The poignant tale of a tragic suicide reinforces the need to learn more about the disorder that dramatically affects the lives of over 5.7 million Americans. Because the mental illness runs in families, researchers are using DNA analysis to find out what puts someone at risk of bipolar disorder, and how to improve diagnosis and treatment.
The story begins one morning five years ago, when the automotive industry was shocked by the suicide of one of its brightest stars, Heinz Prechter. He killed himself despite seeming to have it all: a successful company he had built from nothing after coming to America, a beautiful and intelligent wife, growing children, and dozens of friends.
But in fact, Mr. Prechter had something else, which almost no one else knew about: the mental illness called bipolar disorder, formerly known as manic depression. His moods would swing from extreme happiness and boundless energy to deep, dark, depressed lows. During one of those lows, he took his life.
In other words, bipolar disorder killed Heinz Prechter.
Today, the tragedy of his death is driving scientists at the University of Michigan Health System and elsewhere to perform research that should give hope all that have bipolar disorder, and to their loved ones.
Because bipolar disorder runs in families, the scientists are focusing on studying genes. By collecting DNA samples from thousands of people with the disease, and comparing it with DNA from people who don’t, they hope to find out what puts someone at risk of bipolar disorder, and how to improve diagnosis and treatment.
Hundreds of bipolar patients and healthy comparison volunteers are still needed in order to make those discoveries possible. Each volunteer gives a small blood sample and agrees to be interviewed each year.
The scientists are getting help from Mr. Prechter’s wife, Waltraud, known as Wally. She has given substantial money and effort to build the DNA “bank,” called the Prechter Genetic Repository, and to fund research projects and raise awareness.
Out of her family’s sorrow, she hopes, will come real advances in identifying the combination of genes that make someone susceptible to the disease that took her husband. And with those discoveries, she hopes, the stigma and secrecy that surround bipolar disorder will evaporate.
“I had lived with Heinz for 24 years, and experienced what he went through. I had an idea what other people with bipolar disorder are going through, because if you’re not in those shoes, you don’t know,” she says. “And I wanted to do something about it. I wanted to change the way we look at that illness and help change the way we treat people who have it, bring it to the forefront and help fix it, once and for all.”
One of the leaders of the bipolar research effort is Melvin McInnis, M.D., a U-M psychiatrist and geneticist, and member of the U-M Depression Center. He holds the Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression chair at the U-M Medical School.
“The genetics of bipolar disorder is something we’ve known about for almost a hundred years, because in essence it appears to run in families. But what we really do not know is what exactly is inherited, how it is inherited, and the mode of transmission between generations,” he says.
The Prechter DNA project is trying to identify specific differences within genes that might work together to make a person more likely to develop bipolar disorder – or more likely to have frequent or severe “manic” and depressed episodes over the course of their life. The scientists also are looking for genes that might make someone with bipolar disorder more likely to have lifelong depression at the same time.
This, in turn, could help lead to tests that could tell doctors which medications might work best for each patient, and keep them balanced and well over the long term. It may also lead to blood tests to help identify which members of a family are most at risk of developing bipolar.
“We have a number of treatments for bipolar disorder, and for many patients, these treatments are very effective,” including drugs like lithium, says McInnis. “Unfortunately, there are a large number of patients for whom these treatments are not effective. Probably 30 to 50 percent have a very difficult time with their treatments,” whether it’s because they don’t do enough to ease the bipolar episodes, or because they cause side effects.
That lack of effective treatment is a big reason for the high risk of suicide or suicide attempts among people with bipolar disorder, McInnis says. Like Heinz Prechter, anywhere from 5 to 15 percent of bipolar patients will attempt or commit suicide sometime in their life.
Many people with the disease also suffer horrible social consequences during their manic and depressed phases. Half of people with bipolar disorder have some sort of alcohol or drug abuse problem, and many have trouble with relationships, including a high rate of divorce. During manic periods, patients may take financial risks or make extremely large purchases that they can’t afford, leading to economic troubles down the road.
But the manic episodes also can have their upsides, especially in people such as Heinz Prechter who have the “hypomania” variety of bipolar disorder. Such patients don’t experience quite as “high” a mania as others, and may appear to others as just especially energetic and driven.
