Q:  Dad's Weightlifting & Manic Episodes

My father is a 67 yr old diagnosed bi polar manic depressive who loves weightlifting.  My family and I have noticed a correlation between his weightlifting and the onset of a manic episode.  We haven't been able to find any information or studies which establish a cause-effect relationship, however, his behavior over the past ten years lead us to believe that the weightlifting stimulates his adrenaline, which  elevates his self confidence and misleads him into thinking he's "healthy."  He then begins to miss his medicine, and before you know it we have a full blown manic episode on our hands.  My question is:  are there studies which indicate a direct relationship between the two, or is it simply a coincidence.  We don't want to keep him from something he loves, but if it influences his sickness it's best for everyone.  He feels we are trying to take away something he loves without the proper justification - rightfully so.  His doctors say he should exercise but we feel it's detrimental to everyone's overall health.  Please Help us!

Sincerely,
Caught in the Middle
 

Dear Scott -- 
Hmm, interesting.  Well, the first thing that came to my mind -- and then we'll deal with your hypothesis -- was that the weightlifting could be not a cause but a marker or a signal.  That is, it could be that some "manic" phase begins and the very first indication is that he starts really going at it with the weights, more than his usual regimen.  This would be like one of my patients years ago where her mother said "when she starts wearing a hat, you know you're in trouble; she never wears hats when she's well" -- and mom was quite right about that, we learned over time.  In this scenario, when he started lifting heavily  (so to speak), that would be the time for the family to put on the "full court press" regarding monitoring medications and sleep and being prepared to limit access to things he's hurt himself or others with in the past.  

(By the way, this theory would predict that before the change in weight lifting, you'd see a change in sleep -- waking earlier usually; or broken sleep, for example.)

But could the adrenalin from exercise stimulate the onset of a manic episode?  Well, interestingly, the time when people with bipolar disorder use stimulants like amphetamines is more at the onset of a manic phase than during depressions, which seems backwards but has been reported repeatedly.  So there's a little link there, though not exactly on target with your theory.  Similarly, people can get really into other kinds of exercise during manic phases -- but again, I've not heard speculation that the exercise itself was causative.  

This is pretty important, because I recommend exercise all the time as both an antidepressant (the data on that are quite good; as effective as Zoloft in a recent trail) and because I have the suspicion that exercise, perhaps through some sort of stress reduction mechanism, may actually act as a sort of mood stabilizer like lithium and Depakote.  So if exercise, for example really vigorous resistance work like weights, could be a trigger, that's a problem.  You can see I thus have reason to try not to believe this is true (so need to compensate by considering it as seriously as possible).  

If you ever get any more insight into either theory -- yours or mine -- , I'd be interested in some feedback (jimp@psycheducation.org).  

Dr. Phelps

Published March, 2003