Bob Post just gave our weekly grand rounds at Penn State. Speaking from his long, productive (over 900 publications!), and illustrious career in studying mood disorders, Bob addressed the long-term course of unipolar and bipolar disorders. He speaks with the passion he feels for the topic and compassion for those who suffer from the ravages of these brain diseases.
Most probably people inherit a genetic vulnerability to mood disorders. It will be a long, long time before doctors can correct DNA anomalies. But stresses and abuse, especially in childhood but even long after, also contribute to the risk of episodes of depression. Current science suggests these environmental variables adversely affect brain structure and function, perhaps via epigenetic effects, which control how genes express coded proteins. More mood episodes are bad. They hurt, carry mortality and morbidity risks, and adversely affect function. Beyond that, they make future episodes even more likely, compromise long-term function and disease course, add medical and substance-abuse co-morbidity, and worsen treatment response.
The good news is that intervention works—decreasing the risk of future episodes, improving outcome, and saving lives. The broad array of treatments for bipolar disorder and recurrent depression—including medicines, stimulation techniques, psychotherapy, rehabilitation approaches, and perhaps even diet and exercise—protect the brain. Many increase levels of brain-derived neurotrophic factor (BDNF), which appears to attenuate the effects of bad life events.
Dr. Post emphasized the importance of early intervention in patients with mood disorders. (The typical lag from onset of bipolar disorder to first clinical attention is typically on the order of 10 to 15 years!) He also stressed the benefits of life-long treatment. In addition to warning patients about side effects, Bob suggests we tell patients about the positive benefits of psychiatric treatments for their brains.