When to Disclose Your Mental Illness to Your Dates

Dating with a mental illness, especially bipolar disorder, can be a minefield to navigate. You need to find someone who will support you in all aspects of life, including your struggles with your mental conditions.

When to Disclose Your Mental Illness to Your Dates - CassandraStout.com

Finding such a person can be daunting. A lot of people who have little experience with mental illnesses tend to think that people with bipolar disorder are “crazy” and out of control. Stigma and awful stereotypes are very real. Some people may bolt as soon as they hear the word “bipolar.”

You have to communicate honestly with your significant other about your disorder, but first you have to disclose to them that you have one. But when do you disclose to your dates that you have more to deal with than a neurotypical person?

Honesty is the Best Policy

You may have a million questions when it come to dating. For example, when do you disclose your illness? Will you be honest on the first date or will you wait until you’ve gotten to know your date before letting them know? If you can’t work and are on disability due to your illness, how do you explain what you do? When do you let your date know if you’re on meds?

Unfortunately, there’s no one-size-fits-all answer to these questions. Dating looks different for everyone regardless of their mental conditions. When you disclose should always be up to you.

If you are just dating casually, disclosing your mental illness isn’t that important. But if you are looking for a long-term relationship, disclosing that you suffer from mood episodes should be your highest priority.

If you can hide your illness and let your boyfriend or girlfriend know months into a relationship that you’ve been keeping something so big a secret from him or her, then he or she might feel betrayed and break up with you, or worse.

When it comes to dating with an illness that is hard to hide and impacts your life every single day, then honesty is the best policy. Letting your date know on the second or third date, before either of you has invested too much into the relationship, is better than waiting until you’ve moved in together.

Tell your date about your disorder before you make any long-term commitments to that person. Explain what he or she can expect when you suffer a mood episode. Let them know what steps you usually take to manage your disorder, and the treatment team you have in place.

This way, your partner won’t be shocked when your moods and behaviors suddenly shift, and may even be prepared to help you through your mood episode.

Final Thoughts

Explaining your mental illness to your dates before you make a long-term commitment is crucial for your relationship to thrive.

Some people may run for the hills when you disclose your struggles. Let them. They wouldn’t have been capable of supporting you or committing to the whole you anyway. Find someone else who you know will be able to remain strong in the face of your mental illness.

Dating with a mental illness can be difficult. But if you are honest with your date about your mental condition before feelings start to grow, then you avoid the risk of alienating them and suffering from a hard breakup.

I wish you well in your journey.

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The Bipolar Parent’s Saturday Morning Mental Health Check in: Lightbox Edition

How are you? I genuinely want to know. My week has been busy.

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Hello, hello! Welcome to the Bipolar Parent’s Saturday Morning Mental Health Check in: Lightbox Edition!

How are you? Have you been getting some sun this week? How’s the weather holding up for you? How’s your mood been this week? What are you struggling with recently? What challenges have you been facing in parenting? Please let me know in the comments; I genuinely want to know.

The Bipolar Parent's Saturday Morning Mental Heatlh Check in: Lightbox Edition - CassandraStout.com

My Week

My week has been busy.

On Tuesday, I had an appointment with my primary care physician, who ordered blood tests to see if there are physical causes to my depression. I wasn’t fasting (I’d eaten snack at toddler group with my kiddo before the appointment), so I couldn’t take the blood tests until Wednesday, which I did.

On Thursday, I saw my psychiatrist. He boosted my dose of antidepressant (Wellbutrin), prescribed an anti-anxiety med (which starts with a B, but I can’t recall the name), and told me to get a lightbox, as I probably have seasonal affective disorder. He said the lightbox will probably cost $150-500 and may be reimbursed by insurance.

I told my husband about the lightbox, and his immediate response was, “Okay, I’ve ordered one on Amazon. It should be here tomorrow.” He told me that the one I needed (with 10,000 lux, or units of light) was on sale for $30. A second lightbox was on sale for $25, so he bought that one, too. So now I have two, one for my bedroom and one for my desk. I adore my husband.

