Q: I have a couple of family members who were never diagnosed with bipolar disorder, but who definitely exhibited symptoms of the condition. My husband has one family member who has been diagnosed with bipolar disorder as well. We’d like to start a family, but I’m afraid that our children might be at risk for developing the disease. How concerned should I be?
A: I think the key piece of information here is that neither you nor your husband has been diagnosed with bipolar disorder. The best studies of bipolar disorder risk have examined the situation in which one parent has bipolar disorder. The risk of their children developing bipolar disorder is probably somewhere between ten and 20 percent.
Since neither of you have bipolar disorder, your children’s risk will be much lower, probably similar to the population prevalence of bipolar disorder of about three-four percent. However, depending on your age there is (knock on wood) a chance that you will develop bipolar disorder in the future, which would change this probability. Most cases of bipolar disorder develop by age 25, but some people develop the illness later in life.
While studies of potential genes involved in bipolar disorder are helpful for learning more about the causes of bipolar disorder, we do not have any way to accurately predict who is at risk for bipolar disorder currently. While some disorders show clear genetic transmission, this is not the case for many psychiatric illnesses. (Reading about Ms. Moser’s dilemmas should help you keep a healthy sense of perspective on your concerns).
For one thing, it is quite likely that the illness we call bipolar disorder can result from a number of different problems related to brain development that ultimately lead to similar symptoms. This may also explain why bipolar disorder can appear either early or later on in life. As a result, it is unlikely that a single gene will be shown to account for any significant number of ‘kinds’ of bipolar disorder.
Another important point relates to the unknown ways in which environment must interact with genes to lead to bipolar disorder. For example, even in monozygotic twins (twins with identical genes at conception), when one twin has bipolar disorder, the other twin does not always have bipolar disorder. Rather, it appears that in only 50% to perhaps 80% of such twin pairs do both twins have the illness.
The bottom line is that bipolar disorder is treatable, and many people enjoy long, happy lives despite being affected. In the situation that you describe, it will be helpful to stay alert for signs of bipolar disorder in your children, but the chance that they may have bipolar disorder should not play a role in your decision of whether or not to have children.
Published On: March 26, 2007
Living With6 Chronic Condition Guidelines to Live By
Facing the challenges5 Rules for Bipolar Relationships