Q:  Is This a Common Pattern with Mania?

My son has been treated for bi-polar. He seems to cycle into mania about once a month.
A period of about 5 days with little sleep, followed by 2-3 days of just sleeping only getting up to pee. Is this a common pattern with mania? (the sleeping for days) or could he have a thyroid condition/hormone? He did have thyroid storm last year. thanks.


Dear Ms. B.' --

Although the rate at which he is cycling back and forth between these two phases is very high, the pattern of sleep you describe is indeed quite classic. This "decreased need for sleep" is one of the most well recognized symptoms of the manic phase; and the dramatic increase in sleep, 16 hours per 24 hours or even more sometimes, is also one of the most well recognized symptoms of the depressed phase.

These rapid cycling rates are often seen in younger people, whereas in adults this would be rather unusual. However, cycle rate itself is not generally regarded as important in making this diagnosis. Instead, it is the pattern that matters, just as you have described.

There is clearly some sort of connection between thyroid and bipolar disorders, so that episode of thyroid "storm" (a phase of being extremely hyperthyroid) may indeed be connected in some way to the current apparently bipolar symptoms. However, psychiatry does not sufficiently understand the connection between these two conditions. Indeed, all that is recognized is that they occurred together more often than one would expect. As a result, there is no clear path toward treatment which results from recognizing this connection; in other words, there is no recognized way to treat the bipolar symptoms by treating with a focus on the thyroid problem or history. 

The one exception to this statement is the research work underway at UCLA, where a rapid cycling bipolar disorder has been treated with very high doses of thyroid hormone, with some success. Don't get too excited about this, as this research is in quite preliminary stages, and moving slowly because there is no pharmaceutical company funding driving it. You will find a summary of their work on my webpage about Thyroid and Bipolar Disorder.

Dr. Phelps

Published July, 2007