Genetic Factors in Bipolar Disorder: No Reason to Be Ashamed

Knowing that bipolar disorder is strongly genetic means nobody is at fault.

Posted Aug 07, 2018

New therapy patients and their family members can have any number of reactions when first introduced to the diagnosis of bipolar disorder. Disbelief and denial are typical responses, but they may also believe they did something bad to bring bipolar into their lives. Or that there is something distinctly flawed with who they are as human beings. They may have carried a sense of shame for years, not fully prepared to deal with the reality of a chronic mental illness. But the truth is, nobody is at fault for having bipolar disorder.

That’s because the foundations of bipolar are believed to be largely genetic, which is the strongest and most consistent risk factor for the disease (APA, 2013). As bipolar disorder is passed through family generational lines, it appears to affect how the brain is formed to handle mood regulation. So when attempting to uncovering bipolar, it’s vital to understand the family’s mental health history to know whether an individual may be predisposed to the disorder. If anyone in the family tree has experienced mood swings, particularly in the closest genetic relatives, a person could certainly be predisposed to bipolar disorder. Then a more precise inquiry can discover where bipolar symptoms may have been hiding in that individual’s own life history.

A little detective work may be useful to figure out a possible genetic history for bipolar. For example, did Mom or Dad show signs of mood swings? High levels of irritability followed by deep sadness? What about Grandma or Grandpa? Were there stories of intensely erratic behavior? Were there aunts or uncles who had serious bouts of depression or psychotic symptoms? Did anyone need serious psychiatric care? Suffer from addictions? What happened to these family members? Remember that having bipolar isn’t their fault either, but this historical information can help explain behavioral and interpersonal patterns through the generations that may have been affected by bipolar disorder.

Various studies not only support a genetic link to bipolar disorder, but also point to early brain development as a table-setter for later bipolar activity. For example, a research team at the University of Michigan found that cells in people with bipolar develop differently compared to cells in people who do not have bipolar. How those cells become neurons and communicate with other neurons are also different compared to the non-bipolar cells (Chen et al., 2014).  Other researchers who observe brain functioning believe that, in people with bipolar disorder, parts of their neurology that typically regulate emotions are not well designed. Two of those brain areas are likely the pre-frontal cortex (PFC) and the amygdala (Townsend & Altshuler, 2012).

The PFC, located in the front of the brain, gives us the ability to form and use logic. It’s in charge of understanding consequences and anticipating future events based on experience. The PFC learns right from wrong and helps us think in a rational, organized, and socially appropriate way. The amygdala lies deep in the central region of the brain and is involved in producing emotions and processing emotional memories. While the PFC is more thoughtful, the amygdala is more reactive.

In a person with bipolar, the functions of the PFC and amygdala, and how they communicate with each other, don’t always work in the kind of balance and consistency necessary for normal functioning. During mood swings, there are measurable shifts in brain chemicals, which alter how nerve cells communicate with each other. These chemicals are called neurotransmitters because they allow chemical messages to transmit from nerve cell to nerve cell. Shifting brain patterns can lack proper regulation between the PFC and the amygdala. The expected result is large fluctuations in mood states that are inadequately tempered by any reasonable assessment of reality around that individual.

Non-genetic bipolar causal factors can be described as catalysts that essentially take the disorder from its genetic foundations and push bipolar symptoms to the fore. These catalysts often include major hormonal changes, such as during adolescence or in postpartum women, or can be the result of self-medication with drugs or alcohol. But again, those predispositional factors have to be in place for bipolar catalysts to trigger the symptoms of bipolar disorder.

One of the mysterious aspects of the genetic connection in bipolar disorder is how the bipolar symptoms can go into hiding and not seemingly affect the individual all the time. It may be hard to believe there's a genetic predisposition to something that seems to go away all by itself. However, when a person with bipolar disorder is between mania or hypomania and depression, they're simply in a baseline mood zone. Moods can swing rapidly or slowly through baseline, so it’s important to understand that bipolar disorder is always present in the genetics and neurology of the individual, whether the symptoms of bipolar are presently active or not. Once bipolar disorder is accurately identified, it has been and always will be a part of that person’s life.

That may seem like bad news to many. If you have bipolar, you may feel like cursing your ancestors for such a fate.

But because of bipolar’s strong genetic influence on brain development, we can target treatment from a neurological point of view. Mood stabilizing medications can effectively support the brain’s ability to regulate bipolar symptoms in a consistent fashion. In fact these medications can have neuroprotective effects, meaning they can protect the brain from damage caused by bipolar mood swings (McElroy, Keck, & Post, 2008). Once stabilized appropriately, people with bipolar can discover a true sense of their own character through therapy, instead of being defined by mood swings and the inability to sync with life around them.

Nobody is ever at fault for having bipolar disorder. The genetic link means that neither the individual nor the family member did anything bad to bring bipolar into their lives. But with proper attention and care for bipolar disorder, people with bipolar can live a more balanced life without shame.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. 130.

Chen, HM, et al. (2014). Transcripts involved in calcium signaling and telencephalic neuronal fate are altered in induced pluripotent stem cells from bipolar disorder patients. Translational Psychiatry, 4, e375.

McElroy, S.L., Keck, P.E., Post, R.M. (Ed.) (2008) Antiepileptic drugs to treat psychiatric disorders. New York NY: Informa Healthcare USA, Inc. 390-391.

Townsend, J. & Altshuler, L.L. (2012). Emotion processing and regulation in bipolar disorder: a review. Bipolar Disorders, 14(4), 326-339.