Genetics of bipolar disorder

I have a few (distant) relatives with bipolar disorder.  From what I’ve learned in medical school, this is not uncommon.  Many diseases have a genetic component, and psychiatric disorders are not exempt.

The branch of the NIH that studies mental illnesses (NIMH) has funded research looking at genetic and molecular mechanisms for years now but I feel like little headway has been made.  Unlike with many endocrine or cardiovascular diseases, we still don’t have a good laboratory test to diagnose depression or bipolar disorder.  We don’t know how many of our psychiatric drugs work.  Lamotrigine is used for both seizures and bipolar disorder.  Seroquel is used for schizophrenia as well as bipolar disorder.  But why?  Clearly they are very different illnesses.  Sure, sometimes we know which receptor (or set of receptors) the drugs target, but how does that translate to relieving the manic or depressive symptoms?

It’s frustrating because I think psychiatric illnesses get labeled as separate from other “physical” diseases partly because we don’t know the mechanisms behind the disorder.  They are seen as less legitimate by a lot of the public.  We can’t just “snap out” of depression any more than other people can magically stop their heart attacks.  If I end up choosing to go into psychiatry, I hope that research will catch up so that I could more effectively help my patients.

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Drugs and bipolar disorder

Just came back from Colorado – and of course did some weed tourism.  Edibles to be exact.  Those brownies were delicious.  Hopefully the county hospital here doesn’t drug test…

I think there’s a lot of people who would tell me to avoid THC, LSD, MDMA, and the whole gamut of hard drugs.  “Hard” being anything beyond alcohol, nicotine, and caffeine.  The medical side of me says okay, probably a valid suggestion.  The other side of me goes – but a ton of people do drugs are just fine.  And I’m medicated so I am normal just like everyone else.

Honestly there’s not much peer-reviewed research out there, not since those recreational drugs have become illegal here.  Ketamine has gotten some hype lately for treatment of depression, but I doubt it will become a commonplace option anytime soon.  We don’t know the effects of these drugs on bipolar patients (as a population), or the interactions with common medications.  I can anecdotally say marijuana was enjoyable though.

I think it just comes down to risk vs reward.  I’m not willing to try anything while I’m unstable, but I don’t mind having a little fun when I’m euthymic.  After all, it’s not like I’m doing this every day or trying anything particularly addictive.  I just wish it were more acceptable to experiment.  There’s no way I would admit to my shrink or general practitioner that I’m trying drugs once in a blue moon.  It could potentially have repercussions on my future medical training/career.  Though to be honest, being open about having bipolar disorder has the same risks, and perhaps even greater stigma.  I’m not going to recommend people try drugs, but that’s not going to stop me from trying a few baked goodies.  🙂

 

23andMe

Genetic testing is a powerful diagnostic technique – and it’s getting cheaper as sequencing costs so much less than a decade ago.  But is it any good for prediction?

23andMe started back in 2006 and offered genetic testing, specifically SNP analysis* of certain parts of your genome.  All you had to do with send them some saliva, and $$$ of course.  In return, they sent you a list of diseases and genetic traits that you might be predisposed to.

Well, the FDA cracked down on them, for selling a medical product/service that wasn’t validated.  Over the past decade, 23andMe has worked hard to test its reliability for just a handful of genetic disorders and gotten them past the FDA.  They stopped giving health information and only gave customers the raw data for everything else.

I don’t particularly care to know what I’m genetically at risk for.  I can probably just tell my family history.  Besides, so many diseases are based more on environmental factors (like not exercising, eating crappy food, etc) that I question the accuracy of the results that 23andMe used to offer.  However, I do think it’s interesting that 23andMe is collaborating to conduct research studies**.

It is incredibly useful and powerful to be able to get sequencing data from a large group of people and try to find genes that are associated with disease.  I really hope this company goes more towards these types of efforts in the future!

*https://en.wikipedia.org/wiki/SNP_genotyping

**http://www.fiercebiotech.com/medtech/23andme-kicks-off-genetic-study-for-depression-bipolar-disorder

Am I sick?

“Do you think you are sick?”

My outpatient shrink asked me that at my first visit.

It’s an interesting question, loaded with potential implications.  I don’t view bipolar disorder as me.  It’s not a huge part of my life.  I just have a label.  A diagnosis.  And since it’s not manifesting itself in any way, I am not currently sick.  I just happen to take a pill every day to keep it away – almost as a preventative measure, rather than as a treatment.

Despite being diagnosed with bipolar 1 (the supposedly more “severe” version), I don’t always identify as someone with mental illness.  At least not on a day-to-day basis.  In the middle of an episode? Perhaps.  I think that’s why I have a hard time relating to many of the people on popular bipolar and depression forums such as Reddit, even though we have the same disease.  Some of that is certainly self-selection.  People who are more ill may be more likely to browse these forums for support, at least compared to people who are stable.

