Bipolar Genetics

I recently started seeing a patient whose previous psychiatrist ran him through absolutely every antidepressant drug that his (expensive) genetic testing suggested he would respond to. He had no improvement with any of them.

I will admit to having been an enthusiastic supporter of genetic testing not long ago. The science was sound on paper.

It has already been shown, before this patient walked into my door. The reason is not that genetics don’t work, because they do. It is just that genetics are only one factor in what happens with this megalith we call mental illness.

We have long known that it includes biological, psychological, and social factors.

Even just within the biological factors — well, everyone has plenty of them. “Intermediate metabolism” and differences in absorption are individual and real.

I am the last one who is going to argue that psychiatry is perfect and should not be attacked.

I am going to argue against people who try to simplify everything into a dichotomy — who make everything into “yes” or “no” classifications.

Life and science simply are not like that.  First, let’s note there is no date given for this quote and also that the organization quoted is an arm of the Church of Scientology (which does not believe in mental illness at all).

Medical science changes. It can change in the wild and unpredictable way that ancient history can change. Because every time you do another excavation, what you believe happened in the distant past can change very quickly.

Second, this quote was authored by a Harvard professor and they tend to be a bit on the bombastic side anyway.

An awful lot of bipolar folks have ancestors who are or have been bipolar folks.  European series estimate about 1/5 to 1/4 of folks who are on antidepressants for a bit can “turn” bipolar.

I can’t tell you whether it is their genetics, or a side effect of antidepressants, or both.

We are still working at learning the genetics of bipolar illness.

I am willing to learn.

There is a saying around Boston —

“You can always tell a Harvard man. You just can’t tell him very much.”

All is change.

My west coast readers must not gloat.

I am beginning to wonder if sometimes this might be true of at least some UCLA men.