Post UpdateThe Genetics Of Bipolar Disorder – Dr. John Nurnberger discusses the bipolar disorder in young people
Post readers are aiding researchers in unraveling the genetics of manE-depression.
Editor’s Note: When teenagers first experience the misery of depression so characteristic of bipolar disorder, they all too often lose hope that the black mood will lift, ending their pain with suicide. We talked to Dr. John Nurnberger, a nationally recognized authority and researcher on the disorder, about warning signs that parents should look for in identifying early-onset bipolar disorder, the lifesaving promise of medication, and the importance of early intervention in rescuing these teens.
Q: How many surveys, published in the March/April ’96 and Sept./Oct. ’97 issues, have you received from. Post readers?
A: We have reviewed 280 responses, and some of the families look like they would be suitable for our research. We have already visited some families or conducted interviews over the phone. We are following up actively on about one out of ten responses.
Q: Should we encourage our readers to respond to the survey for your research, if they haven’t already done so?
A: Yes. My colleagues and I made a few changes in the survey, and we really would like to get additional replies. For the new studies we are now undertaking, we are specifically looking for pairs of brothers or sisters, both of whom have bipolar illness.
Q: Have you confirmed a genetic link in bipolar disorder?
A: There are what we call sporadic cases, where there are no family members with any kind of affective disorder. That occurs in maybe one out of four people with bipolar illness. In the great majority of cases, however, there is either severe depression or manic-depressive illness in the family.
Q: What is the risk for people with a family history of bipolar illness?
A: If a first-degree relative is affected with bipolar illness, one’s risk is 25 percent, as compared with about 7 percent in the general population. For a child with two affected parents, it’s 50 percent. If one’s identical twin is affected, the risk is about 65 percent.
Q: At what age do symptoms of bipolar illness usually appear?
A: The most common single period of new onsets is in the late teenage years and early 20s.
Q: What are the symptoms of early onset in teens?
A: The symptoms in teenage years are similar to those in adults, but it may seem more like a behavioral problem than a mood problem at first. We look for episodes of major depression with weight loss, trouble sleeping, depressive thinking, not being able to enjoy anything, suicidal thoughts. We look for manic episodes–increased activity, grandiose ideas, increased talkativeness, decreased need for sleeping, distractibility, impulsivity.
We also think about drug and alcohol abuse, impulsive sexual behavior, getting in trouble with the law and school, changes in behavior at home, trouble with the family.
Q: Are these changes different from what might be recognized as adolescent turmoil?
A: It typically is a radical departure in the way a person is behaving. It is something more pervasive than adolescent turmoil where all aspects of a person’s behavior are changed and interrupted.
Q: Is there often a delay between teenage onset of symptoms and proper diagnosis and treatment?
A: There may be a delay, which can be devastating to a person. You really want to diagnose this condition and treat it as soon as possible because kids might otherwise lose years of their lives to illness. A kid who is dealing with mood disorder doesn’t go through the normal developmental experiences in the same way that other kids do because they are trying to keep their own thoughts and moods under control. What happens is that they end up with a developmental lag–months or years behind other kids when they emerge into their 20s. It’s bad to let them go through these episodes, not just from the standpoint of what happens to them during the acute episode, but from the standpoint of what happens to them later on as they age. We have reason to believe that these disorders set up a pattern in the brain that then can repeat itself or sustain itself in people as they get older, so you want to interrupt this as soon as possible. Early intervention and medication can help people for the rest of their lives.
Q: Do teens usually experience both manic and depressive episodes?
A: We see different patterns. Sometimes it develops with minor depressions that are not even bad enough to come to clinical attention by themselves, but they may progress to more severe depressions or mild highs following that. Sometimes the first signs are mild mood disorders. Not everyone with a mild mood disorder is going to develop bipolar illness.
Q: Are these teens particularly susceptible to suicide?
A: They are in the sense that people with mood disorders are at increased risk for suicide, so teenagers are as well when they get these disorders. In some ways, they may be more at risk because they have fewer inhibitions than older people have. They may be more impulsive, so in some ways they may be at greater risk than adults.
Q: Can lithium help prevent suicide in these teens?
A: Yes, we should think of lithium and Depakote as potentially lifesaving medications for these disorders. Those are probably the two major medications that we use now for bipolar disorders. Sometimes we have to add on antidepressants or other medications.
Q: What would you advise parents?
A: If your son or daughter has a dramatic change in behavior that persists for weeks at a time whether or not it is accompanied by a shift in mood, it may be advisable to get a professional opinion.
Q: Could gene therapy someday help treat bipolar illness?
A: Gene therapy is probably most practical for less genetically complex disorders than bipolar disorder. I think what’s likely to happen in the next few years is that some chromosomal locations are going to be confirmed and we’ll start to understand what the genes are at those locations and how they work. I think the next step will be understanding the biochemical pathways and interrupting those pathways with new medications. That, I think, is the promise of genetic research in the near term.
Q: Is there a national support group for teenagers with the disorder?
A: The Depressive and Manic-Depressive Association is a good resource. The national headquarters is in Chicago, and there are chapters in many different cities. The National Alliance for the Mentally Ill is another resource.
Q: Indiana University has a well-respected genetic counseling center for psychiatric disorders. Are there such centers around the country?
A: There are many places where people can get that kind of counseling: Washington University in St. Louis, University of Chicago, and Johns Hopkins University, to name a few. Many university medical centers can provide these services through their psychiatry departments.
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