On Friday, I walked to the store, pushing Toddler in the stroller, to pick up my prescriptions. Apparently the pharmacy only received orders for the antidepressant. I called my psych doc and left a message asking the office to re-fax the prescription order. I always play phone tag with them, which is extremely frustrating.

Taking care of my mental health is so difficult and expensive. There are multiple doctors involved, and our insurance has a high deductible which just reset this January. The antidepressant prescription was $51. So, with the addition of the lightboxes, that’s over $100 spent just this week, not to mention the cost of the doctor’s appointments.

I’ve also eaten out for lunch every day this week. Not because I couldn’t plan ahead and pack sandwiches, but because I’m depressed, and one of the ways I find myself trying to feel better is going to restaurants. It works in the moment, but afterwards I feel buyer’s remorse as each fast food meal is forgettable, unhealthy, and expensive.

Spending this much on myself makes me weak in the knees. My husband would say that I am worth the cost, and “it’s just money.” Having grown up below the poverty line, I am struggling with prioritizing my own wellbeing.

But I need to, if not for me, then at least for my kids. They deserve a mother who is sound in mind and body. I need to prioritize my own contentment. And stop going out to eat unless it’s a special treat, like our family Sunday brunch.

Wish me luck.

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The Bipolar Parent’s Saturday Morning Mental Health Check in: Appointments Edition

How are you? I genuinely want to know!

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Hello, hello! Welcome to the Bipolar Parent’s Saturday Morning Mental Health Check in: Appointments Edition!

How are you? How’s life treating you lately? What have you been up to this week? Have you been maintaining your self-care routine? How are the kids? What parenting challenges have you been dealing with lately? Please let me know; I genuinely want to hear from you!

The Bipolar Parent's Saturday Morning Mental Health Check in: Appointment Edition - CassandraStout.com

My Week

My week has been following the theme of the previous couple of weeks: utterly depressing. I just haven’t been myself lately. I’ve been struggling to do housework and the most basic of tasks, like brushing my teeth (ew).

I missed an appointment with my therapist on Monday. I completely forgot about it. Luckily, I was able to reschedule for Wednesday.

My therapist believes my depression may be seasonal. I have been unusually exhausted lately as well, so she asked me if I would a) get a physical and some bloodwork done with my primary care physician, and b) set up an appointment with my psychiatrist.

I have the appointment with the PCP on Tuesday of next week and the psychiatrist on Thursday. I am blessed to have a treatment team, and decent insurance.

On Thursday, I started potty training the toddler. She’s amazing at it. She only had a few accidents on Thursday; on Friday, she had one. I am so proud of her.

Unfortunately, I was so excited to potty train her, and so focused on asking “do you need to go potty?” every fifteen minutes, that I missed my morning meds (Welbutrin and vitamin D) on Thursday. That threw me for a loop for the whole rest of the week.

Wellbutrin shares a caffeine pathway, which means I can’t simply take it in the afternoon, or the medication will keep me awake at night. No sleep means mania for me, usually. I want to avoid that at all costs, as mania is much more destructive than depression in my experience.

On Friday, I did very little, except to fold 5 loads of laundry that had piled up on my bed. I also, to my chagrin, yelled at my son for making his sister scream. There’s something about a high-pitched, extended, hysterical screaming that goes right to my primal brain.

So that’s been my week. A week of big, stressful changes, that I’ve been experiencing through a thick fog of apathy. Hopefully my PCP and psychiatrist figure out what’s wrong and treat me accordingly. Thanks for listening, and wish me luck!

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How Depression Interferes with Getting Things Done (GTD)

How Depression Interferes with Getting Things Done (GTD) - Cassandrastout.com

When you have depression, your natural inclination when faced with a to-do list is to crawl back into bed, right? Trust me, I’ve been there. When I’m depressed, I’d rather stick my hand into a box of tarantulas than load the dishwasher.

It’s rare that you do get the motivation to tackle something on your list. But, when you do, have you noticed that staying focused on that getting that task done is impossible?

