A new study published in the Molecular Psychiatry journal reports that researchers have found a mutation in a gene that causes bipolar disorder in as many as ten percent of cases. This is fantastic news! Finally, the causes of bipolar disorder are starting to be pinpointed.
The gene, G protein receptorkinase 3 (GRK3), regulates neurotransmitters such as dopamine. The mutation happens in a section of the gene called the promoter, which turns GRK3 on and off. Scientists at the University of California, San Diego (UCSD) School of Medicine hypothesize that what causes bipolar disorder is that the mutation makes the gene hypersensitive to dopamine.
The study took place over a year, and screened DNA samples from more than 400 families with bipolar disorder. The researchers found six mutations in the promoter region of GRK3. Most notable was that the P-5 mutation happened three times more frequently in people who suffer from bipolar disorder than those who don’t.
Research has long pointed to several genes being the causes of bipolar disorder. But this is the first time a single gene has been determined as a cause. Bipolar disorder is characterized by extreme highs and lows. Few therapies work to treat the mental illness, and those that do work aren’t effective for all people who suffer from it. The scientists involved in this study hope that specific therapies that target genes on a molecular level will be developed.
Therapy is a crucial part of treatment. There are several different types of therapies that your mental health professional may encourage you to take.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most common types of psychotherapy, and is often preferred by many mental health professionals. During CBT, you work with a therapist to challenge negative thinking and develop constructive beliefs. That’s the cognitive part. The behavioral part helps you act on these beliefs.
CBT can be conducted one-on-one, or along with family, or with other people who have similar issues in a group setting. During CBT, you will learn about your mental illness and practice relaxation techniques and coping methods.
Interpersonal Therapy (IPT)
Interpersonal therapy focuses on the relationships you have with others, being based on the principle that relationships affect your moods. IPT also helps you express your emotions in healthy manners. The therapy is highly structured, and intended to finish in 12–16 weeks. IPT and CBT are the only therapies that are mandated for mental health professionals to be trained in.
Family therapy goes by many names. To wit: it’s referred to as couple and family therapy, marriage and family therapy, family systems therapy, and family counseling. The driving force behind family therapy is the thought that involving family members benefits patients. People undergoing the therapy learn how to communicate with each other and solve problems.
Psychodynamic therapy operates on the principle that you have unconscious habits and emotions which developed early in life and cause difficulties in daily functioning. The therapy focuses on revealing and resolving these unconscious problems. Dream interpretation and free association are often used. This therapy is a treatment of choice for post traumatic stress disorder (PTSD), but largely used to treat personality disorders.
Art therapy uses art such as music and painting to help you resolve problems and reduce stress. Art therapists will work with you to help tease out messages from your art. They are trained in artistic practices and psychological theory. You do not need to be artistically talented or trained to make use of art therapy.
Psychoeducation is just as it sounds: education about your mental illness from a mental health professional. Psychoeducation can occur in a one-on-one setting or a group session, where several people are informed about their illnesses at once. Family members can also benefit from learning about your mental health condition, and are encouraged to sit in on psychoeducation sessions.
There are several therapies out there, and not every therapy works for every person. Stick with your therapy at first, to see if it works, and if it doesn’t, don’t be afraid to try another.
Mental illnesses are common–roughly 1 in 5 American adults have one–but people with depression or bipolar disorder can sometimes take up to ten years before they seek out care for themselves. Are you ready to take the first steps towards getting a potential diagnosis? Read on to find out where to seek help.
Where to Find Help
Ask your primary care physician for a referral to a mental health professional. Other people who can refer you are crisis centers, or a local Mental Health America office. Ask for more than one doctor, so you can comparison shop.
To get an evaluation, try the psychiatry department of a university. Psychiatrists at a college will be up-to-date on cutting-edge research, and be more willing to stick with proven drugs such as lithium because they’re well-researched.
Contact your health insurance plan to find providers covered under your plan.
If you are a veteran, try the U.S. Department of Veterans Affairs, located online at www.va.gov/health. You can also call 1-877-222-8387. Veterans who already have benefits through the department can visit www.va.gov/directory to find a mental health professional covered under the VA’s plan.
The Substance Abuse and Mental Health Services Administration is also a great place to check for mental health professionals. The department is located online at http://www.samhsa.gov/treatment. You can also call 1-800-662-HELP (4357).
If you work for a large company, you may have an employee assistance program (EAP) available. Contact Human Resources to find a provider under the EAP.
