DBSA Ask the Docs Chat: Dr. Melvin McInnis Chat Transcript
Event Date: May 28, 2008
Host (May 28, 2008 2:57:10 PM)
Just before we start, here is some information on Dr. McInnis:
Host (May 28, 2008 2:57:12 PM)
Dr. McInnis is an established and internationally renowned researcher in the genetics of bipolar disorder. He has published widely in the field and is an active participant in one of the largest and longest-standing collaborations on the illness that began as the NIMH Genetics Initiative for Bipolar Disorder. This endeavor (known colloquially as the "G11") now consists of a collaboration among 11 universities within the U.S.A. and is dedicated to bipolar disorder genetics.
Host (May 28, 2008 2:57:30 PM)
Dr. McInnis has a relatively rare combination of research and clinical experience. He has extensive laboratory leadership experience in a molecular genetics laboratory, as well as experience in genetic analyses and bioinformatics, and a published record of these accomplishments. He also is a recognized clinical expert in assessment and management of patients with complex mood disorders.
Host (May 28, 2008 2:58:14 PM)
After the live chat event, listen to our DBSA Real Recovery Podcast featuring Dr. McInnis on the topic of "Genetics and Bipolar Disorder." http://www.DBSAlliance.org/podcast
Host (May 28, 2008 2:58:55 PM)
The "Ask the Docs" Chat featuring Dr. McInnis will start shortly. If you're looking for the online support group, please click "rooms" on the tab menu/top right corner of the chat applet.
Host (May 28, 2008 3:01:21 PM)
You may begin submitting your questions for Dr. McInnis now.
Host (May 28, 2008 3:01:45 PM)
Reminder: this is a moderated event. Your questions will not show up on the screen immediately, but will be queued for Dr. McInnis to reply to one at a time.
Host (May 28, 2008 3:02:19 PM)
This is the Ask the Docs chat. If you're looking for DBSA's Online Support Group - please click "rooms" in the top right corner.
Host (May 28, 2008 3:03:29 PM)
Very minor technical glitch... the chat will be starting in just a few minutes (2-3). thank you for your patience!
Juls1970 (May 28, 2008 3:06:30 PM)
Dr. McGinnis: My mother was diagnosed with Bipolar 25 yrs ago. What is the percentage, or heridity rate in which I could also be bipolar?
Dr McInnis (May 28, 2008 3:14:16 PM)
If your mother was diagnosed 25 years ago the likelihood would be in the range of 5 - 10 % of becoming
HariKari (May 28, 2008 3:14:25 PM)
BP1 - I'm currently on 6 meds causing a disturbing side effect - flattening of affect. At what point do you say unacceptabe?
Dr McInnis (May 28, 2008 3:15:48 PM)
6 meds is a high number of meds, would suggest discussing with your doctor about which meds are most needed and which ones you could perhaps decrease dose of and perhaps stop.
Paula (May 28, 2008 3:15:57 PM)
If someone w bipolar is treated only for depression, does it make the depression worse?
Dr McInnis (May 28, 2008 3:16:40 PM)
It can do so. Frequently this may cause cycling of mood with irritability.
Paula (May 28, 2008 3:16:53 PM)
How can the G11 project influence the treatment of bipolar & depression?
Dr McInnis (May 28, 2008 3:18:21 PM)
Once we understand the biology and genetics of these disorders, we can expect to be able to predict which medications work best - for a given genetic background. We can also expect to understand the basis for the disorders and help science develop new medicines.
Jim (May 28, 2008 3:18:41 PM)
Is DNA the same as Freuds "id"?
Dr McInnis (May 28, 2008 3:19:35 PM)
Great question ! No it is not. the ID is a psychodynamic concept. DNA is basic biology.
HariKari (May 28, 2008 3:19:43 PM)
Regarding genetics, what are the chances of a child in the family getting it? 1 parent? 2 parents?
Dr McInnis (May 28, 2008 3:20:33 PM)
1 parent 5- 10%; 2 parents 20 - 30% (these are estimates based on population data)
HariKari (May 28, 2008 3:21:05 PM)
Do you believe BP can be treated without medications? Say therapy, good diet, exercise & supplements?
Dr McInnis (May 28, 2008 3:22:46 PM)
all good things are good and to be encouraged. These interventions do not generally keep someone with BPI well, I encourage all good things, including wise use of medicines in collaboration with your doctor.
laska (May 28, 2008 3:22:53 PM)
My diagnosis has changed over the last twenty years. When do you think we will be able to get an accurate diagnosis from blood work?
michele (May 28, 2008 3:23:22 PM)
(This user has moved to Online Support Group) (IP = 24.228.3.247)
Dr McInnis (May 28, 2008 3:24:05 PM)
not sure. there are no tests presently. I expect that the diagnosis will remain a clinical one, there will be support from blood tests but do not expect definitive answers in the short term (5 years).
