have done something irreparable, and believing that the consequences of their actions can harm loved ones, decide on extended suicides, in which they settle scores not only with their lives, but also take their loved ones with them ( more often children).

Bad when too good

The manic stage of BAD is subjectively more pleasant. Patients are not just in a very good, but in a great mood: they love the whole world and themselves in it. The reflection in the mirror pleases, there is not the slightest doubt about one’s own talents and mind, there is more than enough strength and energy, a bonus is accelerated mental activity. Many in this stage sleep for an hour a day, but do not experience fatigue. Sometimes they don’t sleep for whole days - and at least they are cheerful, like an “energizer”. It seems to be great. But no. With mania, desires and new ideas arise too quickly, so a person grabs at each new business, but, as a rule, does not bring any to the end. So productivity at this stage is no more than during depression. But it would be nice if that was the only thing.

The main danger of mania is that a person has no criticism at this moment, and he can do things that he will later regret very much. For example, he can give away all his property to others (sometimes to unfamiliar people or scammers who specifically use this state of his). Or, say, take out loans to go on a trip to the other side of the world, and take a bunch of friends with him. Maybe even steal something - for example, to make an expensive gift. Many patients at these moments enter into hasty intimate relationships, mistaking a chance meeting for the love of their life (and completely “forgetting” that family and children are waiting at home). Finally, often with mania, people, experiencing euphoria, ignore their severe somatic symptoms, as a result, they do not go to the doctor for a long time, and thus trigger a serious illness (pneumonia, for example). In addition, not all patients in the manic phase are "darlings. " Often they show unreasonable aggression if, for example, others do not agree with their "brilliant" advice. As a result of such “angry mania”, conflicts and even situations arise that require the intervention of law enforcement agencies and the hospitalization of the patient without his consent in a psychiatric hospital.

Good intentions…

The worst thing that relatives and friends of a person with bipolar disorder can do is ignore his problem, devalue suffering, while blaming the patient himself and appealing to his conscience. For example, they can call on a depressed person to “pull himself together, not become limp”, say that he is “mad with fat”, etc. A patient at the stage of mania is most often accused of immorality, irresponsibility, frivolity, promiscuity in relationships, etc. However, doing so is like blaming a person with diabetes for not being able to eat sweet cake, or a patient with heart failure for not running a marathon. BAD is a disease like many others. And she needs to be treated. The sooner you start the right therapy, the sooner you can stabilize the patient's condition and the better the further prognosis will be.

Psychiatrists don't bite

Despite the fact that recently people (especially young people) have ceased to be afraid to turn to psychiatrists, not everyone still decides to go to the doctor. Indeed, on the Internet in the public domain, you can find hundreds of questionnaires to test yourself for any mental disorder. And then, after reading various tips, you can also “cure”. Doctors strongly advise against doing this. The smallest harm of self-treatment is that it will not help or lead to incomplete improvement, but it can also worsen the condition. For example, inadequate intake of antidepressants in bipolar disorder can lead from a depressive phase into a severe manic state, from which it will then be difficult to get out. Only a psychiatrist (and not a psychologist, neurologist or doctor of any other somatic profile) can identify bipolar disorder and choose the right treatment. Treatment should be strictly individual, that is, the doctor selects it based on the characteristics of a particular patient and taking into account a specific moment in the course of the disease. The goal of therapy is not only to equalize the patient's mood, but also to prevent recurrence. In the treatment of bipolar disorder, the main role is played by drugs for stabilizing mood - mood stabilizers (lithium salts, some anticonvulsants (anticonvulsants) and antipsychotics of new generations). Modern drugs are much better tolerated than their predecessors, have fewer side effects, as they are designed for long-term use over many years. Against the background of their intake, women can even become pregnant and give birth. In depression, antidepressants are prescribed in exceptional cases, given the danger of changing the depressive stage to manic.

You won't be able to forget

The insidiousness of BAD is that this disease cannot be cured once and for all. But, alas, often, when the patient's mood can be balanced by medication and he begins to feel good (such a state - intermission - is completely indistinguishable from a state of complete health), he can stop taking the drugs. This is a big mistake that does not allow to achieve a stable result of treatment. Sometimes it is required to use medicines (necessarily under the supervision of a doctor) for several months, but more often for years (with periodic visits to the doctor). It is the long-term use of maintenance therapy individually selected by the doctor that allows patients to achieve a stable good condition and feel the joy of life for many years.

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