Until recently, bipolar disorder has been associated only with extreme mood swings-suicidal depressions alternating with manic periods of irrational and even dangerous behavior.

Now: A "soft" form of bipolar disorder has been identified and is estimated to affect 1% to 2% of the American population.

Is It Bipolar Disorder?

Depression associated with bipolar disorder has the same symptoms as common, or "unipolar," depression—sadness, lack of energy, sleep and appetite problems, loss of interest in life, etc. However, doctors can't always tell one disorder from the other. Psychiatrists are typically best suited to make the diagnosis, but they also can miss the telltale symptoms.

If you experience symptoms of depression in repeated, brief episodes, bipolar disorder should be suspected. Even though bipolar disorder is technically defined by "hypomania" (marked by phases of increased energy and activity), in the softer forms, hypomania can be accompanied by irritability and agitation—not just euphoria and grandiosity, the typical hallmarks.

Another red flag: People with bipolar disorder tend to eat and/or sleep more than usual, not less, when they're depressed.

The Right Treatment

For unipolar depression, standard antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), bupropion (Wellbutrin) or venlafaxine (Effexor-usually reduce symptoms within days to several weeks. With bipolar disorder, an antidepressant alone can change a person's mood too dramatically—like flicking a switch from depression to mania.

The prescription drugs that work best for bipolar depression are designed to not only ease the depression but also even out the mood swings. These drugs often are combined with an antidepressant to increase the effectiveness of both medications.

Most effective mood-stabilizing drugs…

  • Lithium is the oldest and, according to many doctors, the best mood-stabilizing drug. Side effects include tremor, diarrhea and confusion.
  • Lamotrigine (Lamictal) is one of the newest mood-stabilizing drugs. In rare cases, it can cause a potentially fatal allergic reaction, marked by a rash.
  • Olanzapine (Zyprexa) often reduces symptoms within hours. In some cases, it can cause major weight gain and even diabetes.
  • Valproate (Depakote) is another tried-and-true mood-stabilizing drug Side effects include sedation and weight gain.

A Healthful Lifestyle

To maximize the benefits of medication, it helps to adopt a healthful lifestyle. If your symptoms aren't too serious—for example, you're still able to work and maintain close relationships--this approach may stabilize your moods without the use of drugs. Recommended…

  • Exercise regularly. Studies have shown that regular aerobic exercise can relieve depression as effectively as some prescription antidepressant medications.

To get started, try this simple strategy: Walk just seven-and-a-half minutes in one direction, then return. Do this every day. Gradually increase the duration if you can.

  • Consume omega-3 fatty acids. Fish oil, the best source of these essential fatty acids, has been shown to improve depression and reduce mood swings. Try 1 g daily of eicosapentaenoic acid (EPA) from fish oil capsules or liquid. Right now, it's not known if the amount of docosahexaenoic acid (DHA) found in fish oil is significant for bipolar disorder.

Caution: Fish oil can have a blood-thinning effect, so check with your doctor if you use blood-thinning medication, such as warfarin (Coumadin).

  • Limit alcohol. For many people, alcohol makes their moods more unstable. If you drink alcohol, abstain for several weeks and monitor your moods. Then slowly reintroduce it-begin with one or two drinks per week and track whether it affects you negatively.

Light/Dark Therapies

Maintaining regular sleep habits and frequent light and dark exposure can help stabilize moods and reduce depression.

  • Light therapy acts like an antidepressant, possibly by affecting levels of the neurotransmitter serotonin.

What to do: Expose yourself to light for 30 minutes or more per day.

Best approach: Use a light box, which can be purchased for about $175 to $300 at Costco or several Web sites, including www.lighttherapy products.com.

Warning: If you experience hypomania symptoms such as agitation, irritability or crowded thoughts, discontinue light therapy.

  • Dark therapy acts like a mood stabilizer and is involved in regulating the biological clock.

What to do: Go to bed at the same time each night, keep your room as dark as possible and get up at the same time each morning. In addition, control your exposure to light. Even if you don't sit in complete darkness, keep lights low after 9 p.m....don't watch TV or use the computer. Use a dawn simulator, a device that wakes you naturally by slowly turning up the lights each morning. For information about where to buy dawn simulators, check my Website, www.copsych.com.

  • Blue light is the wavelength that is believed to regulate the sleep-wake rhythm.

What to do: If it's past 9 p.m. and you want to use your computer or read without disrupting the cycle, wearing yellow-lensed sunglasses that block blue light may help, though this is still being researched. Yellow-lensed sunglasses are available at www.lowbluelights.com.

Eating and exercising at the same time each day also helps stabilize moods.


Cognitive behavioral therapy (CBT), which helps identify and change thinking and behavior patterns that influence moods, has been shown to be as effective as antidepressants. When adapted for bipolar disorder, it may include strategies to help you maintain a healthful lifestyle, reduce stress and identify characteristic unhealthful thoughts.

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