In the U.S. alone, there are over 5 million people currently living with bipolar affective disorder. According to renowned neurologist, Dr. Edward I. Ginns, MD, PhD bipolar is “a common psychiatric illness that is affecting about one to two percent of the population.” He also stated that the disorder is “responsible probably for more lost disability days than all forms of cancer and neurologic disorders.” Dr. Ginns was kind enough to join me for an interview yesterday to discuss what bipolar affective disorder is, the common risk factors, symptoms, treatment options, and new breakthrough research about how a rare genetic disease protects against bipolar disorder.
Candace Rose: What is bipolar affective disorder?
Dr. Edward I. Ginns, MD, PhD: “It’s a common psychiatric illness that is affecting about one to two percent of the population. Believe it or not, it’s responsible probably for more lost disability days than all forms of cancer and neurologic disorders.
Bipolar I is the most serious form and it’s a common psychiatric illness characterized by recurrent swings of periods of high energy and mania to those of low energy. During the manic episodes patients have a reduced need for sleep. They’re more talkative and restless and can have mood swings from happy to just frankly irritable (switching back and forth). During this manic phase generally individuals make poor decisions and have rash behaviors where there is little disregard for some of the consequences. And then you go to the other side where there are cycles of depression that generally include crying, slowed thinking, poor concentration and more social isolationism and pessimism.
What’s important is that is bipolar affective disorder or depression there’s a much higher risk for suicide. For some reason apparently, higher among males.”
Candace Rose: Who is at risk for developing bipolar and is it hereditary?
Dr. Edward I. Ginns, MD, PhD: “Bipolar occurs in all populations. What we really don’t know right now is how to predict those at risk. There are clearly families where there is an increased number of individuals within that particular family that are affected with bipolar. We’ve known for years that there is a significant genetic affect in addition to environmental.
What we’ve done is go into the Amish community where, again, across the Amish the incidence is no different than the rest of the ethnic groups in populations. But in special families where there’s a much higher risk for bipolar (15 – 20%), what was surprising is that we found in these families there was a rare genetic disease, where the individuals with the rare genetic disease did not get bipolar, they were protected. We found that the DNA change was causing the rare genetic disease and from that we found how it blocked bipolar and what chemical reactions in the brain it actually affected.
What we’re learning is that we have now some idea of what chemical reactions that have not been studied in the past may be involved in bipolar. Interestingly, it’s a series where a downstream of where we block bipolar in these rare genetic disorder individuals downstream in other series of the chemicals – it’s where lithium and SSRI’s actually are believed to work. One of the things that we’re believing is that although we have a DNA change that we believe can shutoff bipolar and protect this other rare disorder in individuals, there are actually drugs out there that are used for other medical illnesses that are caused by this series of chemical reactions in this pathway that have never been tried for bipolar. It may be possible then to have a whole new category of drugs sooner than we could think. There truly hasn’t been a new drug for bipolar in over a decade.”
Candace Rose: Can you tell us more about your research?
Dr. Edward I. Ginns, MD, PhD: “The research actually stems from what we call The Amish Study. Dr. Janice Egeland (who is a professor at the University of Miami, but actually lives in Amish country in Pennsylvania) had studied initially the health, values and health practices of the Amish and when she lived there, she found that in addition to what she was working on there were families with this rare genetic disorder that was a genetic dwarfism. As she did more of her work and focused on bipolar affective disorder, this is where we started seeing that the same families that had individuals with bipolar disorder, also had individuals with this genetic dwarfism. As the years went by we discovered that none of the individuals with this rare genetic disease ever had bipolar affective disorder.
In the past year or so we were able to put the pieces of the puzzles more together and identify what we believe are a novel series of chemical reactions involved in bipolar. And as I said, the pathway is known in other medical conditions where drugs are already being developed, and the hope is that they then might be tried both in model systems to understand more how they could work in the chemical reactions that we’ve identified, but also to think about carefully controlled ways that these drugs might have a benefit to treating bipolar affective and other mood disorders.”
Candace Rose: What are the current treatments for bipolar affective disorder?
Dr. Edward I. Ginns, MD, PhD: “Current treatments are either psychotherapy or drug treatments. Lithium is very much a mainstay, we have the SSRIs. Many of the patients do very well on the medications and therapy, but there are also many who have breakthrough symptoms and could certainly use a more effective treatment.”
Candace Rose: What should you do if you think your loved one might have bipolar affective disorder?
Dr. Edward I. Ginns, MD, PhD: “What’s most important is to have the individual quickly examined by a health professional and get within the system, whether it’s through nursing or other professional. There are other genetic or environmental causes that can look like bipolar disease, things like endocrine disorders, thyroid and it’s important to get them within an infrastructure where it can be rapidly evaluated and particularly evaluate if they’re having more depressive swings, whether they’re liable to have self harm or even at risk for suicide. The other is that once they’re evaluated within the healthcare system it’s important to decide whether and what therapy is best. It often in today’s drugs does not work immediately, so again, that’s a critical thing to evaluate and make decisions about.”
Candace Rose: Well, thank you Dr. Ginns. Where can we go for more information?
Dr. Edward I. Ginns, MD,PhD: “There are several sites, and one is the National Institute of Mental Health in Bethesda, Maryland. That is the central research and clinical site for information. The other is National Alliance for the Mentally Ill in Washington, D.C. and there are chapters in every state and many in different parts of states.”
For more information, please also visit:
- NAMI/MA: https://www.namimass.org/
- NAMI/National: https://www.nami.org/
- Bipolar Foundation: https://www.bipolar-foundation.org/
- Ryan Licht Sang Bipolar Foundation: https://www.ryanlichtsangbipolarfoundation.org/site/c.ltJZJ8MMIsE/b.2107311/k.BCD3/Home.htm
- International Bipolar Foundation: https://ibpf.org/
- Balanced Mind Parent Network: https://www.thebalancedmind.org/about-us
- Juvenile Bipolar Research Foundation: https://www.jbrf.org/
- Depression and Bipolar Support Alliance: https://www.dbsalliance.org/site/PageServer?pagename=home
Link to our paper at Nature Molecular Psychiatry: