Exercise has been touted as a vital part of treatment for depression. It increases blood flow to the brain and increases endorphin levels, which can act as a natural antidepressant. The problem is that most of the research in this area has been done with a focus on unipolar depression, not bipolar depression. Since bipolar and unipolar depression differ in several ways, it’s worth taking a look at the unique effect of exercise on bipolar depression.
The Diagnostic and Statistical Manual of Mental Disorders describes the symptoms of unipolar depression and bipolar depression in the same way. However, research has shown that there are variations between the two. For example, people with bipolar disorder experience higher rates of slow movement, impaired thinking and judgement and higher rates of psychotic episodes. Also, major depressive disorder requires only a single episode of depression. Bipolar disorder is cyclical, and patients experience depression at a higher frequency.
Possibly related to the frequency of depressive episodes is the fact that between 45-65% of people with bipolar disorder lead sedentary lifestyles. Rates of heart disease, metabolic syndrome and type II diabetes are all higher in people with bipolar disorder. Cardiovascular disease is the number one cause of death in bipolar disorder patients.
With this in mind, why is it so hard to be more physically active in order to stave off heart disease and lift mood?
-There are financial barriers. Joining a gym or team can be expensive. With less than half of people with bipolar disorder able to hold a full-time job, funds may need to funneled elsewhere.
-Depressive symptoms often bar the desire for physical activity. Loss of interest in exercise can become a real problem, especially if the person didn’t particularly enjoy it to begin with. Fatigue is also a big issue. When the effort of showering seems like too much effort, running or weight lifting seem impossible.
-Being overweight is hard. Everything takes extra effort. Depending on how overweight a person is, carrying groceries in or walking around the block can feel like a marathon.
-Having a lack of social support can be a big barrier. Isolation can be an automatic reaction to depression and people need help and encouragement to get out and take care of themselves.
Even though it can be difficult to develop a routine, there are benefits of exercising specific to bipolar disorder.
-Because people with bipolar disorder have such high rates of heart and metabolic disease, it’s important to take advantage of the health benefits of exercise like strengthening heart muscles, lowering cholesterol, lowering blood pressure and helping to control blood sugar.
-Exercise can help people with depression socialize more. Going to the gym or playing a sport can help people get out and interact with others in ways that don’t seem as threatening as one-on-one conversation.
-Having a regular exercise routine helps keep a normal daily routine going. Having a daily routine helps control bipolar symptoms and can lengthen the time between episodes.
-Some bipolar disorder patients have said that exercise helps contain hypomanic symptoms. Hypomania includes periods of excess energy and a potential for risky behavior. Exercise can help ease that excess energy.
There is a double-edged sword to exercise in regards to bipolar disorder.
The extra energy experienced in hypomania is also experienced during mania, likely to a greater extent. In this state, exercise can exacerbate or induce manic symptoms. Patients need to stick to a regimen and limit exercise time during periods of mania in order to avoid overdoing it.
Any exercise regimen should be discussed with and cleared by a doctor, but it’s important to keep up the routine of exercise in order to maintain the benefits. It’s equally important to watch for any additional manic symptoms possibly related to exercise.
Image credit: Shawn Henning