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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How to Spot Bipolar Disorder in Teens And What to do About It

Bipolar disorder, a mental illness of two extremes, is difficult to spot in teenagers because even healthy teens are volatile. The disease typically develops in the early 20s.  But the symptoms are often misdiagnosed, especially in teens. What does bipolar disorder look like in a teenager, and how does a parent spot it?

Let‘s dig in.

Bipolar disorder is characterized by “highs” (called mania), and “lows” (called depression). Bipolar patients also have hypomanic episodes. Hypomania means “below mania,” and is considered a lesser form of mania. There are also mixed episodes, where a bipolar patient suffers a form of mania and depression at once.

teenager
Three teenage boys playing on a guitar. Credit to flickr.com user chiesADIbeinasco.
Used with permission under a Creative Commons license.

Common Symptoms

Teen-onset bipolar disorder is similar to adult-onset. Adolescents suffer similar symptoms to adults. Here are the symptoms of manic, hypomanic, and depressive episodes in teens:

Mania Hypomania Depression
  • Racing speech and thoughts
  • Increased energy
  • Decreased need for sleep
  • Elevated mood and excessive cheerfulness
  • Increased physical and mental activity
  • Hypersexuality
  • Reckless and risk-taking behaviors
  • Drop in grades
  • Irritability, aggressive behavior, and impatience
  • Excessive spending
  • Difficulty concentrating
  • Grandiosity
  • Productivity
  • Exuberant and elated mood
  • Decreased need for sleep
  • Elevated mood and excessive cheerfulness
  • Unusual confidence
  • Hypersexuality
  • Reckless and risk-taking behaviors
  • Extreme focus on projects at work or at home
  • Increased creativity
  • Anhedonia – loss of interest or pleasure in normally enjoyable activities
  • Sadness or irritability
  • Fatigue
  • Shame or guilt
  • Sleeping too much or insomnia
  • Drop in grades
  • Loss of appetite or overeating
  • Anger, worry, and anxiety
  • Difficulty concentrating
  • Thoughts of death or suicide

But there is one crucial difference between teenagers and adults who suffer bipolar disorder: teenagers tend to be rapid cyclers, which means they suffer mood episodes more frequently than adults. Adults typically vacillate between defined episodes of hypomania, mania, and depression, with periods of wellness in between lasting from weeks to years. But teenagers vacillate between extreme mood states within hours to days, with very few periods of wellness in between. Teens are similar to children with regard to rapid cycling.

Irritability and Rage

Teens who suffer from bipolar disorder can exhibit irritability during both manic and depressive phases, just like children and adults. For teenagers, irritability can be a constant issue during the manic phase. Like children, teens are more likely than adults to become irritable. Unlike most children and adults, however, adolescents who present with irritability are more likely to be hostile, and even violent.

Slamming doors, yelling, and even telling parents that they hate them is normal for many teenagers, and they recover quickly. But a bipolar teen’s rage is much more extreme. He or she might not be able to calm down for days to weeks. They may hit themselves or others, or break possessions. Adolescents suffering from mania may think their parents are out to get them, to the point where the teens hide in their rooms or throw away their phones. In extreme cases, teens may end up psychotic, where they engage in delusions, hear voices, or see things that aren’t there. If your teen is acting paranoid or psychotic, he or she may need to be hospitalized.

Issues with School

School may be more difficult for teenagers with bipolar disorder than those without. High school forces teens to keep a very rigid schedule, and there is a lot of pressure to perform. If hospitalized, they may miss school and must catch up, resulting in more stress due to missed workload. 

Social navigation can also trouble teens. For teenagers, explaining their bipolar disorder to their friends may be next to impossible. Teens with bipolar might suffer guilt or shame after an episode, which makes dealing with their illness even more difficult, and may impact their friendships.

Solutions/Taking Action

If you can’t tell if your teen suffers from bipolar disorder and you have doubts, it’s okay to consult a doctor. Get a referral from your child’s pediatrician to a behavioral therapist or child psychologist. Refer to the symptom chart, and describe your teen’s manic and depressive symptoms to the doctors. There’s no neon sign over your child’s head that will tell you definitively that your teen has a mood disorder. But if you have suspicions, getting a psychiatric evaluation for your teen is the best step you can take. A diagnosis may help both you and your teen as you parent during his or her adolescence. For more on what to do if your child is bipolar, click here.

Parenting a bipolar teen may be extra difficult. You need to teach him or her how to manage extreme emotional states, and how to deal with his or her rage in a constructive manner. But don’t give up. Dig in now and keep looking for help. There used to be few resources for dealing with mood disorders; now there are plenty.

Even with help, these are going to be difficult years. Finding a balance may be tricky. But there is hope for teenagers with bipolar disorder. Bipolar is one of the most treatable disorders. With talk therapy, and possibly medication, your teen can live a healthy and fulfilling life. You can raise a successful bipolar adults, but first you need to get through the teen years.

I wish you luck in your journey.

