Our Treatment Philosophy of Bipolar Disorder
It's more than happy / sad cycles
Biorhythms are important for a number of biological functions. They impact
us in many ways with both daily (circadian) and annual (circannual rhythms).
We have had some success moving away from the traditional happy/ sad
description of bipolar and instead describing the cycles in terms of feeling
"fast" or "slow". Do you feel you may have bipolar disorder? Take our
"fast"/"slow" test to see how your clock is running. Start a stop watch. Put it
face down and go about your business. After some period of time try to
"guess" how much time has passed. Then compare it to the amount of time
that has passed on the stopwatch. People in the slow phase of the disorder
tend to say less time has passed. People in the fast phase tend to say more
time has passed.
Check out this link on time disruption in depression:
A BETTER EXPLANATION:
Why does everyone seem to have bipolar disorder? It seems like the diagnosis
du jour and suddenly everyone has some form of cycling mood disorder.
There are three possible explanations and they are not mutually exclusive.
1. Bipolar disorder is overdiagnosed: As something becomes popular. As it
becomes more well known. It becomes easier to see and some people start to
see it everywhere. There certainly is some of this going on with bipolar
disorder. We see many patients who have
2. Bipolar disorder has been under diagnosed in the past.
3. The environment is changing to cause more bipolar disorder.
Bipolar Disorder is traditionally defined as cycles of elevation in mood and
activity (mania) and significant periods of inactivity and decreased mood
hence the term "bipolar" or two opposite poles of mood. Reasons for this have
often been described as a chemical imbalance. I have found this answer to be
somewhat unsatisfying and instead feel an evolutionary model more
accurately explains what is occurring. We base our treatment approach on this
theoretical model using empirical research as well.
There is more going on than happiness and sadness. I think it is better
understood as a "clock disorder" as opposed to a "mood disorder". In fact, the
condition has been linked to annual and daily rhythms in the following articles:
(Bipolar patients always feel out of sorts with the world. They are "up" when
the world is sleeping and hibernating when the world is going. They feel warm
and flushed at times during the evening (signifying their body temperature is
elevated because they "feel" like they should be awake. They feel inert and
lethargic at times during the day. (Like their body wants to sleep.)
Treating their disorder as a clock disorder makes them keep stricter day/night
cycles (bright light activity in day....darkness and slowing down at night.)
Bipolar disorder tends to occur in those with some Northern Ancestry. It also
has been shown to have a genetic link to Seasonal Affective Disorder. SAD is
described as a subtype of affective disorder (mood disorder) with a seasonal
pattern usually in the winter when sufferers experience clinical depression and
has a greater prevalence in countries with greater northern latitude. reference
to SAD
One possible evolutionary explanation is the bipolar disorder is an adaption to
living in areas with harsh winters. Individuals get very active or "manic"
during the summer when light is plentiful and the environment is more
forgiving. They then enter a state of inactivity or hibernation in the winter to
conserve calories and save themselves from too much exposure to a harsh
winter. They then reenter hyperactivity when the weather lightens to get
everything done they need to get done.
How could that effect people living in Florida where we don't have very harsh
winters? Why do some people cycle throughout the year?
The secret is in the light. Here is some research linking bipolar to disturbances
in light processing and some common mood stabilizers and how they effect
light and melatonin.
Seasonal rhythms are predominantly determined by length of sunlight not
temperature. In other words as the length of day shortens and lengthens our
bodies feel we are different periods of the year.
Two periods in our experience that naturally seem to be present.
Around Sept-November seems to be a period of depression
Around April- Sept seems to be a period of mania and also anxiety. Now we
would expect this anxiety to be associated with fear over the coming winter. In
fact the period after the Summer Solstice (June 21st) is associated with a high
violent crime rate see below:
And in fact suicide rates are relatively low around Christmas (see below).
(May has the highest suicide rate)
What about other cycling?
Well we live in a world where we can control light exposure but room light is
very different from natural sunlight so our bodies read it differently. And this
possibly accounts for all the weird cycling we see. For instance, look at this
research below that shows a seasonal variation in depression markers. What
this means is that if you get the season wrong...you may get depressed. How
do you get the season wrong? By having confusing light cues that make your
body think it's a bad time of year.
What can you do to live with Bipolar?
1. Keep your mood chart.
Three days in a row (up or down) may signify an upcoming episode. A small
adjustment at this point may alleviate or assuage an episode. It is important
to follow your cycles when they begin, how long they last and what alters
them.
Here is a link to a blank mood chart to download :
Here is a link to instructions on filling out a mood chart:
2. Keep a regular schedule.
Active in the day. Shut down at night. Little light exposure late in the evening.
No caffeine. No alcohol.
3. Take your medication as prescribed. Small changes as cycles start can avert
depression and mania.
4. Don't trust your feelings...don't act on them. Learn them.
5. Chart your activity...ask for feedback.
6. Light therapy under instruction from physician.
7. Avoid alcohol and drugs. These disrupt circadian rhythm.
8. Start to understand your "fast" and "slow" times. Start a timer then start
doing something else. After a while try to guess how much time has passed.
Are you guessing faster or slower than actual time?
9. Join the "Society for Circadian Sanity." It's easy. Just start acknowledging
that your body has a daily rhythm...start developing a healthy respect for it and
learn what time of day you should be doing different activities.
A Fun Site on Seasonal Biorhythms
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