You will first talk to your referred mental health professional on the phone. Ask them about how they like to approach therapy and medication. Make an appointment if you feel comfortable with them during the phone interview.
At the appointment, your psychiatrist or psychologist should refer you to a lab to check your thyroid levels and rule out other physical causes of mental illness symptoms. Your doctor will ask you why you called him or her, what you think the problem is, and about your job and living situation. You may be given a few questionnaires to evaluate your mental health and any adverse symptoms. This testing can take hours.
Sometimes, a mental health professional may want to interview your family and friends. Your doctor cannot interview them without your consent. Consider asking your loved ones if they’d be willing to submit to an interview.
After that, be patient! Getting a diagnosis–and an accurate one, no less–takes time, but it’s an important part of developing a treatment plan, including therapy and/or medications.
You know how and when to disclose your mental illness, and even if to disclose to family and friends. But what about your employer? Read on to learn how to protect yourself.
When choosing to disclose a mental illness at work, there are several factors to consider. You might face stigma from your coworkers–or worse, your bosses. Those you work with might not understand, or even want to understand, your daily struggle. However, with disclosure might come special accommodations–like extra breaks–which are part of your civil rights. There are certain protections available to you.
Americans with Disabilities Act (ADA)
The Americans with Disabilities Act (ADA) is a protection that you should be familiar with. The ADA is just like it sounds like: a federal law that protects Americans with disabilities at private employers with more than fifteen employees, as well as state and government employers. There are two conditions you must meet for the act to apply:
Your disability impairs your life, essentially making working difficult. This condition applies to difficulties with regulating emotion, concentrating, and other ways your mental illness interferes with your ability to work.
That, while your illness makes working difficult, you can get the work done.
The Rehabilitation Act of 1973 (Rehab Act)
The Rehabilitation Act of 1973, or Rehab Act, is a federal law very similar to the ADA that applies to schools. Any agency that receives government funding is covered under the Rehab Act.
Family Medical Leave Act (FMLA)
The Family Medical Leave Act (FMLA) is a useful law that helps people keep their jobs while taking an extended leave of absence. The FMLA only applies to companies with over fifty employees, and after you have worked for the company for a year minimum. The FMLA lets you take up to twelve weeks of unpaid leave to care for a sick family member or recover from an illness yourself.
States also have their own protections for Americans with disabilities.
What Accommodations Can I Receive? How?
Under these laws, you can receive special accommodations: working from home, flexible start times, written directions, feedback from your bosses and coworkers, more breaks, and quiet places to take those breaks. These changes to the workplace are intended to be an aid for you so that you can complete your tasks.
But how do you apply for these accommodations? The process isn’t difficult, but the onus is on you to ask. Once you do, your employer is mandated to talk with you.
First, contact the human resources (HR) department and ask them what channels you need to go through to apply.
Write down your request. Be very specific as to what accommodations you need, and explain to HR how these will help you in the workplace.
Talk with your treatment team–therapists and psychiatrists–to see if they can offer any proof that you suffer from a mental illness.
Take notes at every conversation you have with your boss. Do not delete any emails that apply to the request.
Be reasonable and flexible. Your strongest advocate is you, so be prepared to negotiate.
What if you’ve been discriminated against because you suffer from a mental illness? There are legal protections available for you:
If the employer is a private one covered by the ADA, then you have to reach out to the Equal Employment Opportunity Commission (EEOC). File a complaint at the EEOC’s website, www.eeoc.gov.
If, however, the employer is a federal agency, like a school or governmental employer, then you must reach out to the Equal Employment Opportunity Office (EEO). File a complaint at the EEOC’s website, federal division.
States have protections as well. If you’ve been discriminated against despite these laws, look up your state’s Fair Employment Practice Agency (FEPA).
The Department of Labor manages the FMLA. If you’ve been denied your legal right to twelve weeks of unpaid leave, then contact them.
There are several protections available to you should you choose to disclose your mental illness to your employer. Whether or not you should is completely up to you. As we said, you might face stigma from your coworkers or bosses, but if you’ve been discriminated against, you can file complaints. You have a right to accommodations. All you have to do is take that step forward.
You know when and how to disclose your mental illness. But should you? We cover whether you should disclose to friends and family.
Pros and Cons
When you think about whether to tell people, think about what the consequences will be if you don’t tell them as well as if you do. Thinking this through can help you decide if you truly want to disclose your mental illness.
