Do You Wonder about Your Family? 
Connor’s mom was diagnosed with bipolar disorder before Connor was born. He’s now an adult who was diagnosed with Bipolar I Disorder ten years ago. He has a brother and a sister, both grown, also. But his sibs, Todd and Della, have never experienced psychiatric symptoms, and feel healthy, balanced, and able to cope with the challenges of life. They don’t really understand why Connor has so many struggles.
(Healthy siblings often don’t.)
Sadie’s dad has Bipolar II Disorder and Sadie was diagnosed with Bipolar II during her second year of college. Her three brothers, James, Tim, and Hal, don’t experience symptoms of bipolar disorder … but they each have other things going on. James has been melancholy throughout his life, Tim has OCD (but refuses to deal with it), and Hal eventually was diagnosed with PTSD after a deployment in Iraq.
What’s going on in these two families?
Functional Brain Connectivity Affects Vulnerability and Resilience to Bipolar Disorder
Why is every child in one family plagued by brain dysfunctions that result in psychiatric disorders, while the other family has only one child with a psychiatric illness?
First of all, we don’t understand yet the full answer to that question. But as a result of extensive studies, neuroscientists understand more than they used to.
We’ve talked before about genetic markers and traumatic experiences.
But something else has emerged to give us more insight. The default mode network was discovered several years ago.
Learning about it helps us understand how neurons in the brain are connected.
Functional Brain Connectivity in the Default Mode Network (DMN)
So first, let’s talk about the default mode network (DMN). The DMN is a network of neurons that connect brain regions that are necessary for bringing up information about yourself and how you felt in certain experiences in the past, thinking about others with empathy, judging someone’s attitude, remembering the past and thinking about the future … all these skills depend on the default mode network.
When you focus on a task, whether it be writing a report, balancing your checkbook, or changing a tire, the DMN becomes quiet or de-activated.
That’s because your attention, concentration and focus is right there, right in the moment, honed in. And the DMN quiets to allow you to do your thing.
When that highly-focused task completes, the DMN activates again.
It’s at its peak when you’re wakefully resting. Not when you’re asleep.
Let’s say you’re “sittin’ on the dock of the bay, watching the tide roll away
…”. In times like this, your DMN is in full throttle. Organizing, sorting memories, rebuilding the connections (synapses) while you’re daydreaming. Or while you’re meditating.
It’s a beautiful thing.
That is, if you’re brain is healthy.
Impaired Connections Play a Role in Bipolar Symptoms
Researchers know that in bipolar disorder connections like these don’t work properly. Sometimes the connections break down and don’t work at all.
Bipolar disorder and other psychiatric disorders affect the connectivity of some important networks, such as the default mode network, the sensorimotor network, and the central executive network.
When there’s an imbalance between the functions of the default mode network and the sensory motor network, the result is … chaos … and disconnect.
And the chaos that ensues really mirrors the chaos that happens in bipolar disorder. What happens on a brain level can be expressed in your real life. In a very direct way. It’s almost palpable.
Bipolar’s genetic link creates another piece in the puzzle. But researchers still work to understand the bridge from the genetic link to bipolar symptoms. We do know that siblings of a person with bipolar disorder are ten times more likely to also develop bipolar symptoms than someone who has no relatives with this disorder.
And yet, in spite of that statistic, a large number of relatives continue to be healthy and unaffected.
So why are some sibs able to “avoid” developing a disorder like bipolar, and others aren’t?
What Makes the Difference?
A team of researchers at the Icahn School of Medicine Mt.Sinai NY set out to learn more. They worked with a group of 78 people with bipolar disorder diagnoses. The team screened these participants to ensure they had not experienced an episode of mania or depression in 3 months. Then, they recruited 64 of their siblings — BUT ensured these siblings had NOT experienced bipolar symptoms. Finally, they added 41 healthy volunteers with no psychiatric disorders as a control group.
Using functional MRI scans, they collected data of the functional brain connectivity of bipolar patients, their unaffected siblings, and healthy volunteers to compare. They took the fMRIs during the resting state, when subjects were awake but not focusing on anything in particular. They wanted to first look at what the brain was doing when these folks were “sittin’ on the dock of the bay…”
Some aspects of brain region connectivity remained the same in all three groups. But they found changes in the default mode and sensorimotor networks. In bipolar disorder, the sensorimotor network doesn’t work smoothly. But rather it disrupts the processing of sensorimotor information in the brain. And creates chaos.
The authors of this study pointed out that recent studies have revealed reduced motor coordination, sensory integration, and selective attention in both bipolar patients and their unaffected siblings.
Increased Motor Impulsiveness with Impaired Functional Brain Connectivity
And in this current study, increased motor impulsiveness was associated with those who
were diagnosed with bipolar disorder, as well as their siblings.
To simplify, the study demonstrates the cause of the kind of reduced GABAergic and glutamatergic receptors that coroners see in autopsies of people with bipolar disorder. The impaired neuroplasticity that results from the dysfunction of the DMN and sensorimotor network probably bears responsibility.
In other words, the broken down connections in these important networks in the brain may help explain the chaos of symptoms in bipolar disorder.
And, the study also confirmed the connection between default mode connectivity and resilience…or in this case, the ability to of the brain in certain individuals to NOT develop bipolar disorder.
Great Connectivity in the Default Mode Network = Resilience
So the better the connectivity in the default mode network, it appears, the more resilience that individual has, even if he’s related to someone with bipolar disorder.
And that introduces new ideas for developing novel ways of preventing bipolar disorder, or at least changing its course.
And both the default mode network as well as the sensorimotor network could possibly be made stronger and more resilient through interventions that enhance plasticity in those networks.
So that’s the lesson we learned from siblings who haven’t been affected by bipolar disorder. We learned that the adaptations that occur in some sibling brains perhaps could be explored and used to protect all relatives from this illness. And hopefully in the process, a similar method protects everyone from this disruptive and cruel illness.
Neuroplasticity. You’re going to be hearing a lot about it. You’re going to want it for yourself and your family.
Hope for the Future…and Hope for Now
There’s hope for the future to wipe out the suffering caused by bipolar disorder, PTSD, anxiety and thoughts about suicide.
But for now, we don’t have those developments. We’ve only just begun.
However, we STILL have hope. Hope for feeling better, being better, living better. And that’s 
through treatment that leaves others in the dust. In the years I’ve been in practice, I’ve treated patients with just about every conceivable psychiatric disorder, and have prescribed medications that target a kaleidoscope of symptoms. I still do.
But the most robust and extraordinary tool I’ve found for helping people to recover, build lives and relationships, and experience the joys of life, is IV ketamine treatment. Administered with the utmost care and precision to enhance it’s best effect on the delicate systems of the brain, I’ve been privileged – sometimes joyfully overwhelmed – at the numbers of people who have enjoyed real remission, joy, and relief.
If you’ve been dragging a severe psychiatric mood disorder around with you without real and lasting relief, call us.
Disorders like depression, general anxiety, social anxiety, PTSD, OCD, bipolar disorder and suicidal thoughts can be relieved…and quickly. This isn’t like those antidepressants that take weeks or months for you to feel the benefits.
We specialize in treatment-resistant psychiatric disorders. There aren’t many that ketamine treatment doesn’t conquer. We often say that ketamine treatment isn’t for everyone. And it’s not. But more than likely it could change your life for the better. Let’s find out.
To the blooming of your best self,
Lori Calabrese, M.D.