Skip to main content

Bipolar and Cortisol

Y'all know about Bipolar as the mood disorder of Up and Down.  You have seen the movies, watched the soap operas and dramas.  The medications promise to reduce the number of trips around the loop de loop.

That's important, because what goes up must come down, and the fall can be mighty.  But there is more to is that that.

In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to maintain balance.  The list includes: dysregulation of hormones, neurotransmitters, and immune system; irregularities in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain.

In other words,

Over the next few weeks, I will sample this list, especially the items that are true all the time, even when not on that roller coaster.

Dysregulation of cortisol is one of my favorites, to use the term loosely.  Cortisol is the get-up-and-go hormone.  It gets you out of bed in the morning and manages energy throughout the day in response to stress.

In a healthy body, cortisol fluctuates throughout the day.  Its high morning level gets you out of the door on time.  An occasional spike when it's time to give a presentation at work gives you the energy to marshal your resources.  By evening, the level drops so you can drop off to sleep.

If your stress levels are chronic and your cortisol level stays high, you get weight gain, high blood pressure, weak muscles, mood swings, anxiety, fuzzy brain, compromised immune function, poor sleep...  Any of this sound familiar?  You do not have to have bipolar to experience chronic high cortisol levels and the poor health that comes as a consequence.

In general, healthy means higher in the morning, lower at night.  Sort of like this:

Bipolar moves the whole curve up from the base line and flattens the curve.  So, not quite enough in the morning, making it a struggle to get out of bed and get going in the morning, and too much at night, leading to difficulty falling asleep.  The upshot is not enough sleep, causing fuzzy brain in the morning, leading to poor performance at work, raising anxiety and cortisol levels as the day goes on, leading to poor sleep, and repeat.

Here is the big deal.  People with bipolar have this flattened cortisol curve and chronically higher baseline even when not in an episode, not depressed, not manic.  This issue could account for much of our lowered life span, on account of cardiovascular disease and metabolic disorders.

Here is the REALLY big deal.  The more episodes of mania and depression, the flatter this curve.  There are those who like to play with mania, or at least hypomania.  If they could get just a little up, they could get an energy surge, accomplish whatever it is they think they need to accomplish.  When they do that, they are damaging their brains.  Full Stop.

Okay, so what to do about it.

When you are digging yourself into a hole, the first thing to do is stop digging.  Don't play with mania.

But how to manage the cortisol curve on a daily basis: life style, life style, life style.  You can do better if you do more than take your meds.

I allow for my difficulty getting up.  I usually plan my day around ninety minutes of brain dead in the morning.  If I have to leave the house early, I wake up early.  I give myself more than the bare minimum to run out the door.  I prep the night before, set out clothes, make a list of the last things I have to pack in the morning, whatever.  Protect myself from my own zombie.

On the other end of the day, I guard my wind-down time.  Agitating or energizing television watching -- most of it is scheduled at my bedtime.  I don't watch it.  Or I watch it on youtube the next day.  I go home early from parties, or skip them altogether if agitating people will be there.
Life style, life style, life style.

There are hundreds of these little tricks.  Sometimes it's a pain in the butt.  But health and stability are worth it.  So future posts will follow this pattern: describe the wonkiness; provide a work around.
Keep your stick on the ice.  We're all in this together.

photo of roller coaster at Wild Adventures by WillMcC,
used under GNU Free Documentation License
The Persistance of Memory by Salvidor Dali
graphic of wave by VOG Designs, used under Creative Commons License
Zombie by Jean-noël Lafargue, used under Free Art License
Flair from


Popular Posts

Loony Saints - Margaret of Cortona Edition

Every once in a while, Prozac Monologues reaches into my Roman Catholic childhood's fascination with saints, especially the ones who today might be assigned a diagnostic code in the DSM.  Twice, Lent Madness has introduced me to new ones that I share with you.

A few years ago it was Christina the Astonishing.

Today it's Margaret of Cortona.  If you're a Lent Madness regular, you'd expect Margaret to be a shoe in for the first round of voting, where her competition is a stuffy old bishop/theologian, because Margaret became a Franciscan and, more significantly, her story features a dog.  Lent Madness voters are suckers for dogs.

Mood Charts Revisited

Mood chart is one of the top search terms that bring people to Prozac Monologues.  I wrote about mood charts in July, 2010, first as a recovery tool and later as a way to illustrate the differences between various mood disorders.  Both posts promised sequels, promises that remained unfulfillable until now that I have spent several months doing cognitive remediation at  Maybe cognitive remediation is worth another post -- later.

Following last week's tale of misdiagnosis and mistreatment, this week's long delayed return to mood charts seems timely.

What is a Mood Chart

Introducing Allen Frances

Allen Frances was the editor of the DSM-IV, first published in 1990.  He is now the fiercest critic of its next major revision, the DSM-5.  For over three years, he has been blogging weekly to this end at Psychology Today.  This week I will summarize his steady drumbeat.  I hope soon to publish an open letter to him.

Frances' complaint in a nutshell is that the DSM-5 creates fad diagnoses and changes criteria of older diagnoses to medicalize a whole range of normal behavior and miseries.  The link lists these problem diagnoses and a number of the following points, in an article published all over town last December.

These issues have been discussed widely, in public and private circles.  I am not qualified to address each point, though I did give a series over to one of them, the bereavement exclusion.  The best of the batch, if I do say so myself, is Grief/Depression III - Telling the Difference, which got quoted in correspondence among the big boys.