Does it get worse over time
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Does it get worse over time -- and how about exercise?

Q: I suspect that I may be Bi Polar. Now that I have started researchin, I am petrified! My ups and downs are long stretches, months actually. I hate the down side of it, but I don't feel worthless or suicidal, just down and run down. The up side of it is awesome! I have tons of energy, and I do become more mischevious (and I can see that it could get me into trouble), but I don't got so wound up that I can't function. I don't seem to have the extremes on either end. My question (and I am crossing my fingers on this hoping you'll tell me I'm just a moody wench) is: Does untreated/undiagnosed Bi Polar get worse over time? I first noticed the depression about 5 years ago, and the hyper side about 2 years ago. Should I be prepared to see shorter, more extreme periods of ups and downs?? I can handle the way things are now, except I never see the depression coming, and don't realize I'm in a depressed state until some time in the middle of it. (And I really hate that!) My last one stretched for nearly a year. When I started coming out of it (which was extremely dificult) I went to my doc who gave me Zoloft. It knocked me out for two weeks, and then made me feel as though I went back into a depression, so I stopped taking it. One other thing: Are there any studies that show that exercise is beneficial in reducing the symptoms of BP?? Thanks a bazillion! Des

Dear Des --
Wow, a bazillion: cool!  I guess maybe this is one of those more up times?  Or at least not a depressed time -- hopefully. 

Hey, no worries, you're just a moody wench.  (There, did I get that right? For more help on diagnosis, read that section of my website, if you haven't been there yet. )  Ok, question one:  "Does untreated/undiagnosed Bi Polar get worse over time?"  Answer: in some people clearly yes, but seemingly not everybody; or at least in some people it's so slow it doesn't look like things are worsening (meaning maybe years later they'll conclude differently).

Sorry to say the worsening pattern seems to be more common in women than in men, at least in my practice (versus the numerous things that are worse about bipolar than in men that have been shown so by research -- like more mixed states, more rapid cycling, and of course having to deal with how do you do pregnancy, as well as increased risk after pregnancy.  Oops, better stop there -- hating men yet?). 

Next question: "Should I be prepared to see shorter, more extreme periods of ups and downs?" Can't say for sure, as per above: possible but not certain; perhaps a little more likely than not, again based on my experience with patients.

One other thing: "Are there any studies that show that exercise is beneficial in reducing the symptoms of BP?"  Ah, now there's a good one.  Answer A: definitely it's been shown that exercise is a good antidepressant (references are on my site under Phelps; I wrote a paper on that subject a long time ago.  And recently there was another one showing exercise and Zoloft having equal antidepressant effects, and that exercise might be better in the long run, especially if you continue to do it (like, duh -- except that if I read it right, even the people who didn't continue were doing slightly better than the Zoloft people 6 months after treatment.  Very cool).  And, fortunately exercise has not been shown to have a destabilizing or "pro-manic" effect, like all the conventional antidepressants.  So, for bipolar, it's great -- an antidepressant without risk (unless you put a bazillion ergs into it -- careful there...).

Answer B on that subject: does exercise act as a mood stabilizer (in addition to acting as an antidepressant; i.e. will it help prevent manic phases or cycles or a manic component to a mixed state)?   I think maybe so but there's no direct research on that.  There is one research group looking at keeping a very regular schedule of activities, including when you do your exercise, and that is looking like a good thing -- i.e. not only doing it but doing it at a regular time.  There seems to be something about trying to convince your biologic clock what time it is that is a good thing.  For more on the biologic clock and some stunning graphs on the importance of dark time as well as light, see some new pages I just added (the links in this sentence). 

Dr. Phelps

Published December, 2000

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