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Expert Q&A

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Can a person 'discourage' bipolar disorder?

Asked by Nancy Gorlan, Minneapolis, Minnesota

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If a family shows a history of bipolar disorder -- in a mother and her son -- are there environmental steps the son can take to "discourage" the development of bipolar disorder in his children?

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

Expert answer

Your question is an outstanding one -- in both senses of the word. It is a great question, but it is also outstanding in the sense that it has yet to be definitively answered.

This is an example of how scientists don't always tackle the most obvious and important questions. You might be able to guess the reason. To fully answer this question, researchers would have to study many high-risk children from birth and try different types of interventions to see what did and didn't protect against the development of bipolar disorder. The study would require a huge subject population and at least 30 years to do.

So in the absence of this type of evidence, we have to rely on what we know about bipolar disorder in general. Fortunately, we know enough about risks and protective factors for psychiatric conditions in general that we can be fairly confident in making some suggestions.

Your question is not unrelated to one I answered several weeks ago about a bipolar child with bad home behavior. My answer created a fair amount of controversy because I focused on the possibility that the home environment, rather than the bipolar disorder per se, might be driving at least some of the problem. Of course, in the case of the particular questioner, this thought was purely hypothetical. But in general it is far from hypothetical that environmental adversity markedly increases the risk for all psychiatric conditions.

Science is increasingly finding that mental illnesses walk a tightrope strung between genes and the environment. In fact, not just mental disorders, but all the illnesses of the modern world (e.g. heart disease, dementia, diabetes, cancer) seem to walk the same tightrope. And they all follow the same basic formula: They arise when vulnerability meets adversity.

Adversity immediately conjures images of war, family violence or death of a loved one. But it is apparent from many studies that adversity has other less-recognized faces, including sickness, poor nutrition and various types of environmental pollution -- all of which can promote the development and/or maintenance of mental illness.

Vulnerability also wears many faces. We think immediately of genes, but recent data show clearly that environmental exposures (especially early in life) play a large role in programming how one's genes are expressed. "Good genes" are no help if they are silenced, and "bad genes" don't pose much threat if they are not expressed. This insight is fueling the rise of a field called epigenetics, which is rapidly confounding any simple separation between genes and the environment.

So the first thing to say regarding how to protect children at increased genetic risk for bipolar disorder is that they should be shielded from environmental adversity. I am not saying to avoid the types of environmental challenges that build character and make us stronger and more resilient, but to avoid the kind of stressors that are overwhelming, chronic, irresolvable and destructive. Families that provide love, support and guidance to their children are a powerful bulwark against psychiatric illness and promote good outcomes when illnesses like bipolar disorder do develop.

In addition to providing challenges, but avoiding adversities, it is important to provide children with the healthiest environment possible. In this regard, everything that is good for your heart is also probably protective against developing bipolar disorder. Studies suggest that diets heavy in sugar are a risk factor for mood disorders. Such dietary patterns also increase risk because they lead to obesity. Poor sleeping patterns are both a symptom of bipolar disorder and can bring the illness on, so learning good sleep hygiene is especially important for young people at genetic risk for the disease. Teaching children how to handle stress in productive ways without becoming swamped by anxiety or anger is also likely to provide significant protection against bipolar disorder.

Finally, there is tremendous interest in the world of psychiatric research regarding whether treating high-risk young people with medications will protect them against developing severe mental illnesses such as bipolar disorder and schizophrenia. My take on the data is that the jury is still out. Nonetheless, if it were my child and I saw clear warning signs of bipolar disorder, I would bring the child into psychiatric treatment immediately and not hesitate to use medications if my doctor thought they were indicated.

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