Daily Routine May Help Bipolar Disorder

Study Shows Regular Sleeping and Eating Patterns May Help Stabilize Patients

From the WebMD Archives

Sept. 8, 2005 -- Most of us function better when we maintain a regular daily routine, but for people with bipolar disorder, routine may make a big difference in recovery.

Researchers from the University of Pittsburgh School of Medicine report that bipolar patients fared better when their treatment stressed the importance of establishing daily routines for things like sleeping and eating.

Social rhythm therapy, as it has been dubbed by the researchers, is based on the idea that irregular sleeping habits and those associated with other daily activities can trigger manic episodes by disturbing the body's sleep-wake (circadian system) clock.

"We see patients with bipolar disorder as having exquisitely sensitive and fragile body clocks," researcher Ellen Frank, PhD, tells WebMD. "They need to be more attentive than the rest of us to things like when they get up and go to bed and when they eat their meals."

'A Manageable Problem'

Once known as manic depression, bipolar disorder is characterized by extreme swings in mood, energy, and ability to function. Periods of highs and lows are referred to as manic or depressive episodes. Medications such as lithium are prescribed to people with bipolar disorder; these drugs can help stabilize mood swings.

According to the National Institute of Mental Health, more than 2 million Americans have bipolar disorder.

The study by Frank and colleagues included 175 severely ill patients with the disorder, all of whom were treated with medications. In addition, about half of the patients got social rhythm therapy from the beginning of the study.

The Importance of Routine

These patients learned the importance of establishing regular routines, and they also learned strategies for anticipating and coping with stress.

"We teach them to think of their illness the way someone with diabetes or asthma would; as a health problem that can be managed," Frank says. "A diabetic has to be careful about what they eat and when they eat. And people with asthma probably shouldn't have three dogs and two cats in the house."

The study is published in the September issue of the journal Archives of General Psychiatry.

No difference was seen between the two treatment groups in the time it took to emerge from a manic episode. But patients who got the social rhythm therapy had longer periods of stability between such episodes. Those who were most successful in establishing regular routines saw the most improvement.

The intervention translated into a 72% increase in time between manic events, Frank says.

A Holistic Approach

Depression and bipolar disorder patient advocate Sue Bergeson, who suffers from depression herself, says the study by Frank and colleagues shows for the first time in scientific terms what many patients have long understood.

Bergeson is vice president of the Chicago-based Depression and Bipolar Support Alliance.

"It is clear that medication can take you only so far," she says. "An effective wellness strategy for bipolar disorder and depression has to go beyond that. We know that we have to get enough sleep and understand our triggers. And travel can be problematic."

Bergeson watched her sister Barbie battle undiagnosed bipolar disorder for years. Five years ago, Barbie took her own life, a few months after her disease was finally identified.

"She had been misdiagnosed for years," Bergeson says. "She had gone through decades of struggle with no light to be seen, and she was just worn out."

Her sister's suicide led Bergeson to learn as much as she could about her own illness and become a voice for others with depression and bipolar disorder.

"It is not OK that so many people die of this," she says.

She recommends a holistic approach to treatment that includes drug therapy, talk therapy, and maintaining a healthy lifestyle.

Bergeson says paying attention to routine doesn't mean life has to be boring.

"In fact, I just got back today from a trip to Las Vegas," she says. "I can have a good time and do fun stuff just like anybody else. I just have to make a plan and think it through and take steps to minimize the impact."

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SOURCES: Frank, E. Archives of General Psychiatry, September 2005; vol 62: pp 996-1004. Ellen Frank, PhD, professor of psychiatry and psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine. Sue Bergeson, vice president, Depression and Bipolar Support Alliance, Chicago.
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