Have you tried to complete a task like “pick up the living room,” only to end up staring at the mountain of toys, not knowing what to do next? I’ve been there, too.

Turns out there’s a scientific reason behind the inability to get things done (GTD) with depression. It’s called a “lack of cognitive control,” or, more colloquially, “executive dysfunction.” There’s even a disorder for it: executive dysfunction disorder.

Getting things done, or GTD, is a productivity system developed by David Allen. GTD encourages people to “brain dump” everything in their heads out onto paper, and then file that away into a trusted system. A trusted system involves calendars, your phone, and anywhere you’d like to schedule tasks.

But executive dysfunction interferes with GTD because a brain dump can be overwhelming for people with depression. I’ve written about executive dysfunction and how it relates to bipolar disorder before. But it’s been a while since that post, so I figured a refresher is in order.

What is Executive Function?

Executive function, when things are going well, is the ability to set goals and self-monitor. This means that you can recognize that picking up the living room requires you to pick up one toy at a time, rather than staring down a mountain of them.

Executive function is, in so many words, the ability to break tasks down into compartmentalized parts.

Most of the time, executive function, for people who have learned it (which is a whole ‘nother post), is automatic. But studies have shown the depression (and bipolar disorder, and attention deficit hyperactivity disorder) interferes with executive functioning. Breaking down tasks into parts is extremely difficult when you’re suffering from depression.

Which is why you end up being overwhelmed when looking at that mountain of toys. you literally cannot comprehend the steps it would take to clean the living room.

How to Cope with Executive Dysfunction

The good news is that executive dysfunction can be managed with ideas like these:

  1. Consciously break projects up into steps. I’ve written recently about how to break tasks and projects into steps, so I’ll just summarize here. Next time you’re facing a task, try writing down every step you can think of. Then put them in the order that you need to accomplish. Then tackle the task, one step at a time.
  2. Use time management tools such as colorful calendars and stopwatches. Once you write down the steps of a task, try timing yourself to get each step done. Make a game of it, and you’ll be able to complete the steps more quickly.
  3. Schedule repeating reminders on your computer or phone, using sites like Remember the Milk. Reminders can be extremely helpful. Use a calendar app on your phone to make appointments, and set notifications for thirty minutes ahead (or however long you need to get to the appointment). “Set it and forget it” gets the task out of your head and into a trusted system.
  4. Set goals in advance to coincide with ingrained habits, such as flossing your teeth right after brushing. Setting goals to follow ingrained habits is a great way to build new ones. They’re called “triggers,” and they’re a positive way to  build upon a foundation that you already have. When you do one habit, you immediately follow it with another. If you’re a tea drinker, try taking the trash out every time you boil water, and you’ll never have to remember to take the trash out again.

Final Thoughts

Structure is extremely important for people who suffer from depression. Executive dysfunction is a real problem.

Consciously breaking projects down into steps, using time management tools such as calendars and repeating reminders, and setting goals to coincide with ingrained habits are all ways to improve executive functioning.

You can do this. You can improve your executive functioning.

I wish you well in your journey.

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3 Easy Steps to Declutter Your House with Depression

3 Easy Steps to Declutter with Depression - Cassandrastout.com.

Decluttering the house when you have depression sounds like a nightmare. After all, decluttering is a huge project, isn’t it? Everyone has junk they need to get rid of in their homes, and some people (like me) have entire rooms filled with useless stuff.

And clutter can contribute to feelings of overwhelm and depression. Let me explain. If there’s a toy on the living room floor, every time you pass that toy, your brain makes a split-second decision as to whether to deal with that toy.

If you decide against dealing with that toy, the toy will remain on the floor, and every time you see it, you have to make a decision: pick up the toy and put it somewhere else, or leave it. Every time.

Say there’s 5 toys on the floor. That’s 5 decisions you have to make. You quickly begin to suffer from decision fatigue.

This is why a cluttered room is so overwhelming and difficult to start cleaning, especially when you have depression. You’re looking at the big picture.

What about Decluttering with Depression?

