Bipolar Disorder: A Genetic Issue in Utero?

[RonPrice]

This is a longitudinal, retrospective account going back to my conception in October 1943. I make reference to a genetic predisposition to bipolar disorder(BPD) due to a family history of affective disorder in a first-degree relative, my mother(1904-1978). She had BPD, although her disability was never given that medical diagnosis. About half of all patients with BPD have one parent who also has a mood disorder. There is, therefore, a clinical significance in my mother?s mood disorder in the diagnosis of my own BPD. The high heritability of BPD has been well documented through familial incidence, twin, and adoption studies. There is an unquestionable justification for the inclusion of my family in my understanding of BPD. No specific gene has yet been identified as the one "bipolar gene." It appears likely that BPD is caused by the presence of multiple genes conferring susceptibility to BPD when combined with psychosocial stressors. I make this point as an opening remark and pass on to my story.(1)
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(1) For an elaboration of the subject of the genetic connection of BPD and in utero BPD see: David Healy, Mania: A Short History of BPD, Johns Hopkins, 2008. Genes may also contribute to the age at onset of BPD and a phenomenon called genetic anticipation. Anticipation refers to the phenomenon of an illness occurring in successive generations with earlier ages of onset and/or increasing severity. In a recent study using registry data of bipolar subjects, age at onset of first illness episode was examined over two successive generations. Subjects born from 1900 through 1939(my mother) and from 1940 through 1959(myself) were studied. The median age at onset of the first episode of BPD was lower by 4.5 years in subjects born during or after 1940. The goal of what is sometimes called ?personalized medicine? is to utilize a person's genetic makeup for appropriate disease diagnosis and treatment, an idea conceptualized initially in the era of Human Genome Project.
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(2) The diagnosis that has been made in my case, in addition to the several I have received over the years from psychiatrists, is a diagnosis that is standardized according The Diagnostic and Statistical Manual of Mental Disorders(DSMMD-4th edition-1994) which provides diagnostic criteria for mental disorders. I use the term bipolar disorder not manic-depression throughout this document and the acronym BPD. In the DSMMD there is a 5 axis/level system of diagnosis that is used and, in my case, axis/level 1 is for clinical disorders that are mood disorder. Axis 3 in this system is for what they refer to as acute medical concerns that relate to BPD; axis-4 is for psycho-social and environmental problems that contribute to BPD and axis-5 is an overall caregiver?s assessment of my functioning on a scale 1 to 100. In my case, my caregiver, namely my wife, evaluated me at 61-70 on the numeric scale which reads as follows: ?this adult has some mild symptoms as well as some difficulty in social and occupational functioning. Generally, though, he functions pretty well. He also has some meaningful interpersonal relationships." The bar is set much higher by government departments in order for my wife to get a Caregiver?s Allowance. My symptoms are not sufficiently extreme. Readers wanting access to this diagnostic tool can easily find it on the internet. I have appended it to this statement in appendix 2. I should emphasize at the outset of this statement that any research showing that some form of psychotherapy or talk therapy is an effective substitute for medication is, at best, arguable and not something I am prepared to entertain anyway after 28 years of dependence(1980-2008) on medication. Likewise any research showing that health food and nutritional supplements like fish oil, for example and/or vitamins and minerals and/or amino acid(s) are effective for BPD. The literature now available to those wanting to explore the subject, the field of BPD, is massive both on the internet and off and much of it may be more useful than this statement to readers at this site.

BPD is not medically curable but it is possible through psychiatry, medicine, some types of talk therapy and nutritional adjuncts to achieve varying degrees/periods of long-term stability. I feel I have achieved this by degrees since the 1960s. That is not to say that I have never had any more episodes since those 1960s, that I have not become hypomanic again nor exhibited other symptoms of BPD--I have and I still do.

My wife, Chris, has suffered from different disorders all of our married life and her years before our marriage in 1975 were also beset by different troubles. Her story is long, but I have not included it here except in a tangential sense when it seems relevant to my own experience of BPD. My references to marriage, family, work and values are emphasised in this account, but briefly and only en passant. My religion, the Bahai Faith, which provides the base for my values, beliefs and attitudes, is also important--but I do not focus on this Faith here, except in an indirect way. However important this religion has been to me in the past or in the present, I do not refer to it in my elaboration of my experience of BPD.
----------------INSTALMENT #2 TO COME IF READERS DESIRE IT-------Ron