Q:  Helping Loved One and Seasonal Cycling

Hi.  I have a brother-in-lae who was diagnosed BP about 8 years ago.  (He is now 42 years old.)  I will make this as short as I can.  He is COMPLETELY resistant to taking medication and to any type of psychiatric help, except when he is hospitalized and he has no choice.  Over the past three years, this is the pattern we have seen develop:  He seems to become very sluggish and unmotivated in the winter months (December through March), starts picking up speed by April, and by June, he's moving full force toward a manic episode, if he isn't already in one and hospitalized for it.  Then, he gets out of the hospital, and if it is still early in the season (July or August), he usually ends up back in before Christmas.  We asked the doctor about this last time he was hospitalized (in October) and they said he is affected by the amount of light there is during the day.  They said he is more "calm" in the winter months because there's not as much sunlight and that "levels him out" but the more sunlight there is (and of course, not being on his medication, the greater the chance of him having a manic episode.  Are you familiar with this being told to patients, and if so, can you offer me any more information than they had as to why this is the case?  (Spring is on it's way, and we're worried!)  THANK YOU!

Dear Mary Beth -- 
Fearing that this may not be of much use to change things much, I can affirm: yes, we do see quite a few folks whose manic symptoms seem to cycle with the seasons.  At a subtle level I think it's like that for many, but certainly not all people with bipolar disorder (making the whole thing more puzzling).  Why?  Well, clearly our "biologic clock" has something to do with it.  For an example of that, see a really remarkable case from Switzerland who cycled every 48 hours like a clock: one day up, next day down.  Some remarkable graphs of his hormones, and even his brain scan, can be found on my website, here.  

As for what to do, your website mastermind has written an essay about this, because it affects so many people.  I'll ask her to tack that on here.  Please see this page .

Dr. Phelps

Published April, 2001