My husband and I really want to have children, but I have a family history of mental illness, and I have bipolar disorder. I'm afraid to pass it on to my future kids. My husband worries about this, too. What are my chances of passing this on, and could it potentially get worse?

For mood disorders like depression and bipolar disorder, genes are an important risk factor. But your genes are certainly not your destiny.

Here are some numbers to illustrate:  On average, the risk of developing bipolar disorder is a little less than 1% (or about one person out of 120). For people who have a parent with bipolar disorder, the risk is about 8% (or about one person out of 12). You could see that glass as half empty, but you could also see it as half full. Even if your child would be 10 times as likely to develop bipolar disorder as the average person, there is still a greater than 90% chance that she or he would not develop bipolar disorder. These numbers come from studies that use a strict definition of bipolar disorder. If we use a broader definition, the percentages are higher, but the message is the same. Having a parent with bipolar disorder means risk is increased, but the absolute risk is still low.

While we do know that genes affect risk of developing bipolar disorder, we don’t know which specific genes are important. It’s likely that many different genes can increase risk of bipolar disorder and different genes are important in different families. So there are no genetic tests that would tell you if your children are at higher or lower risk.
It’s important to remember that help is available and recovery is possible. The choice to have children is a very personal one—related to many things other than mood disorders. I certainly wouldn’t advise someone living with bipolar disorder or depression never to have children. In the same way, I wouldn’t advise someone living with diabetes never to have children. But I would advise them: If you know your child is at higher risk of developing diabetes disease, you’ll want to watch more closely and pay extra attention to healthy diet and exercise. And if you know your child is at higher risk of developing a mood disorder, you’ll want to watch more closely and pay extra attention to healthy sleep and positive daily routines.

If you haven’t already read Andrew Solomon’s book, Far From the Tree, I recommend it highly. It’s filled with remarkable stories about families with children facing all sorts of developmental and health challenges. A DBSA Honorary Advisory Board member, Andrew Solomon is a person who both lives with a mood disorder and has had a child with health issues—so he knows that territory well.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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