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A bipolar. Not a bipolar patient or a bipolar victim. I chose not to refer to bipolars as either. That doesn’t mean he won’t be a patient or a victim.

Yesterday I was unfortunately consulted about what to do in a very extreme case of bipolar 1 mania. I am not a psychiatrist and that is the reason I was consulted: the person doesn’t want to see one. Being myself a suicide survivor, having been a patient and a victim, I might be of some help, or so those who sought me thought. In this case, the only responsible thing to do is to be honest and refer them to professional help and, most probably, hospitalization.

I will not sugar coat the pill: whatever it is that suggested the bipolar disorder DX (today we know it is more of an umbrella class of morbidities), it is incurable, very hard to treat and, in extreme situations, it does require intervention. However, there are ways to manage the condition and even live a functional life with it, as with so many other chronic conditions.

Bipolar disorder is one of the cyclothymic conditions. There is not only much controversy about them, but very little is known concerning its neurophysiology, causation and triggers. What we do know is:

  1. that the cyclic behavioral manifestation have a neurochemical counterpart;
  2. that there are triggers – unfortunately, each bipolar has their own set of triggers and it is very individual
  3. that exercise has some effect. What effect, we really don’t know
  4. That bipolars may be trained (and train themselves) to identify the onset of an episode

I was a rare and extremely severe case of “whatever” (within the bipolar spectrum or related to it, considering the dozens of DXs I received). Recently, the “whatevers” tend to be interpreted as epilepsy. Maybe this is because the cyclothymic emotional symptoms are not visible anymore. Ever since I became a competitive powerlifter, in 2006, they have been decreasing. At each diet adjustment, it became better. Understanding the triggers became easier.

Unfortunately, we still lack a significant sample of powerlifting bipolars to generalize any guideline. In fact, we have no sample at all: I have myself as a lab and I have very good professionals (an endocrinologist, a psychiatrist, a nutritionist, a psychologist) working with me.

What did we learn that may be of use to other bipolars? And where does lifting come into the equation?

  1. The the triggers may be identified. By identifying the triggers, it is possible to intervene and prevent, at some level (sometimes quite successfully), the altered state from evolving into a full blown episode. Whatever the altered state is, lifting has been successful in either slowing down the process or totally quenching it. Both the weightlifts and the powerlifts are successful. In more advanced altered states, the powerlifts may be more effective since they be performed with less speed and, therefore, allow for more control during a critical period where motor control, visual and auditory responses are compromised.
  2. There is published evidence concerning the effectiveness of physical activity in general in the acute treatment of bipolar disorder. Where does this effect come from is still unclear, but it may be related to aminergicsynaptic transmission in the central nervous system. Whatever it is, it works. From my experience, ANY intense physical activity works during acute phases. However, the only form that has medium term effectiveness (meaning lasting for more than a couple of hours) is strenuous strength exercises. Powerlifting, strongman or weightlifting.
  3. It provides a powerful focus tool. The extremely fast chain of thoughts and sensations a bipolar experiences during an acute phase is almost unbearable. This is what Edgar Allan Poe referred to as a pain so extreme there are no words to describe. An anonymous writer described it as an impulse to vomit in a mouthless body. The peaceful concentration required to decelerate the bar during a squat or a bench press or the few moments of recruiting mental tools to deadlift a bar are effective quenching actions over that condition.
  4. For long term control and management of the bipolar condition, powerlifting is an interesting project to invest in. Notice that I used the word “project”. Powerlifting is not a pill nor a hypnosis session. It is a long term commitment. But so is the bipolar condition

References

Ng, F. The effects of physical activity in the acute treatment of bipolar disorder: A pilot study. Journal of affective disorders. Volume 101, Issues 1-3, Pages 259–262 , 2007. http://www.jad-journal.com/article/S0165-0327(06)00492-7/abstract?cc=y

Vancampfort, D. et al.  A review of physical activity correlates inpatients with bipolar disorder. Journal of Affective Disorders . Mar 5;145(3):285-91, 2013

Rensford, CP .A role for amines in the antidepressant effect of exercise: a review. Med Sci Sports Exerc 14(1):1-10, 1982 (http://europepmc.org/abstract/med/6280014)

Perry, A. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999;318:149, 1999.

 

  • Eric Brown

    Amazing work. As always, I am very proud of you.