Importance of routine in bipolar disorder

Routine and lifestyle factors are important for the balance and healthy functioning of all of us, and can be particularly critical for maintaining stability in some psychiatric conditions.

Bipolar disorder in particular is a condition that is profoundly affected by many conditions of daily life.

As you know, bipolar disorder is a mood disorder characterized by fluctuations between the lows of depression and the highs of mania.

Individuals with this condition may experience only one or two episodes of each during a lifetime, or may cycle quickly between depression and mania. Regardless of the frequency of mood shifts, bipolar disorder is a very serious illness that can wreak havoc in a person's life.

Along with mood fluctuations, other areas of life that are disrupted by bipolar disorder include sleep, appetite, energy, sexual interest and concentration.

lthough there are effective medications available to treat bipolar disorder and help individuals to remain in a normal mood state, sometimes life events can trigger or exacerbate the condition even when medication is being used.

Disruption in daily routine is one example of something that has long been known to cause or worsen episode recurrence in bipolar disorder.

Staying up all night to study for an exam or party can trigger depression or mania in some individuals or cause them to shift from one extreme to the other. Likewise, traveling and the associated jet lag can do the same.

Although the reason for this is not fully understood, it is hypothesized that disruption of circadian rhythms is rather central to bipolar disorder.

While it seems obvious that stressful events could trigger mood shifts in susceptible individuals, even non-psychologically stressful changes in routine can make it difficult for the body to maintain stability with its sleep/wake cycle, appetite, energy, and alertness rhythms.

Social cues can come to govern these rhythms and when these cues are changed, the body's biological rhythms are also disrupted.

Events as seemingly innocuous as changing meal times, doing shift work or changing sleep/wake habits are all examples of environmental influences that can have a profound effect on the biological rhythms used by our bodies and can in turn cause mood shifts in individuals with bipolar disorder.

Sometimes cognitive over-stimulation such as can occur when starting a new job or relationship, attending a conference or going on vacation can be all that is needed to trigger a recurrence of depression or mania in bipolar disorder.

Any abrupt changes in these areas take on more importance for vulnerable individuals and their effects should be minimized. Avoiding sudden changes in routine is the best way to prevent them causing problems. Instead, daily routines including regular sleep/wake times, meal times, time for taking medication, going to and from work and regular exercise are all important and should not vary much from day to day.

However, when life circumstances make it impossible to maintain the routine, learning to manage change can help. For all of these reasons, therapy for bipolar disorder should include more than simply medication. Although medication is necessary for mood stability in these individuals, therapy should also include helping patients to understand the influences of daily routines and strategies for making necessary changes less disruptive.

At Okanagan Clinical Trials we currently have a number of ongoing studies in bipolar disorder. If you are an adult experiencing bipolar disorder, you may be eligible to participate in a study of an investigational medication. Contact our office for a free, no obligation medical assessment or for more information.


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