Bipolar and pregnant? Bipolar drugs lose effect during pregnancy, so women need higher doses to stay well, says a new study from Northwestern Medicine® research. The new findings offer one of the first in-depth studies of how physiological changes during pregnancy reduce the effects of a commonly used drug to treat bipolar disorder, making women more vulnerable to recurring episodes. Women on various prescription drugs for bipolar issues wonder what to do when they become pregnant. Here's what one new study found.
The new findings will help psychiatrists and physicians prevent bipolar manic and depressive symptoms during pregnancy, which are risky for the health of the mother and her unborn child, says a November 1, 2013 news release, "Bipolar and pregnant." Women may ask what will those bipolar drugs do to the baby? Or what will happen without the prescription drugs if a severe depression or other mood change strikes during pregnancy?
When a woman with bipolar disorder becomes pregnant, she and her physician often don't realize her medication needs adjusting to prevent the symptoms from coming back – a higher risk during pregnancy. There also is little information and research to guide dosing for psychiatric medications during pregnancy.
Approximately 4.4 million women in the U.S. have bipolar disorder with women of childbearing age having the highest prevalence
The new study shows the blood concentration of the commonly used drug lamotrigine decreases in pregnant women. About half of the women in the study had worsening depressive symptoms as their lamotrigine blood levels dropped. The drug levels fall because women have increased metabolism during pregnancy.
"Now physicians change the dose of the drug in response to women's symptoms worsening," said lead investigator Crystal Clark, M.D., according to the November 1, 2013 news release, "Bipolar and pregnant." Clark is an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and a psychiatrist at Northwestern Memorial Hospital. "We need to optimize their medication dosing so they stay well."
The study results will help physicians understand how to increase their patients' doses during pregnancy and then reduce them postpartum to avoid toxicity, Clark said. Guidelines for prescribing the drug for pregnant women with the disorder also are included. The American Journal of Psychiatry published the study on November 1, 2013.
Depressive episodes -- as opposed to manic -- are most likely to recur in pregnant women with bipolar disorder
"The safety of the fetus is at risk," Clark said in the news release. "Pregnant women that are depressed are less likely to take care of themselves which often leads to poor nutrition, lack of compliance with prenatal care and isolation from family and friends. It has also been linked to premature births and babies with low birth weights among other poor birth outcomes."
The new study's findings will help psychiatrists and physicians prevent bipolar manic and depressive symptoms during pregnancy. A grant, (R01 MH 075921) from the National Institute of Mental Health of the National Institutes of Health, supported the study. Another interesting study, this one from, Salk Institute scientists, looks at genetic variation in the brain. In that study, Salk scientists found a surprising degree of variation among genomes of individual neurons from the same brain, according to the November 1, 2013 news release on that particular research. See, "Study finds a patchwork of genetic variation in the brain."
It was once thought that each cell in a person's body possesses the same DNA code and that the particular way the genome is read imparts cell function and defines the individual. For many cell types in our bodies, however, that is an oversimplification. Studies of neuronal genomes published in the past decade have turned up extra or missing chromosomes, or pieces of DNA that can copy and paste themselves throughout the genomes.
The only way to know for sure that neurons from the same person harbor unique DNA is by profiling the genomes of single cells instead of bulk cell populations, the latter of which produce an average. Now, using single-cell sequencing, Salk Institute researchers and their collaborators have shown that the genomic structures of individual neurons differ from each other even more than expected. The findings were published November 1 in Science. Check out the new special issue of Science just published on November 1, 2013, "The Heavily Connected Brain."
"Contrary to what we once thought, the genetic makeup of neurons in the brain aren't identical, but are made up of a patchwork of DNA," says corresponding author Fred Gage, Salk's Vi and John Adler Chair for Research on Age-Related Neurodegenerative Disease, according to the November 1, 2013 news release, "Study finds a patchwork of genetic variation in the brain."
In the study, led by Mike McConnell, a former junior fellow in the Crick-Jacobs Center for Theoretical and Computational Biology at the Salk Institute, researchers isolated about 100 neurons from three people posthumously. The scientists took a high-level view of the entire genome---- looking for large deletions and duplications of DNA called copy number variations or CNVs---- and found that as many as 41 percent of neurons had at least one unique, massive CNV that arose spontaneously, meaning it wasn't passed down from a parent. The CNVs are spread throughout the genome, the team found.
The miniscule amount of DNA in a single cell has to be chemically amplified many times before it can be sequenced
This process is technically challenging, so the team spent a year ruling out potential sources of error in the process. Cells with different genomes probably produce unique RNA and then proteins. However, for now, only one sequencing technology can be applied to a single cell.
"If and when more than one method can be applied to a cell, we will be able to see whether cells with different genomes have different transcriptomes (the collection of all the RNA in a cell) in predictable ways," says McConnell in the news release.
In addition, it will be necessary to sequence many more cells, and in particular, more cell types, notes corresponding author Ira Hall, an associate professor of biochemistry and molecular genetics at the University of Virginia. "There's a lot more work to do to really understand to what level we think the things we've found are neuron-specific or associated with different parameters like age or genotype," he explains in the news release.
You brain has about 86 billion neurons. But the real power of the central nervous system lies in the smooth coordination of large numbers of neurons. You may also wish to see, "Structural and Functional Brain Networks: From Connections to Cognition," "Short-Circuiting Depression," or "Special Neuroscience Podcast."