Treating Bipolar Disorder Requires a Treatment Team, Not Just a Treatment Plan

As a mental health clinician and the mother of a professional baseball player, I've spent a lot of time thinking about what sports can teach us about stability, structure, and support. Over the years, I’ve also had the opportunity to work with athletes managing serious psychiatric conditions like bipolar I disorder (BD-I). Through those experiences, I’ve come to believe that mental health care, like athletics, demands coordination, discipline, and mutual support. It works best when it’s treated like a team sport: everyone—patients, providers, care partners, and community members—has a role to play, and no one wins alone.

The power of routine

BD-I is marked by alternating episodes of depression and mania, each with distinct disruptions to mood, energy, and behavior. These fluctuations can impair daily functioning if not properly managed.

While antipsychotics remain the standard of care in managing BD-I, psychosocial support is also critical to long-term wellness. One of the most effective non-pharmacologic strategies to mitigate mood episodes associated with BD-I is the establishment of consistent daily routines, including regular physical activity.

Circadian rhythm disturbances are common in BD-I. Adherence to structured schedules, including consistent sleep and activity patterns, can help regulate mood cycles and reduce the frequency or severity of manic or depressive episodes.

Sports offer a natural framework for this kind of structure. Within the context of sports, routine is inherent: practice sessions occur on set days, game schedules create predictability, and training programs instill discipline. For individuals with BD-I, participating in sports or adopting similar structured routines can provide a stabilizing force. In this way, the consistency that benefits athletes can also support patients by reinforcing daily rhythms and promoting mood stability. When patients, care partners, and clinicians work together to align on treatment plans, support routines, set expectations, and reinforce healthy habits, we create a framework that’s more likely to stick.

Exercise as an extension of clinical treatment

Exercise supports more than just physical health—it serves as a potent modulator of neurochemical activity. Physical activity triggers the release of endorphins, activates the dopaminergic system in the prefrontal cortex, and helps lower cortisol levels, reducing the impact of stress on the mind and body.

These changes do more than improve mood. They can support neuroplasticity, which may help the brain adapt more effectively to mood regulation challenges common in BD-I. They also enhance executive function skills, such as planning, focus, and emotional regulation, that are often impaired during both manic and depressive episodes.

Additionally, exercise can help lift the brain fog many patients report during depressive phases, improving clarity and day-to-day functioning. Regular movement, when integrated into a broader treatment plan, can serve as a valuable tool in restoring a sense of emotional balance and connection to self.

Beyond the brain, exercise delivers benefits throughout the body. People with BD-I are at higher risk of cardiovascular disease, obesity, and metabolic syndromes due to a combination of factors: physiological effects of the disorder, lifestyle patterns associated with mood episodes, and the side effects of some commonly prescribed medications to treat the condition. Regular physical activity can help address many of these, strengthening the connection between body and mind. As I often say to patients, “Physical well-being nurtures mental well-being."

The power of community and accountability

BD-I can be incredibly isolating. The enduring stigma surrounding serious mental illness often discourages patients from disclosing their diagnosis. And when people feel shame, they tend to retreat.

That’s where being part of a team, whether through an actual sports team or by viewing one’s care support network as a team, can be transformative. In both cases, the structure, shared goals, and sense of accountability can foster belonging. The sense of responsibility to others can spark movement even when personal motivation feels out of reach. Over time, that sense of responsibility can help foster connection, and connection can support confidence and engagement in their own care.

This dynamic of shared responsibility and mutual encouragement mirrors what successful mental health care should look like. Care partners, coaches, and players all play a vital role in reinforcing routines and detecting mood fluctuations that may warrant clinical attention.

Community organizations—whether a recreational league, yoga studio, or support group—can provide a sense of belonging that reinforces treatment goals. It’s this network of support that transforms care from a solitary effort into a collective one.