How To Know If You May Be Genetically At Risk For Bipolar Disorder
Bipolar disorder is a mood disorder that affects about one in 40 adults in the US, and it’s the sixth-leading cause of disability worldwide. Though it is a chronic and potentially severe mental illness, bipolar disorder is generally treatable. However, when untreated, it can significantly impact a person’s daily functioning and well-being. That’s why understanding the causes and risk factors for developing bipolar disorder—including genetics—can be important, so you can take preventative measures and learn to recognize symptoms if they do arise.
What is bipolar disorder?
Bipolar disorder is typically characterized by extreme mood swings between an “up” or manic state and a “down” or depressive state. These moods are commonly referred to as episodes. The frequency of these shifts and the intensity of the episodes are what determine which type of bipolar disorder an individual has. There are three primary types of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder.
Bipolar disorder I is characterized by mania that lasts a week or longer and may require the individual to be hospitalized. Individuals with bipolar disorder type I may or may not have also experienced a major depressive episode. Bipolar disorder II involves shifts between hypomanic episodes, which are less severe periods of mania, and depressive episodes. Unlike with bipolar disorder type I, individuals with type II must experience both a high and low period. Cyclothymic disorder involves mood shifts whose severity or duration don’t meet the criteria for bipolar disorder I or II.
Symptoms of bipolar disorder
The primary symptoms of bipolar disorder are the shifts between manic and depressive states. Symptoms of a manic episode may include:
Feeling restless
Feeling very happy or euphoric
Feeling agitated or irritable
Having racing thoughts
Being unrealistic about one’s abilities
Talking quickly
Being jumpy
Taking excessive risks
Displaying poor judgment
Being impulsive
In extreme cases, symptoms of psychosis such as hallucinations or delusion
Symptoms of a depressive episode may include:
Feeling fatigued
Feeling sad, hopeless, or helpless
Isolating oneself from friends and family
Experiencing changes in appetite resulting in weight gain or loss
Having difficulty making decisions
Having a hard time focusing
Losing interest in usual activities or hobbies
Talking slowly
Having thoughts or behaviors of self-harm or suicide
If you or someone you know is experiencing suicidal thoughts or behaviors, seek help immediately. The National Suicide Prevention Lifeline can be reached 24/7 by dialing 988.
Genetic factors increase the risk of developing bipolar disorder
Like many psychiatric disorders, bipolar disorder is thought to have a significant genetic basis.
Is bipolar disorder genetic?
In other words, both genetic and environmental factors can contribute to a given individual’s risk of developing bipolar disorder. Let’s take a closer look at each of these.
The genetic component
Bipolar disorder is considered one of the most heritable mental disorders. Studies suggest that if an individual has a first-degree relative (a biological parent or sibling) who has bipolar disorder, they have a 15–30% chance of developing it themselves. If they have two first-degree relatives with the disorder, they have up to a 75% chance of developing it themselves. So while having family members with bipolar disorder doesn’t guarantee that you’ll develop the disorder as well, it likely increases the chances.
It is thought that numerous gene variants contribute to the development of bipolar disorder—each in a small way. Researchers haven't yet found a single, specific genetic marker that is always present in people with bipolar disorder. However, multiple genes—and numerous genetic variants within them—have been linked to the condition. In a genome-wide association study, researchers identified 64 genomic loci, which included 161 genes, that were connected to bipolar disorder. While no single gene may be responsible for the disorder’s development, certain genes have been more strongly implicated. In a 2022 study, which included details from approximately 14,000 individuals with bipolar disorder and a similar number of healthy controls, researchers concluded that AKAP11 is “a definitive risk gene”.
Many gene variants that have been identified are thought to exert influence on brain function. In a study published in the journal Archives of General Psychiatry (Arch Gen Psychiatry), researchers found that variations in the CACNA1C gene may help explain cognitive impairments in bipolar disorder. Additionally researchers in a whole-genome study and meta-analysis identified variations in several protein-encoding genes that contribute to brain structure and function.
As we continue to identify common genetic markers in bipolar disorder, we can learn more about the role specific genes play in the manifestation of symptoms in a person’s life. Future directions may include more large-scale human genome studies and other collaborative efforts to accumulate details. In a summary of the above-mentioned genome-wide association study, the National Institute of Mental Health stated that identification of the location of specific genes “will continue to increase rapidly with the addition of new cohorts”.
The environmental component
It’s thought that environmental factors also play a role in an individual’s likelihood of developing bipolar disorder. It may be that elements of their upbringing could predispose them to be at risk for a mental health condition like this later in life. Or/in addition, difficult, stressful, and/or traumatic life events may have the potential to trigger the expression of a gene that relates to this disorder. Environmental factors or events that have been found to increase risk include:
Abuse
Other trauma
High-stress events like divorce or the loss of a loved one
Significant levels of chronic stress
Certain medications
The role of alcohol
It’s also worth noting that some research relates substance use disorders—especially those involving alcohol—to bipolar disorder. First, bipolar and substance use disorders are often comorbid, meaning that it’s not uncommon for a single individual to experience both concurrently. While excessive or problematic alcohol consumption may be a coping mechanism some turn to in an attempt to manage symptoms, research suggests a potential genetic link as well. Further research is needed to understand the exact relationship between these two disorders, but limiting or avoiding alcohol may be helpful for those who have or are at risk for developing bipolar disorder.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
How to know if you may be genetically at risk for bipolar disorder
If you know of a biological first-degree relative of yours who has bipolar disorder, you may be at increased risk of developing it too, as described above. If you’re not connected with or aware of the health history of every member of your biological family, tracking down this information can be useful. In cases where this is not possible, some people wonder whether at-home genetic tests may help them understand if they may have a family history of a disorder like this. However, since researchers have yet to isolate the exact gene(s) associated with bipolar disorder, such tests are unlikely to be accurate.