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How to Spot Depression in Children, Even Preschoolers

Trigger Warning: Brief discussion of suicidal ideation.

Preschool depression is often overlooked, because the symptoms are difficult to spot or may be explained away by hopeful parents and teachers. Depression in adults is widely known, but can preschoolers suffer clinical depression? Science says they can.

Scientists began studying depression in preschoolers 20 years ago, and the research continues today. According to the conclusion of a new study led by Dr. Joan Luby of the Washington University School of Medicine in St. Louis, preschoolers suffer depression. Luby’s team examined 306 children ranging from 3 to 6 years old. This study demonstrated that 23% of the 3-year-olds endured depressive symptoms every day for two consecutive weeks. As the age of the child increased, the rate of major depressive disorder diagnoses also increased. The 4-year-olds suffered depressive symptoms at a rate of 36%, while the 5-year-olds showed a rate of 41%. The children who had suffered extremely stressful or traumatic events in their lives also had a higher incidence of depression than the controls.

Preschoolers generally can’t describe their emotional states. They’re still learning what emotions are and they lack the ability to vocalize them. This is the difficulty in diagnosing depression in preschoolers, and why you may need help spotting it. In order to allow the study participants to express how they perceive themselves and get a sense of what young children were feeling, Dr. Luby’s team asked a series of questions using puppets. How the children responded gave the researchers a clue about how the kids were feeling.

Further complicating the picture is the prevalence of other conditions along with depression, like Attention Deficit Hyperactivity Disorder (ADHD). In Dr. Luby’s study, about 40% of the study participants also dealt with ADHD, which tends to drown out symptoms of depression, because the symptoms are similar. This can even persist later in life. Children who suffer depression are more than four times as likely to suffer an anxiety disorder later in life than kids who don’t suffer depressive symptoms.

preschooler
A preschool-aged boy in blue hoodie sprawling on a parent’s lap. Credit to flickr.com user Quinn Dombrowski. Used with permission under a Creative Commons license.

But what does depression look like in a 3-to-6-year-old?How can you, as a parent, spot it? Well, depression in children looks a lot like depression in adults. For example, anhedonia, the inability to experience pleasure from normally enjoyable activities, can show up in adults as a lack of enjoyment in things like golfing or writing. Preschoolers with anhedonia find little to no joy in their toys. Both adults and children with depression are restless and irritable. Depressed kids whine a lot, and don’t want to play.

When they do play, children may decide that their stuffed animals decided to “die” today and decide to bury them. Anytime you see a preschooler demonstrate methods of suicide or death with a stuffed animal without mimicking an episode of your life, such as a death in the family, your antennae need to come up. That could indicate suicidal thoughts.

But the most common symptom of depression in children is deep sadness. Not someone who’s sad for a day, but all the time, no matter who he or see is with or what he or she is doing. Sadness in the face of goals that have been thwarted is normal. But depressed children have difficulties resolving the sadness to the point where the misery affects their ability to function regularly. If your child appears to be sad to the point of inability to enjoy anything or regulate their other emotions, then get a recommendation from your pediatrician for a child psychologist or a behavioral therapist.

Other notable symptoms of childhood depression are an exaggerated sense of guilt, shame, and insecurity. Depressed preschoolers generally feel that if they do a naughty thing or disobey, that means they are inherently bad people.

Here’s a breakdown of the symptoms of depression in children of any age, including preschoolers:

  • Deep and persistent sadness
  • Irritability or anger
  • Difficulty sleeping or focusing
  • Refusing to go to school and getting into trouble
  • Change in eating habits
  • Crying spells
  • Withdrawing from friends and toys
  • Fatigue
  • Anhedonia – inability to derive pleasure from enjoyable activities, like playing with toys
  • Whining
  • Low self-esteem and insecurity
  • Shame and guilt
  • Timidity

Preschoolers may be especially vulnerable to depression’s consequences. Young children are sensitive to emotions, but lack the ability to process strong feelings. Early negative experiences–including separation from a caregiver, abuse, and neglect–affect physical health, not just mental. Multiple studies have linked childhood depression to later depression in adulthood.

This is why properly diagnosing and treating these children early is so vital. One established intervention for treating childhood depression is called Parent-Child Interaction Therapy, or PCIT. Originally developed in the 1970s to treat violent or aggressive behaviors in preschoolers, PCIT is a program where, under the supervision of a trained therapist, caregivers are taught to encourage their children to manage their emotions and stress. The program typically lasts from 10 to 16 weeks.

The Bottom Line

Dr. Luby’s research is met with resistance. Laypeople typically think the idea of preschoolers suffering depression ridiculous, and even some doctors and scientists don’t believe children are cognitively advanced enough to suffer from depression. Preschool depression remains a controversial topic, which makes it harder to diagnose in your child.

But depression in children 6 years and older has been well established by decades of data. Is it really so hard to think that preschoolers might suffer depression as well? Dr. Luby and her team have been looking at the data for 20 years, and have concluded that preschoolers can suffer depression, just like older children and adults.

Admitting that your child is depressed may make you feel like you’re a failure. After all, if you can’t protect your children from depression, who can? But clinical depression is chemical. This is not your fault. You may have been told that depression doesn’t exist in preschoolers, or that you’re overreacting. You may be called a helicopter or hovering parent. But trust your instincts. You know your child better than anyone else. Don’t be afraid to go against stigma for your child’s benefit.

Up to 84,000 of America’s 6 million preschoolers may be clinically depressed. If your child is one of them, you are not alone. There is no shame to depression. The condition is not your child’s fault, just as in adults. No parent likes to see her child suffer, and getting help for depressed children is vital to their well-being.

If your child suffers depressive symptoms, especially anhedonia, ask your pediatrician for a recommendation for a behavioral therapist or child psychologist. Typically, the earlier the intervention, the more successful the results.

Good luck.

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America Has Highest Rate of Bipolar Disorder Diagnoses in 11-Nation Study

Bipolar disorder, a disease characterized by “highs” (called mania) and “lows” (called depression), does not discriminate. It affects men and women equally, has been affecting children more and more, and appears to have a roughly similar incidence across all ethnic, racial, and socioeconomic groups. About 2.4% of people around the world are diagnosed with bipolar disorder in their lifetimes.

According to a new 11-nation study conducted by researchers around the world, the United States has the highest incidence of bipolar disorder, at 4.4%. India has the lowest rate at 0.1%, followed by Japan at 0.7%. Lower-income nations typically demonstrated lower rates. Colombia, a lower-income nation, bucked the trend with a incidence of 2.6%.

But why does the U.S. experience the highest bipolar rate among all 11 nations studied? Let’s dig in.

Wealth

Wealth may play a role. Individuals in higher-income nations were more likely to be diagnosed than those in lower-income nations. The exception is Japan, with an incidence rate of 0.7%.

Unfortunately, the U.S. also has the largest worldwide gap between the rich and the poor. The economic stressors are greater than in other Western societies. This means there are more psychological stressors among the poor of America, which may lead to substance abuse and fragmentation of the family.

Immigrant Melting Pot

Genetics may also contribute in the rate of bipolar disorder in different countries. Studies have confirmed that the condition sometimes runs in families, and that the lifetime chance of an identical twin of a bipolar twin developing the disorder is about 40% to 70%. So the genetic makeup of a country may affect the rate.

But what about immigrants? America is known as the “melting pot” of the world, due to all the immigrants that come here. Among people who have emigrated, the actual expression of bipolar disorder is the same as it is in the population that those people have left. However, what’s interesting to note is that, in those cases, their children tend to have higher rates of mental illnesses, including bipolar disorder, by a factor of as much as tenfold.

Social scientists suspect that the lack of extended family and cultural systems may result in higher incidences of bipolar disorder, as environmental stressors play a factor in the development of the disease. With a lack of familial support, immigrants have less of a buffer in terms of a social network, especially when they first arrive.

And immigrants seeking a new life in America might be more risk-taking than people who stay in their home countries. The immigrant belief that they can find success here takes a certain mindset of grandiosity and other symptoms of hypomania, which may be more common among people who suffer from bipolar disorder.

Stigma

map.jpg
A stylized map of South America. Credit to flickr.com user Stuart Rankin. Used with permission under a Creative Commons license.

Stigma also plays a part in the incidence rate of bipolar disorder among different countries. Fewer than half of those suffering from the disorder sought help for it. And only a quarter of those in low-income countries were treated by a mental health professional for bipolar disorder.

Some cultures are reluctant to talk about psychiatric things. Lower-income nations experience higher rates of stigma. Fewer people are willing to come forward with their struggle with mental illnesses, which leads to a lower perceived rate of bipolar disorder.

Cultural awareness of mental illnesses also contributes to the problem of stigma. Americans are fairly aware of bipolar disorder as a disease, whereas the symptoms of the condition may be missed or ignored in lower-income nations. This leads to lower rates of diagnosis.

The Bottom Line

No matter where people live, bipolar disorder causes serious impairment among those who suffer from it. People need to be less afraid about seeking help for their mental illnesses. Educating individuals about the disease may help combat stigma. Greater awareness among cultures will only help people get much-needed treatment.

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Can Early Symptoms Predict Bipolar Disorder? Evidence Shows Differing Patterns of Risk Factors

pills2
A picture of pink pills in a bubble pill container. Credit to flickr.com user Kris A. Used with permission under a Creative Commons license.

Two patterns of antecedent or “prodromal” psychiatric symptoms may help to identify young persons at increased risk of developing bipolar disorder (BD), according to a new analysis in the Harvard Review of Psychiatry.

