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Study: Daily Routine Helps Bipolar Disorder


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Study: Daily Routine Helps Bipolar Disorder

By JENNIFER C. YATES, Associated Press Writer

Tue Sep 6, 8:34 PM ET

Patients suffering from bipolar disorder who underwent therapy to help them maintain a regular daily routine and cope with stress were able to avoid relapses over a two-year period, a study has found.

The study, published in September's Archives of General Psychiatry, examined a therapy developed by researchers at the University of Pittsburgh School of Medicine.

Using what researchers dubbed interpersonal and social rhythm therapy, patients were taught how to keep to normal sleeping, eating and other daily routines. They also were shown how to anticipate and cope with stress just as a diabetic who would be taught, for example, how to cook and eat differently.

"This is really a disorder characterized by massive disturbances in the body's clock and in all the things the body's clock controls," said Dr. Ellen Frank, lead author of the study. "Their clocks need to be very carefully protected and we need to do everything we can to shore up and protect that fragile clock."

Bipolar disorder, also commonly referred to as manic depression, is a brain disorder in which sufferers experience cycles of mania, depression or mixed states. Treatment for the disorder varies by patient, but often involves some type of medication combined with therapy.

Frank, a professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic, said doctors for years have counseled bipolar sufferers about managing their lives but no one had ever systematically put that information together. She said social rhythm therapy does that, and also teaches patients to identify the triggers in their relationships with other people that can cause relapses.

In the study, 175 patients suffering from the most severe form of bipolar disorder were divided into several groups. All the patients were given medication for the disorder, but only some received interpersonal and social rhythm therapy.

The researchers found those who received the therapy were more likely to not have relapses of their illness during a two-year maintenance phase.

Dr. Gail Edelsohn, an associate professor of psychiatry at Thomas Jefferson University Hospital in Philadelphia, said sleep, especially, has a huge effect on those with mood disorders.

"This is a very important study because what's happened is that since we have a variety of medications which are extremely useful, I think the psychosocial interventions were prematurely cast aside," Edelsohn said.

Dr. Suzanne Vogel-Scibilia, president of the National Alliance on Mental Illness, said it's most important that bipolar sufferers have access to care, something that doesn't always happen because of the high costs of health care.

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On the Net:

http://www.upmc.edu

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I have the WORST time adhering too and maintaining a schedual. I know they can make life easier but something in me always seriously resists them

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I am trying very hard to get some sort of routine established in my life.  If not a daily routine, then a weekly routine.  What I wouldn't give to work the same days every week!  I would LOVE to be able to predict my schedule!  I'm working on it.  Speaking with my manager.  Speaking with my OT.  Getting control of my course hours.  Looking for a new job which treats its employees like human beings (or at least pays better for the same level of abuse).  I hope to gain some stability soon. 

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I've been doing pretty well for someone like me, but I've got two problems: a pre-adolescent bitchiness about going to bed on time, and a job that usually gives me no control over my time. 

So even knowing about social rhythm therapy, I can't usually manage much routine.  Or, the routine I have is disordered, in that I spend half the day revving myself up and then do things like overeating, zoning out in front of the TV, and spending too much time in this chair to "recover."

Argh.  Sounds like I need to go through some training of my own.

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I'm glad to see this report. The basics made sense, though the social rythm name is a little goofy.    I've done another search and there is very little available on the web on protocols or practical application.

I've ordered the hardback manual for clinicians and should get it in a week or so.  Will try to post some summaries and suggestions.

A.M.

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I'm great at keeping a routine of not having a life. But I'm not so sure I could do much above that.

<{POST_SNAPBACK}>

this is my routine too. NOTHING it's the only thing that keeps me sane.  If I have to leave the house for anything it better be scheduled way in advance.

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I'm proud to say I actually got into bed at 10:00, took my ambien, and was asleep by 10:45.  Did give myself a little scare waking up at 3:30, but I did get back to sleep by 4:00 and woke up without an alarm at 7:20.

I got up and used my "grow-light" for 20 minutes and wow, it does make a difference in how alert I am in the morning.  I still needed caffeine in the pm, but that will probably get better, too.  Yay, serotonin!  This makes me remember how nice it was last winter to have a regular sleep schedule and be rested.  I'm going back to daily use until spring.

I'll be interested to see if my current cocktail plus the light box is enough to battle the seasonal slow-down and jitters I usually experience in the fall.  The light box did help with the depression, but Depakote never quite managed my irritability.  My hope is that lamictal will be more effective at keeping the hypomania/depression completely at bay.

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I think it's true for unipolar depression as well, although it wasn't part of this study.  There's certainly something screwy in my hypothalumus (sp?) when I'm at my worst, and a regular schedule is something to be wished for like a new bicycle from Santa Claus.

What sizes/brands of special lights have people found helpful, and do they help with getting back to and maintaining a more regular schedule?

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I've been using my "grow light" for 4 days and already I'm waking up alert and refreshed in the morning.  Another week and my energy will be up, from my experience.

Here's a site:  Apollohealth.com.  The website has study results and a questionnaire that helps you figure out what kind of light treatment will be effective for your sleep. 

I have the "GoLite."  Virtues:  much narrower spectrum than most lightboxes, and it seems to be the most effective spectrum.  Because it's bright and narrow-spectrum, I don't need to use it for as long (30-40 minutes with full-spectrum lightbox, 15-20 with the GoLight.  Very small and about 8 ounces so I can take it out of town, use it at my computer or dining table, etc.  Downside: it costs about $150 if you shop around on the web.  I got mine at Costco.  It is simply the best $150 bucks I have spent.  Sure, you can build your own, but it will be big and clunky.  If you're broke, that's the best thing to do.  But if you can get a doc to prescribe it, you may get something from insurance. 

SAD a mis-used term.  Most BP I know have seasonality to their cycles.  Also, light boxes don't just treat seasonal problems.  You can use them if you are an insomniac or have disturbed sleep year round.

Edited to add:  I seem to remember a number of SAD & sleep disorder websites that included instructions on building a lightbox.  Great if you're handy.

Anyhow, I hope if you're having trouble with your sleep/wake schedule you'll consider using some sort of light therapy.  Even if it's just going outside in the sun first thing in the morning.

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I've done the light therapy both with homemade "grow light" setup and with a light manufactured for this purpose (which I managed to get paid for on the last day of an insurance policy that actually covered such things -- ask your insurer about this).

Light treatment can definitely help regulate sleep, brighten mood, and is *at least* as effective with depression, in my case, as any anti-depressants. Big things to look out for are that light treatment is seriously ramping up your serotonin, and so should be thought of no differently than a drug. Mixing light treatment and any other serotonin-affecting drug can be dangerous, leading to mania or serotonin syndrome. In my experience, the light treatment works much faster than drugs (and I react amazingly fast to drugs, usually noticing the effects of SSRIs within 1-3 days for instance). The mood effects hit me the same day I do the lights, and sleep improves that night (since melatonin production is increased when serotonin is increased). Likewise, starting and stopping the lights on a day-to-day basis works for me, though some docs may argue this is bad. But actually I may do this this year, where I'm working outside Monday-Friday and am getting way lots of sunlight (it still feels like July to me in the daytime, sunny and 80s and 90s even in New England). But on weekends, when I may get out less or it may be too cold to get in the sun much, I'll probably do the light box thing a bit.

I'm all rambly tonight.

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