How to Survive Bipolar Disorder

What can individuals with bipolar disorder do to maximize their chances of staying alive?

Bipolar disorder is a challenging illness. It used to be called manic depressive disorder, and it has one of the best textbooks ever published in the discipline of psychiatry.

The authors of the book include one person who lives with bipolar disorder, none other than the prolific author Kay Redfield Jamison.

Buy Manic Depressive Illness and Recurrent Depression on Amazon (affiliate link)

GSK used to hand this out for free…well played, well played.

Kay and I have never met. For somebody I've never met, her thinking has influenced my life tremendously.

Prior to becoming a very publicly bipolar author, she was a very privately bipolar Psychologist who did a remarkable amount of scholarship and clinical care. When she decided to come out about having bipolar disorder, she decided to stop seeing patients. That decision always bothered me. Why should a patient with bipolar disorder not get the benefit of a clinician who actually understands what they're going through?

So, when I came out about having bipolar disorder to my colleagues, and again when I started writing about it? I didn't stop seeing patients. It was a bit of undoing for a decision Kay made, in Kay's life, for reasons that made sense to Kay, that I took issue with in my heart.

I wish there were more healers for the me I was at age 20, who I knew would understand. It felt very lonely, as a young person, to look at all these put-together doctors and not know that any of them actually understood what I was going through. It later turns out many of the doctors who cared for me also shared this secret affliction, I would learn only decades later.

When it came time for me to choose what to do with my career and with my voice as I became a writer, I did the opposite.¹

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Today's article is about a subset of those lessons. Here are a few “how tos” for those seeking to stay alive with bipolar disorder

Bipolar disorder is an episodic illness. Sometimes, and not other times. That is the sine qua non of bipolar disorder. Another crucial, if not literally mandatory, feature is the nature of bipolar disorders’ circadian connection. The moods of bipolar disorder are profoundly related to the cycles of the Earth. In the late fall, during the second and third weeks of October in the northern hemisphere, the amount of daylight changes rapidly. Daylight saving time was invented to address this phenomenon, giving us a little bit of light, a little bit later.

The earth’s tilt is not subtle, and the higher or lower you live on the surface of the globe, the more profound its impact on your underlying biology, and for individuals with bipolar disorder, that is deeply connected to mood.

So, tip one, for individuals with bipolar disorder, I want to live a life with less chaos based on variability in their mood? Consider a Move towards the equator.

There is some negative data for this approach based on mood self-report, I’ll note². However, when scientists used a hard endpoint—suicide attempts—they found a significant relationship between the amount of light hitting the patient on their spot on the globe and fewer suicide attempts in bipolar individuals:

There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. … All estimated coefficients were significant at p < 0.01.³

For many of my patients and my friends with the illness, moving to Texas, Florida, or even Costa Rica can be remarkably stabilizing if depression is the primary driver of unwellness.

Variability in the amount of light in the day is, depending on how finely tuned your underlying biology is, poisonous to the ability to maintain one's mood within expected and tolerable parameters.

The closer to the equator you live, the more stable your life may become with respect to depression or suicide attempts. The trade-off is that at least one study noted more average episodes of mania in bipolar sufferers in equatorial zones:

Data on the total episode number and number of manic and depressive episodes separately was available in 439 subjects. The subjects had been ill for 7.45 years, had experienced an average of 3.29 episodes of mania and 1.08 episodes of depression. Thus episodes of mania were seen to be more frequent.⁴

A subsequent paper—by more authors than I’ve ever seen on a science paper in my life—evaluated an even larger cohort of bipolar patients and their location on the globe.

Solar insolation is a fancy way of saying “amount of sunlight.” This large 2024 study found that other factors matter in suicide attempts:

The crucial outcome here is as follows:

Comparing the ratio of the minimum insolation/maximum insolation of 1 near the equator and a ratio of the minimum insolation/maximum insolation of 0 at a pole, the odds of a suicide attempt increase by 45%.⁵

That is to say, as you move from the equator to the poles, as an individual with bipolar, there is a massive increase in the risk of suicide attempt!

It was protective to have state-sponsored religion in the country where you grew up, which, of course, could be a proxy for several other factors like genetics. It’s also notable that the “state-sponsored religion’s” protective effects might be related to the fact that those state sponsors are often Islamic, and that might change the risk of exposure to alcohol or substance use disorder, another predictor of death by suicide.

Help surviving bipolar disorder? Well, one evidence based strategy is clearly to move towards the equator, and that same data set suggest that avoiding alcohol and drugs will also help reduce the risk that attempt suicide. People who don't attempt suicide don't die by suicide.

You can't modify when you were born, you can't modify the country in which you were born, but you can avoid alcohol and drugs. And some people can choose where they live.

Fly south, my snowbird brethren!

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If you’d like care for your bipolar disorder, or that of your family, consider Radial, where I’m pleased to work.

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Some additional resources:

BPD vs. Bipolar

What is Bipolar Disorder?

Alcohol is Bad Medicine in Bipolar Disorder

Of Cycles and Bipolar Disorder

1. To be clear, I don’t think Dr. Jamison’s decision was bad. I recognize that we learn different lessons when we make different decisions. One of those things I’ve learned is the protective power of maintaining a professional career while living with an acknowledged diagnosis that, at least for some people, you could’ve kept hidden.

2. Bauer, M., Glenn, T., Grof, P., Rasgon, N. L., Marsh, W., Sagduyu, K., ... & Whybrow, P. C. (2009). Relationship among latitude, climate, season and self-reported mood in bipolar disorder. Journal of affective disorders, 116(1-2), 152-157.

3. Bauer, M., Glenn, T., Achtyes, E. D., Alda, M., Agaoglu, E., Altınbaş, K., ... & Tatebayashi, Y. (2021). Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder. International journal of bipolar disorders, 9(1), 26.

4. Narayanaswamy, J. C., Moily, N., Kubendran, S., Reddy, Y. J., & Jain, S. (2014). Does latitude as a zeitgeber affect the course of bipolar affective disorder?. Medical Hypotheses, 83(3), 387-390.

5. Ritter, P., Glenn, T., Achtyes, E. D., Alda, M., Agaoglu, E., Altınbaş, K., ... & Tatebayashi, Y. (2024). Association between a large change between the minimum and maximum monthly values of solar insolation and a history of suicide attempts in bipolar I disorder. International Journal of Bipolar Disorders, 12(1), 43.