Disclosing To Your Loved Ones
Before you disclose your mental illness to your family and friends, there are several factors to consider. First of all: do you think your listener will understand? Will they be able to support you in the ways you need supported, such as advice, help with doctors or avoiding drinking, or emotional support? Not everyone is skilled at being emotionally available. Make a list of the people around you who have this skillset.
There are three possible outcomes to telling a loved one about your illness:
He or she is completely comfortable with your disclosure, and nothing changes.
He or she is incredibly uncomfortable, and takes steps to end the relationship with you.
He or she says that he or she is comfortable with you telling them this, and proceeds to fade slowly from your life.
Obviously the first outcome is the best and most hoped for. While ending relationships are a concern, it’s entirely possible that he or she wouldn’t have been able to support you anyway, so it’s probably best that he or she disappears from your life.
Telling a loved one about your mental illness takes a lot of courage. Consult your list of people who can give you emotional support to decide whether it’s worth the risk to tell them.
Tune in next week for part four in this series: “Disclosing That You Have a Mental Illness, part 4: Your Employer.”
Are you ready to disclose that you have a mental illness? Read on to figure out how to tell your family, friends, and maybe even your employer that you have a disorder.
1. Prepare Your Listener
In order to best disclose that you have a mental illness, you need to prepare your listener. It’s sort of like writing an essay: first you tell him or her what you’re about to say, then you say it, then you summarize what you’ve just said. Preparing your audience is called “process talk.” Try this: “I want to talk to you about something I’m struggling with. It’s taken me a lot of courage to come this far. I hope you’ll support me.”
2. What You’re Dealing With
Next, you want to give concrete examples of what your mental illness is. Explain a situation or two where you’ve struggled, such as not being able to get out of bed for weeks, or going on multiple unplanned spending sprees when you’re manic, if you have bipolar disorder. Cementing your mental illness in your listener’s head will help them understand exactly what you’re facing every day. Consider providing educational materials such as articles or pamphlets about your mental illness. NAMI.org is a great online resource for the National Alliance on Mental Illness.
3. Ask for Help
Suggest ways your audience can support you. This can involve asking for more breaks or other accommodations at work or school, or simply asking a friend to understand why you can’t hang out as long. You can also ask your loved ones to help you find a doctor and follow through with an appointment, if you feel that your friend or family member will understand and be helpful. Set boundaries here, too: you know yourself best, and you need to explain whether you need advice or just need your audience to listen.
4. What to Share
You definitely don’t need to share everything. Plan ahead as to what you feel comfortable sharing about your experience. It’s perfectly reasonable to explain that you don’t feel like talking about something in particular. If you do feel there are good parts to your illness, like things you’ve learned, try to share those.
Explaining your illness to a listener is an intense experience, and a personal decision. Practice in front of a mirror or with a licensed professional, like a therapist, who may be able to answer any concerns you have. Keep in mind that you need to prepare your listener, explain your illness, and ask for help.
Tune in next week for part three of this series: “Disclosing That You Have a Mental Illness, part III: If.”
How open are you about your mental illness? Have you been thinking about opening up to others? Read on to find out when to disclose that you have a mental illness.
When to Disclose
When you’re well – You don’t want to wait until you’re in a dicey situation for the people around you to find out that you have a mental illness. Disclosing when you’ve got your illness under control will give the people you disclose to time to adjust to the fact that you suffer from a disorder.
When you need people to understand – Sometimes, people who suffer from mental illnesses need special accommodations at work or school. Letting friends know the reason behind why you don’t want to hang out with them during a depressive spiral can prevent them from thinking you’ve grown distant. Telling people you have a mental illness is better when it serves a purpose.
Not after a mass shooting – Unfortunately, people equate acts of mass violence with mental illness. The stigma is all too real. Disclosing your mental illness after someone who reportedly has a disorder commits an act of violence might cause the people you’re disclosing to to link your illness with the perpetrator’s.
When you’re ready – Disclosing your mental illness to friends, family, or even an employer is an intensely personal decision. Write down exactly what you want to say, and practice your words, either in front of the mirror or with a licensed professional. Talking to a therapist about your concerns may help put your mind at ease.
All in all, disclosing your mental illness is a process, the start of which is completely up to you. Tune in next week for the second part in this series of three, “Disclosing That You Have a Mental Illness, part II: How.”
