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Expert Q&A

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What are the chances my future kids will be bipolar?

Asked by K, Michigan

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My boyfriend and I are discussing getting engaged and having children one day. He said he's scared to have kids. His biological grandmother and his father both have been diagnosed with bipolar disorder. He has no symptoms of it, but some of his siblings do. He is terrified that his children could inherit this disorder! My family has no history of it at all. Since neither of us have it, should we be worried?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear K,

The answer -- as best as we know from many studies over the years -- is that you should be worried but not terrified. Although we have very little definitive knowledge about which genes cause bipolar disorder (i.e., manic depression) or how they might do it, there is no doubt that the disease runs in families. Moreover, a person's risk of coming down with bipolar disorder is directly proportional to how many relatives have it and how close they are genetically to the individual.

Consider the situation with twins. If you are an identical twin and your twin has bipolar disorder you have a 50 percent chance of having or getting it yourself. If you are a non-identical twin the risk falls to around 10 percent in most studies. If both your parents have bipolar disorder you have a 50 percent chance of getting it say some studies. If only one parent has it, your odds fall to around 10 percent. What I find really amazing is that if you have a parent or a sibling with bipolar disorder you are about twice as likely to have regular old depression as you are to come down with bipolar disorder.

This last piece of data points to something important. The genes that set a person up for getting bipolar disorder are only somewhat specific for bipolar disorder per se. What really runs in families is a tendency toward mood disorders in general, as well as a number of other conditions, such as anxiety and risk of substance abuse.

But there is a piece of good news. A number of studies suggest that family members without the full disease tend to be more creative and/or intelligent than average, run-of-the-mill folks, which may be part of the reason why the genes for bipolar disorder are still with us. Some of the greatest poets of the past 200 years have had bipolar disorder, as have many artists, scientists and political leaders. If you are interested in this check out a great book called "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament" by Kay Redfield Jamison, Ph.D.

So what is the take-home message for your situation? The fact that neither you nor your potential fiancé have bipolar disorder does indeed offer promise that your children would be at less risk for developing the condition. It is also good that you have no affected individuals in your family. In terms of your husband, his age is also very relevant to what his risk might be of developing the disease. Most people first show definitive symptoms in their 20s and often have a history of mood swings, irritability and depression dating back to childhood. If your boyfriend is a little older and/or has been steady as a rock thus far, his risks of developing the illness (and therefore having a stronger genetic loading that might get passed down to children) is pretty low.

If your boyfriend is a good man and you love him, I wouldn't let what you've described to me stand in the way of marrying or having children. But I would keep half an eye on any future children and intervene early if they show signs of psychiatric abnormality.

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