“Heinz was very imaginative, he had great business vision, and could think out things that other people could not imagine. He was very blessed with a lot of gifts,” says Mrs. Prechter. “ When I first met him, I remember him being extremely exuberant and happy, and very, very optimistic, to the point that I thought, ‘Wow, I’ve never met anyone like that.’”
But when depression struck, as it did shortly after Mrs. Prechter became pregnant with the couple’s twins, it was deep. “It affected his whole being, his thinking, acting, behavior, to the point that he would stay home and just sit in a chair and look out at the river, or want to stay in bed all day.”
That memory of her brilliant husband reduced to such a low, and unable to tell anyone what he was going through, is part of what drives her today, she says. “It think it’s very important to come forward and talk about it, just like we talk about other illnesses. Let’s come up with solutions to help people have a better quality of life, like anyone else who has any other physical illness, like cancer, diabetes or heart disease. Bipolar disorder deserves the same urgency as all these other illnesses.”
She adds, “My husband wanted to make a difference in his life, and if I can leave that for him in his legacy, I think that’s important.”
Facts about the Prechter Genetic Repository and the Heinz B. Prechter Bipolar Research Fund at the University of Michigan Depression Center:
• In addition to U-M researchers, the fund has supported research at Stanford University and Cornell University.
• The repository has expanded with the addition of genetic samples and data from 1,500 patients collected by Johns Hopkins University researchers, who will now work with the other Prechter-funded researchers. The repository can be used by other scientists, too.
• Many more DNA samples are needed, both from people who have bipolar disorder and from people without the disorder, no matter whether they have loved ones with bipolar.
• Giving a DNA sample involves allowing the research team to take a small sample of blood. Volunteers are interviewed at the start of the study, and annually after that, about their health, mental well-being and other issues.
• Those interested in finding out more about the project can call toll-free 1-877-UM-GENES (1-877-864-3637), or e-mail firstname.lastname@example.org.
Facts about bipolar disorder:
• Bipolar disorder was once called manic depression, but the term “bipolar disorder” is more accurate and more commonly used today.
• The main characteristic of bipolar disorder is major swings in mood, which can occur off and on throughout life. These can alternate between manic “up” or “high” periods, and depressed “down” or “low” periods.
• During “up” swings, people with bipolar disorder experience increased energy and restlessness, extreme irritability, racing thoughts, distractibility, little need for sleep, poor judgment, spending sprees, and denial that anything is wrong.
• During “down” swings, they will often experience lasting sad, anxious or empty moods; feelings of hopelessness or pessimism; feelings of guit or worthlessness; loss of interest or pleasure in activities they once enjoyed; decreased energy; insomnia or need for a lot of sleep; chronic pain not caused by illness or injury; and thoughts of death or suicide.
• More than 5.7 million Americans, or 2.6 percent of the population, are estimated to have some form of bipolar disorder. Some experience the form called bipolar I, in which episodes of mania and depression alternate; many more have bipolar II, which features less-intense manic episodes called hypomanias. People who experience four or more episodes in a year are said to have “rapid cycling” bipolar disorder.
• Bipolar disorder runs in families, and children whose parents have it are at an increased risk of developing it themselves. This is why scientists are looking for genes that might be handed down from generation to generation, and play a role in putting a person at risk.
• The drugs lithium and valproate are the most common treatments for bipolar disorder, but mood-stabilizing medicines, antidepressant medications, anti-psychotic medications and talk therapy also help. Once a person finds a treatment that works for him or her, it’s important to take that treatment regularly, even when symptoms aren’t present. Regular sleep habits, exercise, meditation and other lifestyle steps can also reduce the impact.
• Suicide, or suicide attempts, are unfortunately a common occurrence among people with bipolar disorder. People who talk about wanting to die, feeling like nothing will ever change or get better, feeling that nothing they can do will make any difference, feeling like a burden to others, or who abuse alcohol or drugs, give away possessions, or put themselves in dangerous situations, are likely experiencing suicidal feelings and need immediate help.
Source: University of Michigan