Book Excerpt
Bipolar II : Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression -- The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder
by Ronald R. Fieve, M.D.

An excerpt from Bipolar II : Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression -- The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder by Ronald R. Fieve, M.D., published 2006 by Rodale.
Book excerpt reprinted with the permission of the publisher.
Copyright © 2006 Ronald R. Fieve, M.D.

PLEASE CLICK HERE for BOOK PRICE and SHIPPING INFORMATION

BOOK EXCERPT

Bipolar Disorder and Sleep

"How many hours do you sleep on average at night, and what is the quality of your sleep?" are two of the first questions I ask every patient on the initial interview and all subsequent follow-up visits. While the hypomanic usually gloats over how little sleep he needs, getting by on 3 to 4 hours a night, the lack of quality sleep can wreak havoc on his mood and decision-making abilities. Sleep deprivation results in feelings of malaise, poor concentration, and moodiness, and even accidental deaths.

In a revealing sleep study published in the September 2005 issue of the Journal of the American Medical Association, Judith Owens, MD, and her team of researchers from Hasbro Children's Hospital in Providence, Rhode Island, followed 34 pediatric residents from Brown University over the course of 2 years to compare post-call performance to performance after drinking alcohol. During this time, the residents were tested under light call (1 month of daytime duty with no overnight shift, or about 44 hours of work per week) and heavy call (overnight duty every fourth night with an average of 90 hours of work a week). The residents performed computer tasks to gauge their attention and judgment after their light call (after consuming alcohol) and heavy call shifts (with placebo). The residents who were on heavy call and had not ingested alcohol performed worse on the computer tests than those doctors who had taken alcohol and were on light call. Dr. Owens concluded that the residents were so sleep-deprived that they didn't recognize that their own judgment was impaired.

Drugs, stressful situations, and even excessive noise can affect daily body rhythms and moods. Once a Bipolar II mood disorder with disturbed rhythms has begun, it tends to be self-perpetuating, since depression and anxiety are likely to disrupt 24-hour rhythms further. An irregular living schedule can aggravate mood disorders. The old-fashioned sanitarium rest cure was effective with the "nervous" because it put the patient on a regular schedule of sleep, activity, and meals.

Insomnia

How is your sleep? Do you have difficulty falling asleep? Or do you toss and turn most of the night until you fall into a deep sleep just hours before the alarm goes off? A person suffering from insomnia has difficulty initiating or maintaining normal sleep, which can result in non-restorative sleep and impairment of daytime functioning. Insomnia includes sleeping too little, difficulty falling asleep, awakening frequently during the night, or waking up early and being unable to get back to sleep. It is characteristic of many mental and physical disorders. Those with depression, for example, may experience overwhelming feelings of sadness, hopelessness, worthlessness, or guilt, all of which can interrupt sleep. Hypomanics, on the other hand, can be so aroused that getting quality sleep is virtually impossible without medication. In a study at the University of Oxford in the United Kingdom, Allison G. Harvey, PhD, and colleagues in the department of experimental psychology determined that even between acute episodes of bipolar disorder, sleep problems were still documented in 70 percent of those who were experiencing a normal (euthymic) mood at the time. These normal-mood patients with bipolar disorder expressed dysfunctional beliefs and behaviors regarding sleep that were similar to those suffering from insomnia, such as high levels of anxiety, fear about poor sleep, low daytime activity level, and a tendency to misperceive sleep. Dr. Harvey concluded that even when the bipolar patients were not in a depressive, hypomanic, or manic mood state, they still had difficulty maintaining good sleep.

Delayed Sleep Phase Syndrome

This is the most common circadian-rhythm sleep disorder that results in insomnia and daytime sleepiness, or somnolence. A short circuit between a person's biological clock and the 24-hour day causes this sleep disorder. It is commonly found in those with mild or major depression. In addition, certain medications used to treat bipolar disorder may disrupt the sleep-wake cycle. I often recommend chronotherapy to patients. This therapy -- an attempt to move bedtime and rising time later and later each day until both times reach the desired goal -- is often used to adjust delayed sleep phase syndrome. To adjust the delayed sleep phase problem, sleep specialists might also use bright light therapy or the natural hormone melatonin, particularly in depressed patients.

REM Sleep Abnormalities

REM sleep abnormalities have been implicated by doctors in a variety of psychiatric disorders, including depression, posttraumatic stress disorder, some forms of schizophrenia, and other disorders in which psychosis occurs. Special tests, called sleep electroencephalograms, record the electrical activity of the brain and the quality of sleep. From these tests, we know that in people who are depressed, NREM sleep is reduced and REM sleep is increased. Most antidepressant medications suppress REM sleep, leading some researchers to believe that REM sleep deprivation relates to an improvement in depressive symptoms. Yet Wellbutrin XL, a common antidepressant, and some older medications used to treat depression do not suppress REM sleep. Researchers are therefore still trying to determine the connection between the REM sleep mechanism and depression.

