Welcome to Bipolar in Focus, I'm Jane Pauley.
Stability, that's the goal of bipolar treatment. One form of therapy is getting results by helping people find structure in daily routine.
Here to tell us about interpersonal and social rhythm therapy is Dr. Holly Swartz from the University of Pittsburgh Medical Center. Welcome!
The circadian cycle, to start with that, what is it?
The circadian system is actually a host of biologic rhythms that take place in our bodies on basically a 24-hour cycle and there are a lot of them.
So there is the cortisol system, our blood pressure, temperature, sleep-wake cycle.
Hunger, elimination, all sorts of things. And we actually think that in bipolar disorder, this system is fragile.
And it may even be that the genes that control parts of the circadian system may be at risk in bipolar disorder.
And so a lot of the symptoms of bipolar disorder, disturbances in sleep, disturbances in appetite, energy are actually things that would normally be regulated on a 24-hour cycle.
And so, we think that the symptoms of bipolar disorder are, if you will, parts of the circadian system gone haywire.
So we've got to learn how to do things that in the normal circumstance is it comes naturally. So how do bring us in line?
Interpersonal and social and rhythm therapy helps people to learn how to lead more regular lives essentially.
So we talk about developing more regular social rhythms and to develop more regular schedules in their lives.
We actually have a whole system. We have forms that people fill out every day where we keep track of sleep-wake cycles, times of daily activities, meal times.
And we look at people's schedules and try to figure out when people are doing things at a regular time and when people aren't.
One of your insights is that in terms of sleep and sleep is so important, that bedtime is less significant than wake time.
One of the things that sets your sleep time is the time that you wake up. So unless you're getting up at a regular time, it's very difficult to fall asleep at a regular time.
As I often tell people, you can't force yourself to fall asleep, but you can't force yourself to get up at a regular time.
Part of the process is encouraging people to track their own moves daily, hourly, how does that work and why is it important?
We ask individuals to fill out a mood rating on a daily basis. And the idea here is to look at the link between daily moods and regularity of routines.
When the person comes in, we look to see if there's any connection between regularity of routines and mood over the past week
and what we expect to see is that as people develop more regular routines, their moods will become more level.
So what are some ways to impose routine in a daily life?
We recommend that people don't take rotating shift work that they establish a regular wake time,
establish regular meal times and this is something that families can really support individuals with bipolar disorder around.
It's also really important that you have some kind of regular contact with other people every single day, but it's really important to get out of the house.
We think that probably regular exercise is important. And again, if you can establish those kinds of activities at the same time every day, that's also really helpful.
This does seem to really work. What kind of results are you able to see?
We have good evidence to show that it can hasten time to recovery from a depressive episode and it can prevent the onset of new episodes of depression, mania and mixed episodes.
The more regular you can make your social routines, the better off you are.
Dr. Holly Swartz, thank you very much.
And thank you for joining us on Bipolar in Focus.