The trick to decluttering with depression is to break the rooms of your house down into compartmentalized parts. For example, if you were decluttering your kitchen, you’d break the room down like so:

  1. Spice cabinet
  2. Coffee bar counter
  3. Dish cabinet
  4. Cups cabinet
  5. Toaster counter

And so on. Rather than thinking you have to declutter the entire kitchen in a day, you can tackle one cabinet at a time. Break every room down into smaller parts, and you can work at your own pace.

If a cabinet is too much for you at once, then break the room down even further, separating out the top and bottom halves of the cabinet, or right and left halves.

3 Easy Steps to Declutter

But don’t think of decluttering as a big picture project, but a series of simple tasks. There are many ways to purge your stuff, but they all boil down to 3 easy steps:

  1. Sort
  2. Keep/Toss
  3. Reflect.

That’s it. Those 3 easy steps will help you declutter your entire house.

Sort

The first step in decluttering with depression is to sort your stuff.

Take a picture of the space you plan to declutter. This is important for the third step.

Pull everything out of the space. Spread the junk out on a table or bed so that everything is visible.

Next, sort the stuff into piles by category, asking yourself two questions, which you’ll answer honestly:

  1. Have I used this in the past 6 months?
  2. Does it fit my life today?

Then, sort the stuff into yes piles, where you answered yes to both of those questions, or no piles, where you answered no to both of those questions. The maybe pile is for 1 yes, and 1 no.

If you’re on the fence about sorting things into piles, or you think you’re keeping too much, simply ask yourself: Would I take this with me if I had to move today? That question cuts to the heart of the matter.

Once you have all the items sorted into one of three piles, you’re ready for step two.

Keep/Toss

Are you ready for step two? Take a hard look at your piles:

  1. Yes piles: Keep the items gladly, and find places for them in your home.
  2. No piles: Toss or donate the stuff!
  3. Maybe piles: Place these items into a box. Write the date on the box, and set the box aside in your garage or closet. If you haven’t touched the items in the box in 3-6 months, toss the entire box. If you find yourself pulling stuff out, then keep those items and find homes for them.

Reflect

Take another picture, and bask in the glow of a freshly-decluttered space. You did it! Congratulations!

Now think on how you can keep the space clear. Will you adopt a 1-item-in, 1-item-out policy? Don’t let anything into your life that you don’t know to be useful or believe to be beautiful.

Final Thoughts

Decluttering with depression isn’t as difficult as you might think. Break rooms down into smaller parts. Sort your items into yes, no, and maybe piles. Make decisions to keep or toss or set aside the stuff. And take before and after pictures for posterity.

Good luck!

How do you declutter your house? Let me know in the comments!

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The Bipolar Parent’s Saturday Morning Mental Health Check in: Exhaustion Edition

How was your week? I genuinely want to know!

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Hello! Welcome to the Bipolar Parent’s Saturday morning mental health check in.

How has your week been? Have you been spending time on your self-care or has that fallen by the wayside? How have you been sleeping? Hopefully well! Have you been able to adjust back to your daily routines from the holidays, or has that just been a mess? Let me know in the comments!

The Bipolar Parent's Saturday Morning Mental Health Check in: Exhaustion Edition - CassandraStout.com

My Week

I’ve been facing some depression and exhaustion this week.

I missed my meds on Tuesday morning, which is my Wellbutrin, an antidepressant. I took half a dose in the afternoon, but because it shares a pathway in my brain with caffeine, it kept me awake at night. Unable to sleep on Tuesday, I took a sleep aid, which left me groggy and tired all day Wednesday, even after a nap when my toddler was at preschool.

But mostly, I’ve been having a hard time adjusting from Phoenix’s sun to Washington’s overcast skies, cold weather, and 100% humidity.

I just haven’t been able to get myself going this week. We arrived home last Saturday and I didn’t unpack until Friday night. My multivitamin, vitamin D, and iron supplements that I normally take every day were stuck in my suitcase for a week, which I’m sure has been affecting my mood.

All of this has left me worn out and down this week. I’m hoping next week will be better. I’ve unpacked, so that’s a start. But here’s hoping that I’ll adjust to my daily routines again–and soon.