Dash (May 28, 2008 3:24:15 PM)
Are genetics rendering our chemical makeup more influential than the environment, especially the home, that we are raised in for in our developing depression --- in your opinion? Is genetic testing qualifying this opinion?
Dr McInnis (May 28, 2008 3:27:27 PM)
any one environmental factor is likely to be more influential than 1 genetic variant. It is likely that many genetic variants work together to cause the disorder. Often BP arises in the best of circumstances - "out of the blue" and despite all the best environmental effects. the genetic testing currently is not definitive or specifically predictive.
Merlin (May 28, 2008 3:27:29 PM)
Why do some family members develop different mood disorders? Some major depression, others bipolar. Is it a matter of genetics or environment? If both parents have depression, are you likely to develop a more serious case?
Host (May 28, 2008 3:28:15 PM)
While Dr McInnis is typing... don't forget to check out his podcast w/DBSA President Sue Bergeson http://www.DBSAlliance.org/podcast
Dr McInnis (May 28, 2008 3:29:12 PM)
This is the perplexing part of the disorder. Not the same in all those affected in a family. Likely there are different combinations of genes in the siblings with different disorders. The greater the genetic loading the more likely the disorder will be more difficult in the remaining family members.
HariKari (May 28, 2008 3:29:17 PM)
Do you anticipate any testing for which types of meds that would work best from your research?
Host (May 28, 2008 3:30:18 PM)
Be sure to keep your questions coming!
Dr McInnis (May 28, 2008 3:30:24 PM)
we are following individuals over time to monitor which treatments they are on. Over time we anticipate studying the their treatments and outcomes and so expect to have this type of data.
Merlin (May 28, 2008 3:30:27 PM)
Is the probability of a parent giving their child bipolar the same as depression. If not, what is the difference?
Dr McInnis (May 28, 2008 3:31:16 PM)
range of 5 - 15 % probability
Paula (May 28, 2008 3:31:25 PM)
Currently meds seem to stop being effective after a period of time. Other than developing new meds, will G11 help correct this? At age 58 will I live long enough to get some real relief?
Dr McInnis (May 28, 2008 3:32:35 PM)
Certainly hope you will live long and well! G11 hopes to understand the biology of the disorder and guide the discover of new medications. hard to predict how long this will take.
Ocam (May 28, 2008 3:32:39 PM)
is the affectivness of individual meds also heritarily linked....my doc is very interested in which meds have worked for other members of my family
Host (May 28, 2008 3:33:29 PM)
While Dr McInnis catches up (all GREAT questions so far; keep 'em coming!)... we want to remind you about our newest online initiative. Have you checked out the new online home for wellness? If not, visit http://www.FacingUs.org today! See the real face of depression and bipolar disorder.
Dr McInnis (May 28, 2008 3:33:42 PM)
generally we believe this to be true although the scientific data is not great nor sufficient to answer this. Lithium has been studied in this regard and there is some evidence to support this
HariKari (May 28, 2008 3:33:44 PM)
Do you use brain scans in your research?
Dr McInnis (May 28, 2008 3:34:39 PM)
we send some individuals for fMRI to compare brain activation - this is an interest - but not a specialty of mine.
HariKari (May 28, 2008 3:34:41 PM)
Will your research dig up information on SZ (the new stuff out saying it's all part of the same spectrum)?
Dr McInnis (May 28, 2008 3:36:22 PM)
we include data on delusions and hallucinations (psychosis) in our analyses, there is some evidence that genetic loci are specifically driving these experiences, and other loci that drive mood problems. This is early work, although the observation of overlap of disorders has been recognized for a good while.
Merlin (May 28, 2008 3:36:24 PM)
Is there anything that can be done to make a child that is genetically loaded less likely to develop the disorder?
Host (May 28, 2008 3:37:23 PM)
Keep your questions coming.. Dr McInnis is with us for 20 minutes longer. However, anything we don't get to, he will answer for the transcript to be posted on Monday June 2nd! So, get your questions in!
Dr McInnis (May 28, 2008 3:37:58 PM)
be as good a parent as one can be, involve careful clinicians who give wise counsel ( caution of over vs under treatment), this is a challenging balance of when to intervene.
Juls1970 (May 28, 2008 3:38:01 PM)
Does Bipolar always have to have a genetic component? Can someone be diagnosed and not necessarily have someone in their family who also had it?
