It is common to have Bipolar Disorder with winter depression where people are more depressed in the fall and winter, but manic in the spring and summer.
This seasonal pattern is most pronounced in people with Bipolar Disorder Type II (mild to moderate mania with severe depressive episodes), but people with Type I Bipolar Disorder (severe mania and severe depression) can develop a seasonal pattern when they are partially stabilized with medication.
This seasonal pattern is kind of like hibernating where your energy goes low and you have profound desire to sleep more. The shorter days with decreased sunlight along with colder weather are what trigger this effect. Some neuroscientists have theorized that this hibernation like effect may have provided a survival benefit for ancient peoples living in northern climates because food was more scarce in the winter and the days were short so sleeping more was the best thing to do.
Interestingly, not every one feels sad and depressed at this time even though they are sleeping more. Children and teens often just sleep more, but they do tend to fall behind in school as a result. They can just feel stressed about school, but deny feeling sad or depressed. Other times, they say they are depressed because of school and don’t connect it to their low energy, low motivation and sleeping extra.
Optimizing Mood Stabilizers:
There are a number of options for managing seasonal depression with Bipolar Disorder. The first step is to optimize your mood stabilizers such as lithium and lamotrigine (Lamictal). Contact your psychiatric provider to see if there is room to increase your lithium, which may involve a blood draw since the maximum safe blood level is about 1.2.
Similarly, there may be room to increase your lamotrigine dose since peak effectiveness occurs at about 300mg total per day. Also, spiting your lamotrigine dose into equal morning and evening doses may help slightly. Just be aware that lamotrigine has to be increased slowly due to the risk of life threatening rash, which is more common in children and teens.
Avoid Starting an Antidepressant:
Some psychiatric providers will try to add an antidepressant to your medication, but I find this practice to be dangerous because antidepressants tend to destabilize the mood causing more mania and/or depression than they help. Over my career I have seen hundreds of patients with well known Bipolar Disorder be hospitalized simply because they were put on an antidepressant. Most of the time I would just have to stop the antidepressant and the patient was fine.
Try Adding an Antipsychotic:
Another medication option that is growing in popularity is to add an antipsychotic because several of them have been shown in high quality research studies to prevent Bipolar depression, especially when used over several months. I have been using this option some with my own patients and so far the results have been generally positive when they could tolerate the antipsychotic. Weight gain is often a problem with antipsychotics, but have had good results adding metformin to block that effect.
One of my favorite treatments for seasonal depression in Bipolar Disorder is light therapy. Since decreasing sun light due to increased cloud cover and shorter days along with colder weather is what triggers the depressive effect, increasing light, especially the blue wave lengths, can reverse the effect. Full spectrum lamps (10K lumens or more) are highly effective at reversing all forms of seasonal depression including Bipolar Disorder. There are lower power lamps now (~5K lumens), which some of my patients have responded to, but it is not clear if they work for everyone.
I have my patients start with just 15 minutes every morning, typically starting in October, and we increase the exposure as necessary up to 45 minutes every morning. Since many of my patients are children and teenagers, we sometimes add another 15 minutes of exposure in the afternoon to help them complete their homework, but you have to be extremely careful to not induce insomnia or mania.
There are lower power lamps now that are essentially bright florescent or LED lights, but it is unclear how effective they are or how long you need to use them. However, I have cautionary tale that suggest they do work for at least some people. I have one patient that used to get severely depressed every winter, but one year she started getting severely manic through the fall and early winter. It took a few months and a couple of hospitalizations to figure out the problem.
She had gotten a new “craft lamp” for doing her art work that was very bright and put out a pure white light with lots of blue light. She also liked to work on her art in the evening so with the new lamp she would end up staying up all night working on Christmas presents for her large number of friends and family. She switched to working on her crafts in the morning and stopped getting manic.
Travel to Someplace Sunny:
Of course traveling to someplace sunny can help too, but don’t forget to take your medication or you might get manic. Also, avoid tanning beds even though they do help the depression due to the risk of skin cancer and skin damage. Here’s more information on seasonal depression and places to travel to in my article on regular Seasonal Depression.
If you have any other suggests or questions about seasonal Bipolar depression, please leave them in the comments.