Thanks for listening!

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The Bipolar Parent’s Saturday Morning Mental Health Check in: Home Edition

Hello!

How are you? How was your New Year’s eve? Did you go to a party? Stay at home? Did fireworks keep you up? Let me know in the comments, or email me! I promise to reply.

The Bipolar Parent's Saturday Morning Mental Health Check in: Home Edition - Cassandrastout.com

My Week

My week was lovely. My immediate family (husband and two great kids) just arrived home from a two-week trip to Arizona, where my mother-in-law lives. I adore her, so the trip was a great one.

We also spent time with my husband’s father and his wife, and my husband’s brothers. A great deal of my side of the family live in Arizona as well, so my husband and kids were able to visit them also.

But it’s good to be home. I missed my bed. I mentioned previously that I was having trouble sleeping without a sleep aid. I am pleased to announce that I successfully slept each night of the two-week trip without taking anything except my usual Risperidone. That was surprisingly difficult to do!

If you’re on meds, have they helped you? Thanks for listening!

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Getting Support During a Bipolar Depression Episode

Trigger Warning: This post contains a brief mention of suicidal ideation. If you are suffering from suicidal thoughts, please talk with someone from the Suicide Prevention LifeLine at 1-800-273-8255 or www.suicidepreventionlifeline.org.

Anyone who suffers from bipolar disorder also suffers from depression. That’s just the nature of the beast. Sometimes depressive episodes can be debilitating. I’d like to share what my friends and family around me can do to help support me during an episode, and inspire you to make your own list to present to your family and friends. If you can’t bring yourself to make a list, then please feel free to print this article out and hand it to them.

Let’s dig in.

depression
A picture of a white woman holding her head. Credit to flickr.com user Amy Messere. Used with permission under a Creative Commons license.

1. Help Me Keep my Environment Clean

One of the major problems I have when I am suffering from depression is keeping my environment clean. During an episode, my house usually looks like a tornado hit it.

The depression-messy house cycle has been anecdotally supported for a long time. In short, the low energy and overwhelming feelings common to depressive episodes contribute to the inability to keep the house clean, and the resulting mess contributes to depression–specifically to shame. It’s a nasty cycle, one which is difficult to break.

At one point, during a very severe depressive episode years ago, I allowed dirty diapers to pile up on the floor of my living room. My mood–and subsequently my ability to keep the house clean–has improved immensely since the time my son was in diapers, largely due to appropriate medication and therapy.

One way my family and friends can support me–or any of their loved ones suffering from depression–is to encourage me to keep my environment clean. When I’m in the throes of depression, I need external motivation to pick up my space. This is best conveyed through praise and validation for my accomplishments. Please, I tell them, notice if I’ve done the dishes twice in a row, and thank me for doing so.

But if I’m in the midst of a completely soul-sucking depressive episode, I may need more help than just encouragement. When I’m that low, I need to be in a clean environment no matter how it happens. I may need my family and friends to step in and actually do the dishes rather than just thank me for them. There is a time and place for that level of help, and it’s okay to ask for that kind of support. Even hiring someone for me is useful.

I encourage you in turn to tell your family and friends what you need, be it reminders to do however much work you can handle or help tidying your space.

2. Encourage Self-Care

When I’m in the belly of the beast, I sometimes need help taking care of myself, including personal grooming. Brushing my teeth is a struggle. During my senior year of college, I suffered a suicidal depressive episode so bad and so lengthy that I didn’t eat or shower for weeks. My mom drove to my college town two hours away from her home and washed my hair for me. Then she took me to a crisis center, which helped me get back on an even keel. Neglecting myself made my depression worse.

If you are neglecting yourself, I encourage you to reach out to those around you. If you feel you have no one and are suicidal, immediately go to a crisis center. Do not wait.

