Q:  Controlling Bipolar-Purely Chemical?

Dear Dr. Phelps,

I have bipolar disorder, and seem to be very sensitive to my meds.  When I start going into a depression if I up my antidepressant (and I'm on a very low dosage of Celexa), then I start to get manic symptoms quite quickly.  The problem is, my manias are almost never "pure" manias.  I almost always go right into mixed states.  These are awful.  

My question is this.  I realize the need for meds.  They are lifesavers for me.  But do you think it is possible to avoid a clinical depression and/or mania by the way we handle life events in addition to our meds, or is it purely chemical?  How much control do we have? Are we purely at the mercy of these neurons and med changes?

Thanks.
Shannon

Dear Shannon -- 
The usual answer: "both".  There may be quite a bit you can do, either via therapy or exercise (a clearly effective antidepressant that not only does not induce mania but may act as a mood stabilizer also), or spiritual support, or even some approaches like "dark therapy" may be worth looking at.  

Then there are the meds.  You're still having cycles of depression, right?  It's starting to look like a consensus among mood experts now: address this problem by adding mood stabilizer, not by adding antidepressants that just continue or exacerbate the cycling.  I think there's even good consensus that if you're having rapid cycling, one of the best treatments is....taper off the antidepressant.   In my experience, if you go slowly (like several months to get off, even from low dose) the depression does not get worse and the problem overall gets better. 

You are not at the mercy overall, only in the short run while you work on these kinds of changes.   Good luck with your regular exercise program (as long as your doc' says it's safe to begin, you can check out some basics here). 

Dr. Phelps