If you have or suspect you may have a family history of this disorder, it can be helpful to speak to your doctor about what you can do. They may evaluate you for symptoms of bipolar disorder now, help you understand what to look for in the future, and give you tips on lifestyle changes you can make to help prevent onset if you are at risk. These changes may include:
Exercising regularly
Eating a balanced diet—especially one high in omega-3 fatty acids, folic acid, and zinc
Getting enough sleep
Managing stress levels
Addressing any past trauma
How therapy can help
If you have been diagnosed with bipolar disorder, meeting with a therapist regularly is likely part of your treatment plan. If you’re showing symptoms of bipolar disorder or another mental health condition, meeting with a healthcare professional for evaluation is recommended. If you’re concerned about your risk for developing bipolar disorder or another mental health condition, taking care of your mental health now can be a helpful preventative measure. Therapy is one way to do this. With the help of a trained therapist, you can address any past traumas, get help processing your emotions, and learn about self-care strategies you can try to maintain positive mental health.
Attending traditional, in-person therapy sessions with a therapist is not possible for everyone. Some don’t have providers in their area, can’t easily travel to appointments due to a health condition or disability, or can’t receive care for financial reasons. In cases like these, online therapy can represent a viable alternative. With an online therapy platform like BetterHelp, you can meet with a licensed therapist from the comfort of home or anywhere you have an internet connection, and for a cost that’s comparable to most insurance co-pays. Research suggests that online therapy can offer similar benefits to in-person therapy in many cases, so the format you choose is generally up to you.
Takeaway
At what age does bipolar start?
Is bipolar disorder genetic? We’re not entirely sure, but we know that bipolar disorder is a mental illness that genetic risk factors can influence. As such, it’s possible to develop bipolar disorder symptoms at an early age, although the most common age of onset is the late teens, between 15 and 19, and it rarely develops after the age of 40. That being said, because so many genes are associated with the genetic risk of bipolar disorder, as well as other factors such as stressful events or exposure to certain chemical imbalances, it’s not impossible to develop symptoms at any age.
Does bipolar get worse with age?
Some research has suggested that symptoms of this depressive illness can become more frequent or severe as a person ages, and that early onset of bipolar disorder can lead to more severe symptoms late in life. More research is necessary to discover exactly why this is and what can be done to prevent it.
Is bipolar more common in males or females?
Research suggests that bipolar disorder, especially bipolar II, is more common in women than in men, and tends to respond more to seasonal factors. Women also tend to experience more rapid cycling or rapidly switching between depressive and manic episodes. Men tend to have an earlier onset of the disorder than women but tend to respond better to treatment with certain mood-stabilizing medications.
Can you grow out of bipolar?
Though a small amount of new research suggests that it’s possible for a person to experience fewer symptoms of bipolar disorder over time, it’s more common for the symptoms bipolar disorder to worsen with age. Generally, bipolar disorder is considered a lifelong condition with no cure, though it is more than possible for those with the condition to live a long, happy, and healthy life with appropriate treatment and support.
What drugs can trigger bipolar disorder?
Certain medications, specifically some corticosteroids, anabolic-androgenic steroids, and antidepressants, can trigger manic episodes in people who already have contributing genetic factors that can lead to bipolar disorder. Substance abuse can also trigger manic and depressive episodes. These triggers may cause the onset of the condition.
Should people with bipolar have kids?
People living with bipolar disorder can have children if they choose to and be successful, loving, and attentive parents. Pregnancy can make the symptoms of bipolar disorder more severe, which may mean that a pregnant person with the condition may need additional support. It should be taken into consideration that having a family member with bipolar disorder and the associated genetic variations can put the child at a higher disease risk.
How do you test for bipolar?
Generally, bipolar disorder is tested for by a specialist assessment and some physical assessments including testing for thyroid activity.
Do bipolar people know they are bipolar?
Most people living with bipolar disorder are well aware of their condition and an active participant in its management and treatment. That being said, the disorder is sometimes misdiagnosed as depression or another condition, which can make treatment difficult.
How can you tell if a woman is bipolar?
Generally, a person with bipolar disorder will cycle between manic and depressive episodes, or periods of time where their thoughts and behaviors tend toward an extreme of emotion and energy. Manic episodes often present as periods of extreme happiness, high energy, and potential psychosis; a person experiencing a manic episode might not eat or sleep for days on end, speak extremely quickly and seemingly nonsensically, be easily frustrated or angered, and make impulsive decisions like spending large amounts of money in unusual ways. Depressive episodes often present as periods of extreme sadness and listlessness; a person experiencing a depressive episode may not get out of bed for days, let basic hygiene such as showering or brushing teeth fall to the wayside, and feel worthless, hopeless, or in some cases, even suicidal.
Can bipolar be caused by trauma?
Though bipolar disorder is thought to be at least partly genetically based, other risk factors for the condition include experiencing highly traumatic events like abuse or disaster in childhood or experiencing a physical trauma to the brain such as a traumatic head injury.
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