Early signs of BD can fall into a relatively characteristic “homotypic” pattern, consisting mainly of symptoms or other features associated with mood disorders; or a “heterotypic” pattern of other symptoms including anxiety and disruptive behavior. Environmental risk factors and exposures can also contribute to BD risk, according to the analysis by Ciro Marangoni, MD, at the Department of Mental Health, Mater Salutis Hospital, Legnato, Italy; Gianni L. Faedda, MD, Director of the Mood Disorder Center of New York, NY, and Co-Chairman of a Task Force of the International Society for Bipolar Disorders on this topic; and Professor Ross J. Baldessarini, MD, Director of the International Consortium for Bipolar & Psychotic Disorders Research of the Mailman Research Center at McLean Hospital in Belmont, Mass.

The authors reviewed and analyzed data from 39 studies of prodromal symptoms and risk factors for later development of BD. Their analysis focused on high-quality evidence from prospective studies in which data on early symptoms and risk factors were gathered before BD was diagnosed.

BD is commonly preceded by early depression or other symptoms of mental illness, sometimes years before BD develops, as indicated by onset of mania or hypomania. Nevertheless, the authors note that “the prodromal phase of BD remains incompletely characterized, limiting early detection of BD and delaying interventions that might limit future morbidity.”

The evidence reviewed suggested two patterns of early symptoms that “precede and predict” later BD. A homotypic pattern consisted of affective or mood-associated symptoms that are related to, but fall short of, standard diagnostic criteria for BD: for example, mood swings, relatively mild symptoms of excitement, or major depression, sometimes severe and with psychotic symptoms.
The authors note that homotypic symptoms have “low sensitivity” — that is, most young people with these mood symptoms do not later develop BD. However, this symptom pattern also had “moderate to high specificity” — homotypic symptoms do occur in many patients who go on to develop BD.

The heterotypic pattern consisted of other types of prodromal symptoms, such as early anxiety and disorders of attention or behavior. This pattern had low sensitivity and specificity: relatively few patients with such symptoms develop BD, while many young people without heterotopic symptoms do develop BD.

The study findings also associate several other factors with an increased risk of developing BD, including preterm birth, head injury, drug exposures (especially cocaine), physical or sexual abuse, and other forms of stress. However, for most of these risk factors, both sensitivity and specificity are low.

Although many elements of the reported patterns of prodromal symptoms and risk factors have been identified previously, the study increases confidence that they are related to the later occurrence of BD. The researchers note that the findings of high-quality data from prospective studies are “encouragingly similar” to those of previous retrospective and family-risk studies.

“There was evidence of a wide range of [psychiatric] symptoms, behavioral changes, and exposures with statistically significant associations with later diagnoses of BD,” the authors conclude. With further study, the patterns of prodromal symptoms and risk factors may lead to new approaches to identifying young persons who are likely to develop BD, and might benefit from early treatment. The investigators add that predictive value might be even higher with combinations of multiple risk factors, rather than single predictors.

Materials provided by Wolters Kluwer Health

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Brain Training Shows Promise For Patients With Bipolar Disorder

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Credit to flickr.com user m kasahara Used with permission under a Creative Commons license.

Researchers at McLean Hospital, an affiliate of Harvard Medical School, have discovered for the first time that computerized brain training can result in improved cognitive skills in individuals with bipolar disorder.

In a paper published in the October 17, 2017, edition of The Journal of Clinical Psychiatry, the researchers suggest that brain exercises could be an effective non-pharmaceutical treatment for helping those with bipolar disorder function more effectively in everyday life.

“Problems with memory, executive function, and processing speed are common symptoms of bipolar disorder, and have a direct and negative impact on an individual’s daily functioning and overall quality of life,” said lead investigator Eve Lewandowski, PhD, director of clinical programming for one of McLean’s schizophrenia and bipolar disorder programs and an assistant professor at Harvard Medical School. “Improving these cognitive dysfunctions is crucial to helping patients with bipolar disorder improve their ability to thrive in the community,” Lewandowski added.

Lewandowski and her colleagues knew from previous studies that this type of intervention had helped patients with schizophrenia improve cognitive functions. “There is considerable overlap in cognitive symptoms between bipolar disorder and schizophrenia,” Lewandowski noted.

The researchers therefore decided to test the impact of brain exercises in the bipolar population. They randomly assigned patients with bipolar disorder, aged 18-50, to either an intervention group or an active comparison group (used as a control). The intervention group was asked to use a special regimen of neuroplasticity-based exercises from Posit Science — maker of the BrainHQ online exercises and apps — for a total of 70 hours over the course of 24 weeks. These exercises use a “bottom-up” approach, targeting more basic cognitive processes early in the treatment to strengthen cognitive foundations, then moving on to training focused on more complex cognitive functions later in the program. The control group was asked to spend an equivalent amount of time on computerized exercises that focused on quiz-style games, like identifying locations on maps, solving basic math problems, or answering questions about popular culture.

At the end of the study, the participants in the intervention group displayed significant improvements in their overall cognitive performance as well as in specific domains, such as cognitive speed, visual learning, and memory. “The intervention group maintained cognitive improvements six months after the end of the treatment, and in some areas even showed continued improvements,” Lewandowski reported.