3. Watch My Kids

This is a tip for the parents among us, but one of the best ways to support a parent in the midst of a depressive episode should be obvious: watch the kids. If I don’t get time to rest and recover from 24-hour parenting duty, I start to tune out my children and am not the present parent I would like to be. This is even worse when dealing with depression. I try not to neglect my children while depressed, but parenting while suffering from a depressive episode is incredibly difficult. Being able to briefly hand them off to my husband or a babysitter to recharge my batteries is crucial for my recovery during depression.

If you have children and are suffering from depression, try to arrange alternative supervision for them so that you won’t have to take on all their care by yourself. The best time to plan this is when you’re well, but if you didn’t, then call on your friends and family as much as possible during your depressive episode. If you don’t have friends and family around, google drop-in daycares in your city, or ask members of your church if they’d be willing to babysit. I know internet research and making calls is the last thing you want to do during an episode, but getting some time to yourself is crucial for healing.

4. Listen While Maintaining Healthy Boundaries

One of the stressors on me when I’m depressed is the fear that I’m overburdening my friends and family with my negative feelings. Thankfully, my sister is very good at taking care of herself by letting me know when she needs a break from my negativity. She is a great listener, and often provides me a space to feel vulnerable without being judged.

If you can find people who can listen to you while taking care of themselves, they can be an invaluable resource to you. There’s a certain give and take between a person suffering depression and his or her supporters, and the ultimate goal is for everyone to be healthy.

Final Thoughts

The best ways to support me while I’m in a depressive episode is to help me take care of my environment and myself, watch my kids for me, and to listen while maintaining healthy boundaries. This is what works for me. I encourage you to figure out what you need from your loved ones and don’t be afraid to ask for those things. Certain people will better be able to support you than others, and in different ways. Identify these people and lean on them for support.

I wish you well.

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How Specific Gene Variants May Raise Bipolar Disorder Risk

cpgv level
In this data visualization, each horizontal line is an individual. Those with bipolar disorder were more likely to be on the lower end of the CPG2 protein expression scale, and more likely to have gene variants that reduced expression. Credit: Rathje, Nedivi, et. al.

A new study by researchers at The Picower Institute for Learning and Memory at MIT finds that the protein CPG2 is significantly less abundant in the brains of people with bipolar disorder (BD) and shows how specific mutations in the SYNE1 gene that encodes the protein undermine its expression and its function in neurons.

Led by Elly Nedivi, professor in MIT’s departments of Biology and Brain and Cognitive Sciences, and former postdoc Mette Rathje, the study goes beyond merely reporting associations between genetic variations and psychiatric disease. Instead, the team’s analysis and experiments show how a set of genetic differences in patients with bipolar disorder can lead to specific physiological dysfunction for neural circuit connections, or synapses, in the brain.
The mechanistic detail and specificity of the findings provide new and potentially important information for developing novel treatment strategies and for improving diagnostics, Nedivi said.

“It’s a rare situation where people have been able to link mutations genetically associated with increased risk of a mental health disorder to the underlying cellular dysfunction,” said Nedivi, senior author of the study online in Molecular Psychiatry. “For bipolar disorder this might be the one and only.”

The researchers are not suggesting that the CPG2-related variations in SYNE1 are “the cause” of bipolar disorder, but rather that they likely contribute significantly to susceptibility to the disease. Notably, they found that sometimes combinations of the variants, rather than single genetic differences, were required for significant dysfunction to become apparent in laboratory models.

“Our data fit a genetic architecture of BD, likely involving clusters of both regulatory and protein-coding variants, whose combined contribution to phenotype is an important piece of a puzzle containing other risk and protective factors influencing BD susceptibility,” the authors wrote.

CPG2 in the Bipolar Brain

During years of fundamental studies of synapses, Nedivi discovered CPG2, a protein expressed in response to neural activity, that helps regulate the number of receptors for the neurotransmitter glutamate at excitatory synapses. Regulation of glutamate receptor numbers is a key mechanism for modulating the strength of connections in brain circuits. When genetic studies identified SYNE1 as a risk gene specific to bipolar disorder, Nedivi’s team recognized the opportunity to shed light into the cellular mechanisms of this devastating neuropsychiatric disorder typified by recurring episodes of mania and depression.