A new study published in the British Journal of Psychiatry looking at more than thirty years into bipolar disorder research found that people with the disorder are 2.63 times more likely to have suffered adversity as children than the general population.
Adversity is defined here as emotional, sexual, or physical abuse, or the loss of a parent before the age of nineteen. While the loss of a parent did not raise the risk of a bipolar diagnosis significantly, people who were emotionally abused were more than four times as likely to have a subsequent diagnosis of bipolar disorder.
The study, run by researchers at the University of Manchester, gathered data from millions of patient interviews in nineteen studies between 1980 and 2014. The authors of the study believed that bipolar disorder had a similar link to childhood adversity like schizophrenia, and does not just stem from bio-genetics.
The hope that the researchers have is that specialized therapy plans can be put into place for people who have suffered childhood abuse, and that future diagnoses can take into account personal histories.
Lithium is a salt which treats both mania and depression in a lucky thirty percent of people with bipolar disorder. But prior to the discovery of a new method to predict who will respond to lithium, people were playing roulette.
Now scientists at the Salk Institute can predict, with 92 percent accuracy, who will be a lithium responder. All they need is five cells and a test. They discovered that the neurons of people with bipolar disorder are more excitable when exposed to stimuli and fire more rapid electrical impulses than individuals without the disorder. This means that people with bipolar are more easily stimulated.
In an old study, the scientists found that soaking skin cells from bipolar patients in a lithium solution calmed the hyperexcitability–but only for some of them. The next study proved even more fruitful. The researchers soaked lymphocytes (immune cells) rom known lithium responders in lithium solutions, and found the same results–the hyperexcitabilty was calmed. But even though both responders and non-responders had the same excitability, the electrophysiological properties were different.
The Salk team looked for electrical firing patterns in neuronal lines, measuring the threshold for evoking a reaction, and other qualities. Overall, the patterns in responders were completely different than in non-responders.
The scientists were able to replicate the results again and again, which means that this test is proven to work. Now a blood draw is all that’s needed to test whether a patient with bipolar disorder will respond to lithium.
So you’ve discussed your child’s symptoms with a pediatric mental health specialist, and have a diagnosis of bipolar disorder. What now? Thankfully, there are some suggestions you can take, and taking care of your child with bipolar disorder is similar to taking care of an adult with the disorder.
1. Pay attention to medications and therapy appointments
As a parent, you are responsible for making sure your child follows their treatment plan. Use whatever reminders you can to remember to give him or her the medication that he or she needs. If your child must take their pills at school, then open a line of communication with his or her teachers and school nurse. Appointments with his or her therapist are also important. Make sure your child attends their appointments
2. Monitor side effects
Some side effects of atypical antipsychotics, like weight gain and blood sugar changes, are awful in adults–and children do seem to be more prone to them. These drugs were originally formulated for adults, and few have been tested on kids. Ask your child’s psychiatrist what side effects you need to keep an eye on.
3. Work out agreements with your child’s teachers
Some children with bipolar disorder need more help at school, such as more breaks during manic episodes, or less homework. During especially bad episodes, your child may need to be removed from school until he or she stabilizes. Talk to your child’s teachers. Keeping an open line of communication is the best way to ensure your child has success at school.
4. Keep a schedule
Try to be consistent with mealtimes and bedtimes, as well as waking your child up at the same time every day. This will help keep stress in the home to a minimum. Try to be patient with your child as they adjust to new routines.
5. Go to family therapy, if needed
Taking care of a child with bipolar disorder may put a lot of stress on the family as a whole. Your marriage might suffer, and the child’s siblings might be jealous of all the attention he or she gets. Attending therapy as a family may help you handle these issues.
6. Don’t ignore threats of suicide
Suicide threats are extremely serious, even in young children who may not understand what it means. Talk to your children, and if they do have suicidal ideation, give them a safe environment. Remove all the weapons or pills from the house. And talk with their mental health specialists. Crisis lines are always open.
7. Communicate with your teenager
Teenagers may become irritated or resentful if they feel that you’re compelling them to be treated. Talk to them about why you’re giving them medication and taking them to therapy appointments. Educate your kids about their mental illness. Also, it’s important that your teenager avoid substance abuse, as the risks of developing a problem are much higher in teens with bipolar disorder. Alcohol and drugs can interact with medications poorly and worsen mood episodes, so it’s important that your teenager be made aware of the risks.
All in all, taking care of your child with bipolar disorder requires an extra level of parenting. But you can do it. There are steps you can take to help you.