Irregular Sleep-Wake Schedule

This sleep disorder is yet another problem that many with Bipolar II experience and in large part results from a lack of lifestyle scheduling. The reverse sleep-wake cycle is usually experienced by bipolar drug abusers and/or alcoholics who stay awake all night searching for similar addicts and engaging in drug-seeking behavior, which results in sleeping the next day. This sleep disruption and irregularity make it much more difficult for the bipolar patient's physician to treat him or her with conventional medications and adjunctive cognitive therapy. In most cases, the patient needs to acknowledge the drug-seeking behavior and get involved in a recovery program such as Alcoholics Anonymous, Cocaine Anonymous, or other group. Talk therapy with a psychologist is beneficial to many patients as they seek to change destructive lifestyle habits and learn new behaviors that will help them adhere to a more normal sleep-wake schedule.

Bipolar II : Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression -- The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder by Ronald R. Fieve, M.D.,
PLEASE CLICK HERE for BOOK PRICE and SHIPPING INFORMATION

BOOK DESCRIPTION FROM THE PUBLISHER

You are on fire. For a few days, you've stayed up late, woken up early, and accomplished your to-do list -- and then some. You've called friends you haven't talked to in ages, organized your closet, finished your project, danced until dawn, and still made it to work on time the next morning. Everyone and everything is great -- you love life! You've finally "made it," and you're feeling fantastic.

Would you like to feel like this all the time? Who wouldn't?

This buzz, this electric, ultra-positive feeling of focus and productivity is called hypomania, a key symptom of bipolar II, a subtype of the bipolar spectrum. Acclaimed author Dr. Ronald Fieve says millions of the most accomplished Americans enjoy just these types of highs on a regular basis. Many people with this condition never seek treatment for their subsequent lows because they treasure their highs and don't want to lose them.

The danger is that undiagnosed Bipolar II has one of the highest rates of depression and suicide among all mental illnesses, because the lows can be so devastating. But Dr. Fieve wants to spread the word that Bipolar II can actually be beneficial, if diagnosed and treated. That's what drove Dr. Fieve, a world-renowned psychopharmacologist and bipolar researcher, to write Bipolar II, the first book exclusively focused on this little-understood condition. He wants to help people make the most of the highs -- and minimize, if not do away with entirely, the devastating lows.

From his preface:

"From the thousands of patients I have treated since the early 1970s, along with the major diagnostic changes of manic depression, I concluded that about half of my Bipolar II patients used their mild hypomanic highs to an advantage. I labeled this group of gifted people as Bipolar IIB (beneficial) and published a medical journal study on this topic in 1992.

"Since then, I have learned so much more about what keeps patients feeling in top form and living highly productive lives. Throughout this book, I want to help you recognize the earliest signs of this increasingly diagnosed soft condition, Bipolar II, and teach you how to be proactive in preventing debilitating episodes. I want you and your family to see how early recognition of the signs and symptoms of mild to severe depression and hypomania (mild mania) will improve the prognosis for Bipolar II, so you can see your doctor immediately for effective treatment. Above all, I want to help you prevent the tormenting high and low moods that often arise with Bipolar II disorder. And with proper treatment and maintenance, you will be able to prevent them."

Bipolar II : Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression -- The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder by Ronald R. Fieve, M.D.,
PLEASE CLICK HERE for BOOK PRICE and SHIPPING INFORMATION

ABOUT THE AUTHOR

Ronald R. Fieve, MD, has published more than 300 scientific papers in the field of bipolar and depression research. His work has been published in such prestigious publications as The Lancet, Nature, The American Journal of Psychiatry, Archives of General Psychiatry, The Journal of the American Medical Association, L'Encephale, and Lithium. Dr. Fieve has also written two widely acclaimed books on mental health, Moodswing and Prozac (translated into five languages). He is professor of clinical psychiatry at Columbia Presbyterian Medical Center and Columbia College of Physicians and Surgeons, Columbia University, and principal investigator, Fieve Clinical Services, Inc. He maintains a private practice in New York City.

Bipolar II : Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression -- The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder by Ronald R. Fieve, M.D.,
PLEASE CLICK HERE for BOOK PRICE and SHIPPING INFORMATION

BOOK REVIEWS

"In his brilliant new book, Fieve -- a founding father in the study of Bipolar II and one of the first to discover its advantages -- addresses the practical problem that bedevils all bipolars: How do you channel hypomania's creative fire without getting burned? If you suspect that you or someone you love is Bipolar II, buy this book -- now!"

-- John D. Gartner, PhD, assistant professor, department of psychiatry and behavioral sciences, Johns Hopkins University Medical School, and author of The Hypomanic Edge

"I am very pleased that Dr. Ronald Fieve has published this book. Dr. Fieve is a pioneer in the recognition and treatment of bipolar disorder, and his previous work, Moodswing, has been an excellent book for patients with this condition to learn about bipolar disorder and its treatments. Bipolar II disorder is an important and common form of the bipolar spectrum. Dr. Fieve's contributions to our understanding and treatment of this disorder are outstanding, and I believe this book will be a must-read for patients who have bipolar conditions."

-- David L. Dunner, MD, director, Center for Anxiety and Depression, and professor, department of psychiatry and behavioral sciences, University of Washington

Bipolar II : Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression -- The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder by Ronald R. Fieve, M.D.,
PLEASE CLICK HERE for BOOK PRICE and SHIPPING INFORMATION