Dr McInnis (May 28, 2008 3:39:42 PM)
BP can occur in someone who has no family history. BP is a biological disorder however and as such will have some chemical underpinnings - which themselves are driven by genetics,
Dr McInnis (May 28, 2008 3:39:52 PM)
no
Sandy (May 28, 2008 3:39:59 PM)
after my grandson was diagnosed with adhd, they tried all kinds of meds for him, but they may work for a time, then they become non effective. Some meds seem to make him depressed, and has been suicidal at times. Often talks of hurting others. Is very active and thrashes when he sleeps
Host (May 28, 2008 3:41:42 PM)
We have time for a few more questions.
Dr McInnis (May 28, 2008 3:41:48 PM)
working with a doctor and team that you trust is key, good doctors welcome second opinions ( I get them frequently for patients that have persistent difficulties)
laska (May 28, 2008 3:41:52 PM)
How long before we have a blood test to diagnose bipolar?
Dr McInnis (May 28, 2008 3:44:10 PM)
great question - not sure. there are some that are advertised direct to consumer, they are initial tests that really do not rule in or out the disorder. Our understanding of BP will evolve and I expect that genetic subtypes will be identified. We really do not know when this will occur. When scientists say 5 years or so - it means we just do not know.
HariKari (May 28, 2008 3:44:11 PM)
Is BP really more prevalent in our society now? Or are we just recognizing it more now?
Dr McInnis (May 28, 2008 3:45:54 PM)
I think that it is more common. I don't know why this is. Diseases change over time for reasons unknown (this is known from the history of human illness). I also think that we are better at recognizing it - but this alone cannot account for the frequency increase,
Juls1970 (May 28, 2008 3:45:55 PM)
What is your opinion of ECT as a treatment for severe depression?
Dr McInnis (May 28, 2008 3:46:07 PM)
very effective treatment
Juls1970 (May 28, 2008 3:46:14 PM)
What does "genetically loaded" mean ?
Dr McInnis (May 28, 2008 3:47:10 PM)
the greater the number of affected individuals in a family - the greater the load - meaning that there are likely to be more risk genes floating around amongst the family members.
Merlin (May 28, 2008 3:47:12 PM)
How many genes have you found that influence bipolar/depression? Would it be possible to do gene therapy at some point in the future?
Host (May 28, 2008 3:48:40 PM)
Get all the information and register today at http://www.DBSAlliance.org/Conference2008
Host (May 28, 2008 3:48:51 PM)
Last call for questions... we're running out of time.
Host (May 28, 2008 3:49:24 PM)
Well have Dr. McInnis answer about 3-4 more and then give us an update on his research before we sign off. Submit questions now to be included in the transcript.
Dr McInnis (May 28, 2008 3:49:38 PM)
there are a handful of genes that are currently under study - but the risk variants not confirmed. Estimates have been put forth that there may be as many as 30 genes underlying the susceptibility - a combination of 20 + risk variants would cause the disorder. This means as well that the average person would harbor 10 or 15 variants that - if combined with others would cause the disorder
Dr McInnis (May 28, 2008 3:50:18 PM)
Thank you for your interest - we are very enthusiastic about keeping the readership of DBSA updated and will do this periodically
Ocam (May 28, 2008 3:50:21 PM)
in march of this year a number of science journals reported that there was a develompement of the first "medical modle" of bp they called it a new mouse. Im i understanding this report correctly, that there may be animal testing available in the future
Dr McInnis (May 28, 2008 3:52:06 PM)
animal testing is an excellent mechanism of studying genes as they are identified, helps with drug testing and the such, stay tuned
Dr McInnis (May 28, 2008 3:52:20 PM)
yes the % would go up
Dr McInnis (May 28, 2008 3:53:28 PM)
yes - I believe that this is true. Interestingly - it is also under-diagnosed in many situations. so there is both sides of the coin here, often over and often under - diagnosed
Moderator (May 28, 2008 3:54:22 PM)
This will be the last question for Dr. McInnis. More questions will be answered on our transcript, which will be posted online next Monday.
Dr McInnis (May 28, 2008 3:54:24 PM)
yes I do. there are some examples of this experimentally. There is work on ketamine in the experimental setting
Moderator (May 28, 2008 3:54:48 PM)
Thank you, Dr. McInnis. Any closing comments?
Moderator (May 28, 2008 3:55:16 PM)
This concludes our chat. See you online at www.dbsalliance.org.
Dr McInnis (May 28, 2008 3:55:39 PM)
Thanks to all for participating - we really would encourage all to participate in the genetic research if you can - we have been working on this for the past 20 years and are dedicated to finding the genetic basis for the disorder. |