I think for some people, bipolar disorder is part of their identity.  In other words, the ups and downs are part of who they are.  In the arts professions, there is this thought that bipolar-ness contributes to their work, and that their creativity stems from this disorder.  I think this is a very valid point.

However, I feel the opposite.  I see my “manias/hypomanias” and “depressions” as manifestations of the illness, but when I’m euthymic, I consider myself well or not sick.  I know most doctors believe that bipolar disorder is a chronic illness, and that it can’t be cured – that it can only go into remission and requires maintenance medications for the rest of one’s life.  In other words, forever sick. With the huge caveat that I’m not a psychiatrist or psychologist, I’m not sure if I entirely subscribe to that.

Think about it.  Unipolar depression isn’t necessarily viewed as a chronic illness (though for some people it is and they do stay on anti-depressants forever).  We don’t know enough about the biology of depression and bipolar disorder to know if they are mechanistically on the same spectrum, but there is often genetic links based on family history or genome sequencing.  So what’s to say bipolar disorder is any different?  Most of us have more depressive episodes than manic episodes anyway.

So back to the doctor’s question – are you sick?  I wonder what the purpose or intent of the question was, and I wish I had thought to ask.  Was it to see how exactly how I viewed my illness? If it was a part of my identity?  Or was it to ask if I was currently sick and having symptoms? Or was it to determine if I have anosognosia and don’t believe I have bipolar disorder at all?

Regardless, I answered that although I have an illness I don’t see myself as sick and yes, I take my pills every day (or at least try to). I hope I got the point across 🙂

Another day, another week.

I feel so uninspired today.  It feels like this week was just a ton of work and not much sleep.  Oddly, I’m not all that tired.

It’s funny how that statement alone would be enough to trigger a raised eyebrow from my psychiatrist.  Those of us with bipolar disorder know that sleep can be one of those tell-tale signs of what’s to come.  Every year, as summer approaches, I sleep less and less.  The opposite happens going into winter.  It’s like clockwork.  It’s also why I love the summer months – I’m awake, I’m happy, I’m energetic, I’m motivated, and I get so much more done.  Sound familiar?

I probably meet the criteria for hypomania for a couple weeks, if not more.  I try to take advantage of this as much as I can, since I always go through this unproductive slump over the winter (when it’s awfully cold and grey here).  But I always try to be on a lookout in case things spiral out of control.  There’s a fine line between hypomania and mania, and I’ll admit I’m often guilty of sneaking up as close to it as I can.

It’s so tempting to ignore it when it’s not negatively affecting your life.  However, there comes a point when hypomania is no longer advantageous.  When you’re wired and anxious and distracted and reckless and doing a billion things at once because you think you’re superman, you’ve crossed that line.  It’s a shame we can’t predict when to treat hypomania, and when to wait.  I am lucky to have circadian rhythms to tell me when it’s time to do something and come back down to earth.

Despite being a medical student, I tend not to take medications unless forced to.  It’s a little hypocritical.  I’ve seen and know just how effective psychotropic drugs are, and I’ll even encourage others to take them…just not me.  I choose to take my daily lamotrigine, but otherwise I’ll stick to living life on the edge – tempting fate.

First times

Botswana_sunrise

You always remember your firsts: first kiss,  first car, first day of college.  There’s something magical about it that always sticks with you.  Although this blog post is hardly groundbreaking enough to merit such nostalgia in the future, it is nonetheless the first time I’ve started a blog.

I toyed with the idea many times, but I wasn’t sure what I wanted to write about.  Should it be a diary?  An advice column?  Random musings on life?  I settled on a chronicle that perhaps combines all of the above: a chance to document my experiences now, so that I can read it many years down the road and see what’s changed.

Icono_Normativa

But there’s another reason.  I want to write about what it’s like to have bipolar disorder as a medical professional-in-training.  When I was first diagnosed, I spent a lot of time on Google searching for success stories of other physicians or med students.  I wanted proof that it could be accomplished, and that this diagnosis wasn’t a death sentence for my career.  Instead, I found quite the opposite.  Several sad stories in the news, very few examples of doctors, lawyers, or other professionals who admit to having the illness, and even fewer support groups.

Depression is so prevalent in these fields that it has become accepted as a problem that needs to be addressed.  However, bipolar disorder still carries enough stigma to prevent people in our fields from “coming out”.  I don’t know of a single physician in real life who’s bipolar.  I completely understand, as I too write this blog anonymously, due to potential professional consequences of disclosure.

I hope to chronicle the obstacles but also successes in my life, so that if someone were to stumble upon my blog, they could maybe identify with them and take comfort in the fact that they are not alone.

Source of images: Botswana Sunrise – CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=203583; Book – By Raúl Ruano Ruiz – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=22768706