Lewandowski is encouraged by the findings, as they demonstrate that “this type of non-pharmaceutical intervention can significantly improve cognition in patients with bipolar disorder,” she said. “These findings suggest that once the brain is better able to perform cognitive tasks, it will continue to strengthen those processes even after patients stop using the treatment.” In addition, Lewandowski said, “The study indicates that affordable and easily accessible web-based interventions can be effective for a broad group of patients.”

Lewandowski noted that further research is needed to determine how the improvements in these cognitive skills impact work and leisure activities and daily functioning in patients with bipolar disorder.

Text provided by McLean Hospital.

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The Bipolar Parent Master Link List

bipolar
A picture of a double-headed man. One head is smiling, and the other is screaming. Credit to flickr.com user Remy Estepario. Used with permission under a Creative Commons license.

Why, hello, there! The Bipolar Parent just celebrated an anniversary of sorts: two years of weekly posts! The blog has technically been running for about six years, but back when it started, posts were infrequent due to my not having my bipolar disorder under control. I was either riding the highs of mania and unable to focus, or suffering from the lows of depression and unable to muster up the energy to do much of anything, much less blog.

Now that I’ve managed my bipolar disorder better with the help of Wellbutrin and Risperidone, I’ve hit two years with posts every Friday. That’s worth celebrating.

So, here is the master link post for The Bipolar Parent. It will be updated periodically to include the newest posts. I will also be including related links on all future posts. Enjoy!

  1. The Bipolar Parent’s Saturday Morning Mental Health Check In: Sleep Edition
  2. Have Bipolar? You Can Still Thrive This Holiday Season
  3. The Bipolar Parent’s Saturday Morning Mental Health Check In: Mother-In-Law Edition
  4. How to Manage the Winter Blues/Seasonal Affective Disorder
  5. The Bipolar Parent’s Saturday Morning Mental Health Check In: How Are You?
  6. 11 Lessons I Learned From 11 Years of Managing Bipolar Disorder
  7. How to Support a Friend or Loved One Staying in a Psychiatric Hospital
  8. Dear Younger Me: You’re Bipolar, and That’s Okay
  9. Crisis Hotline Numbers and Resources Master Post
  10. What is a Warmline, and How Do You Use Them?
  11. Tips and Resources for Online Support Groups
  12. Getting Support During a Bipolar Depression Episode
  13. How to Communicate with Family During the Holidays When You Have a Mental Illness
  14. 10 Signs That You Are a Highly Sensitive Person (HSP)
  15. Book Review: Balancing Act: Writing Through a Bipolar Life, by Kitt O’Malley
  16. Can a Whole-Foods, Plant-Based Diet Improve Depression?
  17. How to Start Seeing a Therapist
  18. Easing Anxiety About the End of the World: 4 Steps to Combat Climate Change
  19. How to Shield Your Children From the Effects of Your Bipolar Disorder
  20. Bipolar Disorder and Insomnia–And What to do About Sleep Disturbances
  21. Common Pitfalls When Communicating With Your Kids About Your Bipolar Disorder, part II
  22. Common Pitfalls When Communicating With Your Kids About Your Bipolar Disorder, part I
  23. Probiotics May Help Treat Bipolar Disorder
  24. Does Inflammation Cause Bipolar Disorder?
  25. National Depression Awareness Month: My Experience and How to Get Support
  26. National Prevention Week: How I Prevent Oncoming Bipolar Mood Episodes
  27. Book Review: Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry
  28. How Specific Gene Variants May Raise Bipolar Disorder Risk
  29. Shot Through the Heart, and Bipolar Disorder’s to Blame: You Have a Higher Risk of Cardiovascular Disease if You’re Bipolar
  30. How Does Spoon Theory Relate to Mental Illness?
  31. Are You White? You Have a Better Chance of Being Properly Treated for Bipolar Disorder
  32. KonMari Revisited: A Review of the KonMari Method in Tackling the Clutter Demon With Bipolar Disorder
  33. Maternal Bipolar Disorder Significantly Increases Risk for Premature Births
  34. How to Manage Common Bipolar Triggers
  35. How to Survive a Stint in the Mental Hospital
  36. How to Talk to Someone Experiencing a Bipolar Mood Episode
  37. How to Spot Bipolar Disorder in Teens and What to do About it
  38. What Are the Differences Between Bipolar in Children and Bipolar in Adults?
  39. Preemies Have Higher Risk to Develop Bipolar Disorder
  40. How to Spot Depression in Children, Even Preschoolers
  41. How Sugar May Harm Your Mental Health
  42. America has Highest Rate of Bipolar Disorder Diagnoses in 11-Nation Study
  43. Can Early Symptoms Predict Bipolar Disorder? Evidence Shows Differing Patterns of Risk Factors
  44. The Links Between Fibromyalgia and Bipolar Disorder
  45. Brain Training Shows Promise for Patients with Bipolar Disorder
  46. The Bipolar Parent Master Link List
  47. Scientists Link Bipolar Disorder to Unexpected Brain Region
  48. A Quarter of People with Fibromyalgia Show Bipolar Symptoms
  49. Bipolar Disorder Medication and Weight Gain
  50. How to Treat Common Side Effects of Bipolar Medication
  51. How to Clean Your House with Bipolar Disorder and a Toddler, part II
  52. How to Clean Your House with Bipolar Disorder and a Toddler, part I
  53. How to Follow a Mediterranean Diet to Help Manage Bipolar Depression
  54. What is Hypergraphia, and How Does It Relate to Bipolar Disorder?
  55. My Manifestations of Bipolar Mania: Crafting and Frugality
  56. Tackling the Clutter Demon with Bipolar Disorder
  57. Book Review: Dyane Harwood’s Birth of a New Brain
  58. Good, Good, Good Nutrition, Part II: Foods to Avoid When Managing Bipolar Disorder
  59. Good, Good, Good Nutrition, part I: Foods to Eat to Help Manage Bipolar Disorder
  60. Bipolar Disorder Manifests Differently in People Who Binge Eat
  61. Family Study Emphasizes Distinct Origins for Bipolar Disorder Subtypes
  62. Interview With My Parents: On Raising a Bipolar Child
  63. People With Bipolar Disorder More Likely to Die From Age-Related Diseases
  64. Bipolar Disorder Diagnosable By a 15-minute Electrocardiogram, Study Finds
  65. Book Review: Rock Steady: Brilliant Advice From My Bipolar Life
  66. 22 Easy Meals to Make While Depressed
  67. Dealing With Mental Illness Privilege Guilt
  68. Left-handed People Require Different Mental Health Treatments, Study Finds
  69. Gene Breakthrough on Lithium Treatment for Bipolar Disorder
  70. Light Therapy Helps Bipolar Disorder Patients Function
  71. Brain Protein Targeted to Develop New Bipolar Disorder Therapies
  72. Pot Smoking in Teens Linked to Bipolar Symptoms
  73. Children with Bipolar Disorder May Be Diagnosed with Vitamin D Blood Test In the Future
  74. Bipolar Patients Treated with Lithium Rehospitalized Less
  75. Scientists Conclude After 12-year Study That Bipolar Disorder Has Seven Causes
  76. Treatable Condition Could be Mistaken for Bipolar Disorder
  77. People with a Family History of Bipolar Disorder Have Reduced Planning Ability
  78. People At-Risk for Bipolar Disorder May Age Faster
  79. Men and Women Differ When it Comes to Bipolar Biomarkers
  80. Researchers Create Global Map of How Bipolar Disorder Affects the Brain
  81. AI Used for Blowing Pilots Out of the Sky Helps Bipolar Patients
  82. Bipolar? Your Brain is Wired to Make Poor Decisions
  83. Six-Year Delay Between Onset of Bipolar Disorder and Diagnosis, Study Finds
  84. Molecular Mechanism Behind Lithium’s Effectiveness Identified
  85. Children at High Risk for Bipolar Disorder Genetically Vulnerable to Stress
  86. Hippocampus Volume Decreases Linked to Bipolar Disorder
  87. Depression Changes Our Language
  88. Bipolar Genes Linked to Autism
  89. Genes Linked to Creativity Could Increase Risk of Bipolar Disorder, Schizophrenia
  90. Bipolar Disorder Increases Risk of Early Death From Natural Causes
  91. How to Handle Intrusive Thoughts
  92. What Does High Functioning Depression Look Like?
  93. Which Mental Health Professional Should You Use?
  94. The History of the Treatment of Mental Illness
  95. Can Bipolar Disorder Symptoms Contribute to Hoarding?
  96. Bipolar? You Can Survive This Holiday Season, part II
  97. Bipolar? You Can Survive This Holiday Season, part I
  98. New Research Pinpoints Bipolar Disorder Gene
  99. What Types of Therapies Are Right For You?
  100. How to Get a Psychiatric Evaluation
  101. Disclosing That You Have a Mental Illness, part IV: Your Employer
  102. Disclosing That You Have a Mental Illness, part III: Friends and Family
  103. Disclosing That You Have a Mental Illness, part II: How
  104. Disclosing That You Have a Mental Illness, part I: When
  105. Bipolar Patients More Than Twice As Likely to Have Suffered Childhood Adversity
  106. Scientists Predict Who Will Respond to Lithium
  107. What to do if Your Child has Bipolar Disorder
  108. Bipolar Disorder in Children
  109. How to Apply for Disability Benefits for Mental Disorders
  110. Antibiotics Linked to Manic Episodes
  111. Why Should You Chart Your Moods if You Have Bipolar Disorder?
  112. Bipolar Disorder is Toxic–Literally
  113. Antibodies That Cause Encephalitis Linked to Psychosis
  114. Can Blueberry Extract Help Prevent Postpartum Blues?
  115. Substance Abuse and Bipolar Disorder
  116. Bipolar Disorder in Women
  117. App to Detect Onset of Mania In Development by Sane Australia
  118. What to do if You Run Out of Medication
  119. 4 Ways to Educate Someone About Mental Illness
  120. The History of Bipolar Disorder
  121. Mental Illness in the Media–An Incomplete Picture
  122. 5 Ways to Cope with a Diagnosis of Mental Illness
  123. 8 Myths About Mental Illness
  124. Learned Behaviors: Passing on Coping Mechanisms
  125. Nature vs. Nurture: The Causes of Bipolar Disorder
  126. What is Bipolar Disorder?
  127. 6 Strategies for Parenting with a Mental Illness
  128. How to Talk To Your Kids About Mental Illness
  129. The Price of Mental Health
  130. What is Postpartum Psychosis?
  131. How Mental Health Affects Personal Hygiene
  132. The Prevalence of “Nuts”
  133. “How Do You Define Mentally Ill?”
  134. Pregnant While Bipolar
  135. Executive Function and Bipolar Disorder
  136. Safe Medications to Take While Breastfeeding
  137. Stabilizing Medications: Risperidone and Wellbutrin
  138. What is Bipolar Depression?
  139. Bipolar and Suicidal? You’re Not Alone
  140. The Gold Standards of Bipolar Medication, part II
  141. The Gold Standards of Bipolar Medication, part I
  142. Are You “Covering” For Your Illnesses?
  143. How to Clean When Your Brain is a Mess, part III
  144. How to Clean When Your Brain is a Mess, part II
  145. How to Clean Your House When Your Brain is a Mess, part I
  146. How Privilege Affects Mental Healthcare
  147. How to Get Your Much-Needed Forty Winks
  148. How to Work Out with a 40-pound Parasite Clinging to Your Leg
  149. Bipolar? Exercise Will Change Your Life
  150. Good, Good, Good, Good Nutrition!
  151. Why Medicinal Weight Gain is Devastating to the Mentally Ill
  152. What is Cyclothymia?
  153. The Importance of Team You, Part V
  154. The Importance of Team You, Part IV
  155. The Importance of Team You, Part III
  156. The Importance of Team You, Part II
  157. The Importance of Team You, part I
  158. A Breath of Fresh Air: Deep Breathing Techniques
  159. A Beautiful Mind
  160. Hypomania: A Closer Look
  161. What is Hypomania?
  162. What is Mania?
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A Quarter of People With Fibromyalgia Show Bipolar Disorder Symptoms

