Q:  The Benefits of Exercise

I have been in remission from bipolar I for the past 10 yrs.  I still take depakote SR, work ft. teaching, am 56 yrs. old, had several psychotic episodes with hallucinations etc., but I have been mostly symptom free for 10 yrs.  The illness started about '65; I was on and off lithium since '78-'91; remained on it after my last and most lengthy episode; after a short stint on SSI, I again returned to ft. teaching.  Why don't we hear about more bp in remission or recovery?  Are there any documented studies re: remission?  My pdoc says people are in remission from bp; I know some, but I don't hear about it often, except I have seen several in the hospital who resumed their meds and returned to their jobs, as I did.  Since this is a mental illness one can have remission, why is this not documented or addressed more openly; I would like to read more about remission.  I contribute a lot of my wellness to remaining of lithium or depakote and aerobic exercise for many years.  Also, I don't think enough is said about exercise as a way of reducing stress and enhancing one's well being; pharmacies are getting rich, if you know what I mean.  My mother was bp, too.  I have battled this illness ALL my life and am thrilled to be in remission, but I worked very hard at reducing stress etc.  I cannot take anti-depressants, running and bicycling served me very well.  I see mostly bp being treated with meds only; I don't understand how so many hypomanic people cannot exercise; it seems natural and a logical to do.  Thank you for listening.


Dear Ms' -- 
May I use your letter to teach other folks with bipolar disorder?  I strongly agree that exercise may have excellent "mood stabilizing" properties just like Depakote and lithium.  Unfortunately (relating to your point about the money issue), there is no pharmaceutical company to fund the research to show this effect of exercise, so it is unlikely to have a "randomized controlled trial" as is now the standard in medical evidence for a treatment to be shown to be effective.  

Thus, we will have to rely upon people like you to write "testimonials" to the benefits of a treatment.  Note that unlike many herbal remedies, or other basically untested treatments, your approach carries very little risk (unless one overdoes it somehow, or has some unrecognized underlying heart problem, for example; thus the usual "check with your doctor first" warning about exercise).  

In fact, as surely you are aware, it even has multiple other health benefits.  If the effects of exercise could be put in a pill, everyone would want to take it!  And finally, exercise basically comes at no cost at all.  As the Harvard bipolar expert says, "here's what you do: go to your doorway, look at your watch, walk seven and a half minutes in any direction you choose, then walk home.  Do that every day and you'll have an excellent basic program".  Therefore, unlike many other "remedies", exercise can be tried at low risk and very low cost, and even if it doesn't work as a mood stabilizer, it's very likely to have other major health benefits.  

So why doesn't everybody adopt such a program?  That's a good question.  The answer turns out to be pretty complicated (it's been studied fairly extensively).  I've thought about requiring everybody whom I treat to "take the exercise pill" before I give them anything else -- wouldn't that be something, to have to do something so sensible?  But among many limiting factors, as you might have had to work through yourself once, there is this huge one:  while it is very hard for a person who's feeling pretty well to start an exercise program -- just look at how few people routinely do it -- , it's much harder for a person who's overwhelmed by symptoms to do so (especially depression, and perhaps even most especially bipolar depression, which often completely saps a person's ability to feel motivated to do anything, let alone exercise).  

So I'd love to use your letter to "advertise" the benefits of exercise from the point of view of someone who's really seen the effects, and found them to be as good -- clearly better in the long run -- as medications.  I'd remove anything that identifies you directly if you would allow me to reprint it here and on my website as well.  Thanks for writing. 

Dr. Phelps