An Overview of Bipolar Disorder and How Genetics Can Increase Hereditary Risk

Bipolar disorder is a mental health condition characterized by extreme changes in mood and energy levels. Genetics are not the only cause of bipolar disorder, but research shows that its strong genetic component can increase your risk, making the condition one of the most heritable mental health disorders.

Read on to learn more about bipolar disorder and its causes, symptoms, and treatment.

Causes of the Condition

With bipolar disorder, extreme mood changes occur. The shifts can influence a person’s energy, mood, behavior, and level of functioning.

An individual can experience mania (a highly elevated mood), hypomania (an elevated mood not as severe as mania), or major depressive episodes.

While the exact cause of bipolar disorder is unclear, research indicates genetic and environmental factors as possible contributors. 

Is Bipolar Disorder Genetic?

Bipolar disorder is one of the most heritable mental health conditions, with family history being a significant risk factor.

Individuals who have a first-degree relative (parent, sibling, or child) with bipolar disorder have an increased risk. Research shows that children who have a parent with bipolar disorder are 10 times more likely to develop the condition.

Though there are challenges, researchers continue to explore the association between genetics and bipolar disorder.

Problems with calcium signaling are associated with the condition. Genes such as CACNA1C and ANK3, which contribute to the regulation of calcium, may play a role, though this is still unclear.

Other possible gene connections include Neuregulin 1 and G72/30. They are tied to dopamine and serotonin pathways. Dopamine and serotonin are neurotransmitters involved in communication between nerve cells. Both neurotransmitters are associated with mood regulation.

Although it's clear that there is a strong genetic component in the development of bipolar disorder, the complexities continue to be explored.

Other Risk Factors

Apart from genetics, other environmental, lifestyle, and brain-related factors may influence the development of bipolar disorder, or play a role in the course of symptoms.

Brain Injury and Structure

• Head injuries or trauma
• Disruptions or changes to functional brain activity 
• Inflammation
• Fluctuations in cortisol levels 

Environmental Factors

• Stressful or traumatic events
• Lack of exercise or physical activity
• Hormonal changes
• Substance use 
• Childhood experiences
• Social relationships 
  

Signs and Symptoms of the Disorder

Bipolar disorder is characterized by mood episodes consisting of mania, hypomania, or depression. A mixed state, where a person experiences manic and depressive symptoms within a short period of time, can also occur.

Symptoms can also take the course of rapid-cycling, in which four or more shifts between distinct mood states are present in 12 months.

In a manic episode, a person may experience:

• Euphoria or elevated mood
• Inflated sense of self
• Grandiose thoughts
• Excessive energy and racing thoughts
• Decreased need for sleep
• Excessive talking or pressured speech
• Engagement in impulsive or risky behavior that may have consequences (spending, alcohol/drug use, sexual encounters)
  

Symptoms for hypomania are similar to those of mania. However, the symptoms are less intense and less disruptive.

During a depressive episode, a person may experience:

• Isolation and withdrawal
• Prolonged low mood (sadness, hopelessness, etc.) 
• Changes in appetite
• Changes to sleeping patterns
  
• Lack of pleasure or joy in daily activities
• Thoughts of death or suicide
  

Types

There are different types of bipolar disorder, some of which include bipolar I, bipolar II, and cyclothymic disorder.

Bipolar I Disorder

To be diagnosed with bipolar I, a person must experience at least one manic episode. Depression or hypomania may be present at some point during the course of the illness.

Bipolar I is typically more severe than other forms of bipolar disorder due to symptoms of mania. Mania can cause psychosis, with delusions or hallucinations in some cases, or require hospitalization.

Bipolar II Disorder

Unlike with bipolar I, an individual with bipolar II does not experience mania. They instead experience hypomania, a less intense form of mania with potentially shorter-lasting symptoms. A major depressive episode must also occur to fulfill the criteria.

This form of the condition is more common among women.

Cyclothymic Disorder

In cyclothymic disorder, a person must experience depressive or hypomanic symptoms for at least two years. However, the criteria for a full-blown depressive or manic episode are not met. 

Diagnosis

While the onset of bipolar disorder can occur at any point, the typical onset is in a person's early to mid-20s.

Diagnosing bipolar disorder can be difficult. This is because symptoms may present like those of other mental health conditions, and a diagnosis depends on a person’s self-report of their symptoms.

Receiving an accurate diagnosis can take some time, so working closely and consistently with a mental health professional is essential.

When assessing if a patient has bipolar disorder, mental health or medical professionals will review or perform:

• A complete medical history
• A thorough mental health examination, including past and present symptoms
• Medical testing to rule out physical health conditions
  

Ways to Manage and Treat the Condition

Fluctuations in mood can significantly impact a person’s quality of life and productivity, especially when the condition is untreated. While there is no cure for bipolar disorder, treatment can help manage symptoms.

Treatment for bipolar disorder consists of medication, therapy, or a combination of the two.

Medication

Some medication options used to treat bipolar disorder include:

• Mood stabilizers: Lithium, carbamazepine, valproic acid, and lamotrigine are often prescribed to stabilize mood and alleviate mania.
• Antipsychotics: Quetiapine, aripiprazole, risperidone, and other atypical antipsychotics are used to treat symptoms of depression and mania.
• Antidepressants: The use of antidepressants in treating patients with bipolar disorder may vary from patient to patient, as it can trigger episodes of mania in some.

Consultation and monitoring by a psychiatrist is the best way to determine the best combination of medications, discuss concerns, and change a medication regimen. 

Therapy

Therapy is a safe and non-judgmental environment where people can learn about their diagnosis, how to manage symptoms, and establish a routine to support well-being. 

• Cognitive behavior therapy helps you identify stressors and triggers, understand how your thoughts, feelings, and behaviors are connected, replace irrational thoughts with healthier ones, and cope with difficult emotions.
• Family-focused therapy focuses on psychoeducation about the condition, improving communication, problem-solving skills, and self-care and management for family members.
• Interpersonal and social rhythm therapy prioritize developing and maintaining routines to regulate the sleep-wake cycle and coping with stressful experiences.
• Mindfulness-based interventions teach being present in the moment and may help you respond to distressing thoughts or feelings in a more accepting manner.

Because the nature of bipolar disorder can be unpredictable, a combination of actions can help treat it. In addition to medication and therapy, focusing on self-care, establishing a support system, finding balance in daily activities and responsibilities, eating healthy meals, and getting regular sleep can help manage the condition.

Summary

Bipolar disorder is a mood disorder that has a strong genetic component. Having a first-degree relative with the condition increases your risk of developing it. If you are diagnosed with bipolar disorder, various treatment options are available, including medication and therapy.

A Word From Verywell

There is still a lot to uncover about the causes and heritability of bipolar disorder. Researchers continue to investigate the role of genes, neurotransmitters, and other aspects of brain structure and functionality. If you believe you might have the condition or are concerned about your risk, you can talk to your healthcare provider about your concerns and seek a diagnosis. While you can't prevent bipolar disorder in yourself or your loved ones, you can create a plan with a mental health professional to treat symptoms and try to avoid their recurrence.