For the new study, Rathje led the charge to investigate how CPG2 may be different in people with the disease. To do that, she collected samples of postmortem brain tissue from six brain banks. The samples included tissue from people who had been diagnosed with bipolar disorder, people who had neuropsychiatric disorders with comorbid symptoms such as depression or schizophrenia, and people who did not have any of those illnesses. Only in samples from people with bipolar disorder was CPG2 significantly lower. Other key synaptic proteins were not uniquely lower in bipolar patients.

“Our findings show a specific correlation between low CPG2 levels and incidence of BD that is not shared with schizophrenia or major depression patients,” the authors wrote.

From there they used deep-sequencing techniques on the same brain samples to look for genetic variations in the SYNE1 regions of BD patients with reduced CPG2 levels. They specifically looked at ones located in regions of the gene that could regulate expression of CPG2 and therefore its abundance.
Meanwhile, they also combed through genomic databases to identify genetic variants in regions of the gene that code CPG2. Those mutations could adversely affect how the protein is built and functions.

Examining Effects

The researchers then conducted a series of experiments to test the physiological consequences of both the regulatory and protein coding variants found in BD patients.

To test effects of non-coding variants on CPG2 expression, they cloned the CPG2 promoter regions from the human SYNE1 gene and attached them to a ‘reporter’ that would measure how effective they were in directing protein expression in cultured neurons. They then compared these to the same regions cloned from BD patients that contained specific variants individually or in combination. Some did not affect the neurons’ ability to express CPG2 but some did profoundly. In two cases, pairs of variants (but neither of them individually), also reduced CPG2 expression.

Previously Nedivi’s lab showed that human CPG2 can be used to replace rat CPG2 in culture neurons, and that it works the same way to regulate glutamate receptor levels. Using this assay they tested which of the coding variants might cause problems with CPG2’s cellular function. They found specific culprits that either reduced the ability of CPG2 to locate in the “spines” that house excitatory synapses or that decreased the proper cycling of glutamate receptors within synapses.

The findings show how genetic variations associated with BD disrupt the levels and function of a protein crucial to synaptic activity and therefore the health of neural connections. It remains to be shown how these cellular deficits manifest as biopolar disorder.

Nedivi’s lab plans further studies including assessing behavioral implications of difference-making variants in lab animals. Another is to take a deeper look at how variants affect glutamate receptor cycling and whether there are ways to fix it. Finally, she said, she wants to continue investigating human samples to gain a more comprehensive view of how specific combinations of CPG2-affecting variants relate to disease risk and manifestation.

Materials provided by Picower Institute at MIT.

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Shot Through the Heart, And Bipolar Disorder’s To Blame: You Have a Higher Risk of Cardiovascular Disease If You’re Bipolar

heart
A blue heart made of neon-colored light. Credit to flickr.com user Sarah C. Used with permission under a creative commons license.

As if suffering from bipolar disorder wasn’t bad enough, research has shown that people with the psychiatric condition have a much greater risk of cardiovascular disease. People with bipolar disorder tend to have shorter lifespans as well, 25 years shorter on average. Some might assume that’s because of the increased propensity of suicide, but the number one killer of people with bipolar disorder is cardiovascular disease. If you’re bipolar, you have a 5 times greater risk of death during a heart attack. Even the late Carrie Fisher, long-time advocate for mental health and bipolar icon, died of one.

Cardiovascular disease is an umbrella term covering many different forms of heart issues. Among them are blood clots, heart attacks, strokes, congestive heart failure, heart valve problems, and arrhythmia, where the heart beats too slowly or too quickly.

But why do cardiovascular diseases strike people with bipolar disorder so much more than the rest of the population?

Let’s dig in.

Risk Factors

There are several risk factors for cardiovascular disease, many of which relate to being overweight and weight gain. The most common risks tied to bipolar disorder and cardiovascular disease are:

  • Obesity: More than half of the people who suffer from bipolar disorder are overweight. Obesity is defined by a body mass index of greater than 30. Being that overweight puts you at risk of premature atherosclerosis (the hardening of the arteries), as well as increased risk of heart attacks and heart failure.
  • Hypertriglyceridemia: Hypertriglyceridemia, a high concentration of fatty acids in the blood, is 20% more common in people with bipolar disorder compared to the general population. Elevated levels of triglycerides are associated with atherosclerosis, and predispose people to cardiovascular disease. People who are obese will convert more calories to triglycerides, which can lead to hypertriglyceridemia.
  • Type 2 Diabetes: Type 2 diabetes is 3 times more common in bipolar patients, and is often associated with being overweight. People with type 2 diabetes tend to develop cardiovascular disease at a younger age, have more severe cardiovascular disease and more complications from it, and are more likely to have asymptomatic, or “silent,” cardiovascular disease.
  • Hypertension (High Blood Pressure): A 2004 study showed that about 30% of bipolar patients have high blood pressure and high cholesterol levels. Bipolar patients with hypertension tend to have more manic episodes than those without high blood pressure. Researchers from a 2010 study discovered that nearly 50% of patients hospitalized with bipolar disorder suffer from high blood pressure, and the younger a person develops the psychiatric condition, the more likely he or she is likely to develop hypertension.
  • Smoking: Studies have shown that the rate of smoking among people with bipolar disorder is 50-70%, compared with 20% of the general population. Self-medicating with cigarettes and other substances can also contribute to cardiovascular disease.
  • Metabolic Syndrome: According to Wikipedia, metabolic syndrome is “a clustering of at least three of the five following medical conditions: central obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein.” The condition affects up to 50% of people suffering from bipolar disorder, compared to 27% of the general population, and increases the risk of cardiovascular disease and diabetes.
  • Psych Meds: Also of note is the use of psychiatric medications–a class of drugs including mood stabilizers, antidepressants, and antipsychotics–and how they affect the ability to survive a heart attack. A study published in The European Heart Journal showed that if you combine an old-school antipsychotic and any antidepressant, you have an 18-fold increase in death during a cardiac arrest. Combining antidepressants with any antipsychotic causes an over 5-fold increase in risk of death during a heart attack. (A tip of the hat to: Mad In America.) But antidepressants alone are a risk factor for heart attacks. A 2015 study showed that tricyclic antidepressant users had a 36 percent increased risk of heart attack regardless of other factors.

Many of the risk factors for cardiovascular disease in bipolar disorder have to do with weight. And many people with bipolar disorder struggle with weight gain. But why? There are several reasons. For one, if you’re depressed, you may eat more and move less, which contributes to weight gain. Most medications that are used to treat bipolar disorder pack on the pounds, and then contribute to the inability to shed that weight. And more than 14% of bipolar patients suffer from eating disorders, including binge eating. (Incidentally, see another article on The Bipolar Parent to understand how bipolar disorder manifests differently in people who binge eat.)

Solutions

With all this dire news, you might be feeling scared. But fear not! There are ways to lower your risk of cardiovascular disease, most of which involve lifestyle changes.

Weight-Related Solutions: If you are 80 pounds overweight and drop just 10 pounds, you can cut your risk of heart disease in half. Maintaining a healthy diet and exercise program can help you lose weight. Another thing that can cut your risk in half is performing 10 minutes per day of moderate exercise. If you struggle with your weight, changing your medications to those that cause less weight gain might be an option for you, depending on what your psychiatrist says.

Non-Weight-Related Solutions: Quitting smoking has a dramatic effect on the heart: one year after stopping cigarette use, the risk of heart disease drops to half that of current smokers. After 15 years, the risk is nearly that of a non-smoker. If possible, try to change your psychiatric medications to those that don’t have the deadly combination of an old-school antipsychotic and an antidepressant. Sleep is crucial for managing both your bipolar disorder and the health of your heart.

Of course, trying to avoid a heart attack in the first place is your best bet. But if you find yourself suffering from cardiovascular disease, there are ways to manage your condition. Diet, exercise, sleep, and stress reductions can all help.

I wish you luck in your journey.

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