Posted by Ritch on August 20, 2002, at 23:40:31
In reply to Re: Depends on the accuracy of the kindling theory... » Ritch, posted by Randal on August 20, 2002, at 12:19:12
Randal,
Interesting ideas. The first thing you would have to consider is whether or not the parents' bipolar disorder is being controlled or not and whether the parents are themselves taking medication to prevent relapses. If they are non-compliant, should the state have the *right* to intervene to "save their children" with antimanic medications? I think that would fall apart in court, big time. If their parents ARE compliant with their meds and seek a psychiatrist to prescribe prophylactic antimanic medication in the absence of any bipolar symptoms in their child, that psychiatrist could risk a big future lawsuit (not to mention possible ethical conflict in the doctor), so I think that scenario fails legally as well. EVEN if a genetic test were readily available that would show that 75% likelihood, it would still be on shaky legal grounds to prescribe (and especially enforce) medications in absence of any clinical *symptoms*. My conservative idea on the whole issue would be for compliant, knowledgeable bipolar parents to identify the *non-medication* approaches that could be helpful in preventing or delaying the onset of bipolar symptoms in their children regardless of positive genetics in the absence of any current clinical symptoms. Anticonvulsant medications are NOT innocuous substances. My mother had severe nocturnal generalized seizures for many years. She was on 400mg of Dilantin every day for about 20 years. She lost all of her teeth before she was 30 because of the Dilantin. However, many children suffer *life-threatening* seizures that require control with anticonvulsants. I would not want to treat anybody(if I was a doctor) with antimanic meds in absence of any clinical symptoms.
Mitch
> Hi Mitch,
>
> A related question:
>
> Say two bipolar parents have a kid. Statistically the chance of having a bipolar kid is 75% according to the Time article. This is even greater than for twins, and you would know this from birth, even without some sort of genetic test. The genetic test of course doesn't yet exist, but this is a scenario that must be faced now by a significant number of parents. Bipolar people are more likely to marry other bipolar people-- I think they called it assortive mating.
>
> Now should the parents give the kid low doses of some mood stabilizer (lithium, depakote, whatever) in the hopes of keeping the disease from ever surfacing? I mean even in the absence of any (clear) symptoms. Would this work?? My *guess* is that it's got to have some effect on at least slowing the progress of the disease. I might worry about giving a kid such drugs from early on and the possible dangers. However these must be known (and I assume they are not a big problem) since so many epileptic kids receive large doses of anti epileptic drugs throughout childhood.
>
> I guess a related question is whether epileptic kids, treated with such drugs throughout childhood, have a lower than expected rate of bipolar disorder. I understand that epileptics as a whole have a higher rate of bipolar disorder than the general population, so of course this would have to be factored in.
>
> More dramatic things have been done for other diseases. I'm thinking about breast cancer, where women with the gene have actually had mastectomies as a preventative measure. Bipolar disorder is also a life-threatening disease, with up to a 20% lifetime fatality rate from suicide.
>
> If I were such a parent I would want to do something like this. Does anyone know if people in fact do?
>
> Just thought I would throw this out to see if anyone else had any thoughts or experiences with this.
>
> Randal
poster:Ritch
thread:28868
URL: http://www.dr-bob.org/babble/social/20020820/msgs/28992.html