Fibromyalgia and bipolar disorder appear to be connected. New research shows that a quarter of fibromyalgia patients who were screened tested positive for bipolar symptoms. Because these diseases are found in tandem, it’s known as comorbidity. If you have one disorder going on, despite their differences, you might have both.

hache.jpg
Credit to flickr.com user CJS*64. Used with permission under a Creative Commons license.

The causes of fibromyalgia are yet to be discovered, and up to 5% of the population may be affected. More common in women, fibromyalgia is a disorder that causes muscle and joint aches. Other symptoms are fatigue, and, occasionally, depression.

Dr. William Wilke from the Cleveland Clinic in Ohio and his colleagues gave 128 patients with fibromyalgia four questionnaires. The first was the Mood Disorder Questionnaire (MDQ) for bipolar disorder, to determine the link between bipolar and fibromyalgia. Next was the Beck Depression Inventory (BDI) for depression. The scientists also used the Epworth Sleepiness Scale (ESS) for daytime sleepiness, and the Fibromyalgia Impact Questionnaire Disability Index (FIQ‐DI) to assess for functional capacity.

According to the MDQ screen, just over 25% of the patients were likely to have bipolar disorder, demonstrating a clear link between fibromyalgia and bipolar disorder. People who showed symptoms of bipolar also suffered from more severe depressions than people who didn’t show symptoms of bipolar disorder, which is really no surprise, given bipolar disorder’s depressions.

The BDI’s results were also of interest: 79% of the fibromyalgia patients were clinically depressed. Of those people, up to a third of the people who suffered from depression also reported symptoms of bipolar disorder.

The ESS showed that 52% of the patients with fibromyalgia–just over half–experienced daytime sleepiness, which doesn’t relate to bipolar disorder, but is interesting nonetheless.

Wilke’s team pointed out that some medications that treat fibromyalgia may also trigger mania in bipolar patients, and therefore doctors are urged to be cautious.

So, if you have fibromyalgia, you might want to talk to your doctor about the potential for bipolar disorder before you take medications to treat the disease, because those medications can trigger manic episodes. Similarly, if you have bipolar disorder, those muscle aches and fatigue might be something more; get screened for fibromyalgia.

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How to Follow a Mediterranean Diet to Help Manage Bipolar Depression

salm
Credit to flickr.com user Annette Young. Used with permission under a Creative Commons license.

As several studies have pointed out, eating a healthy diet is crucial for managing bipolar disorder. I recently linked to a study demonstrating that a Mediterranean diet helped alleviate the symptoms of depression. New research shows that following such a diet can even help prevent depression in the first place. If you eat these prescribed foods, then you may be able to alleviate or prevent bipolar depression as well.

In addition, following this diet may lower “bad”  cholesterol, reduce the risk of heart disease, and help reduce the incidence of Parkinson’s, Alzheimer’s, and some cancers–including breast cancer, when supplemented with mixed nuts. So why not give the diet a try?

But what is a Mediterranean diet? It emphasizes:

  • Eating fruits, vegetables, beans/legumes, nuts, and whole grains as primary food sources
  • Replacing butter with healthier fats such as olive oil
  • Avoiding salt, and using herbs and spices instead
  • Only eating red meat a few times per month, and eating fish and poultry twice a week instead
  • Drinking moderate amounts of red wine (optional)

To follow the diet more fully, aim for seven to ten servings of fruits and veggies per day. Switch to whole-grain bread, cereal, pasta, and rice. Keep cashews, walnuts, and almonds around for snacking, but don’t eat too many, as they’re high in calories. Don’t eat butter; try olive oil and canola oil as a substitute. Eat healthy fats in general. Nosh on water-packed tuna, trout, or salmon once or twice a week, but avoid fried fish.

Don’t eat red meat unless it’s lean; avoid sausage and bacon. Choose low-fat cheese, fat-free yogurt, and skim milk. Avoid sugar. If you drink alcohol, have a glass of wine at dinner, but purple grape juice can be an alternative. For a sample meal plan that breaks down consumption by calories, click here.

There are a couple of downsides to the Mediterranean diet, however. One is the high cost. A personal finance blog, The Simple Dollar, posted a detailed breakdown of the costs of switching from butter to olive oil, and red meat to salmon, as well as other foods. According to the breakdown, salmon is almost twice as expensive as ground beef, so if you have a large family, then you might want to change over to ground turkey instead.

The other downside of the diet is its complexity. Not only is overhauling your regular eating patterns hard, balancing your intake of proteins, fats, and carbohydrates over several different meals is difficult. I know that when I’m depressed, I choose to make one of these twenty-two easy, delicious meals, most of which are carb-heavy. Those are great, but if you’re trying to follow the Mediterranean diet, then that link is not for you.

But don’t let the cost or complexity of the Mediterranean diet throw you. In-season produce, the backbone of the diet, is generally cheaper than meat, be it red or fish or poultry. And switching from butter to olive oil is easy. You don’t have to follow a diet to a T to get some of the benefits.

By following this diet, you may be better able to manage bipolar depression, which can take all the help you can get. The bottom line is, just do what you can. Eat more fruit. Swap ground beef for ground turkey. If eating more vegetables or switching some unhealthy fats for healthier ones is all you can do, that’s still great. You’ve got this.

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Family Study Emphasizes Distinct Origins for Bipolar Disorder Subtypes

family
Credit to flickr.com user Kat Grigg. Used with permission under a Creative Commons license.

The most common subtypes of bipolar disorder, bipolar I and bipolar II, stem—at least in part—from different biological causes, according to a new study published in Biological Psychiatry. Despite genetic overlap between the two subtypes, each subtype tended to cluster within families, suggesting a distinction between bipolar disorders I and II.

The study, by Dr. Jie Song of the Department of Clinical Neuroscience, Karolinska Institutet, Sweden, and colleagues helps settle controversy over the relationship between bipolar I and bipolar II disorders. Although genetic similarities indicate overlap between the subtypes, the new findings emphasize different origins. According to Song, this is contrary to a common notion among many clinicians that bipolar II disorder is merely a milder form.

“We have tended to view the two forms of bipolar disorder as variants of the same clinical condition. However, this new study highlights important differences in the heritable risk for these two disorders,” said Dr. John Krystal, Editor of Biological Psychiatry.

The study is the first nationwide family study to explore the difference between the two main subtypes of bipolar disorder. Dr. Song and colleagues analyzed the occurrence of the bipolar disorder subtypes in families from the Swedish national registers. Although a strong genetic correlation between bipolar I and bipolar II disorder suggests that they are not completely different, the family occurrence for each subtype was stronger than co-occurrence between the subtypes, indicating that bipolar I and bipolar II disorders tend to “run” in families separately, rather than occurring together.

“Within the context of our emerging appreciation of polygenic risk, where gene variations are implicated in several disorders, the new findings point to only partial overlap in the risk mechanisms for these two forms of bipolar disorder,” said Dr. Krystal.

The study also provided some additional clues that bipolar I and II disorders have distinct origins. Only bipolar disorder II showed gender differences—the proportion of females to males was higher in bipolar disorder II but not bipolar disorder I. And bipolar I clustered together in families with schizophrenia, which was not apparent for bipolar disorder II.

“Hopefully, our findings increase awareness of the need for refined distinctions between subtypes of mood disorder,” said Dr. Song. The distinction between the subtypes also has implications for treatment strategies for patients. Dr. Song added that future research is warranted to characterize new biomarkers to improve treatment and prognosis.

Text provided by Elsevier.

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