Morning Faces Therapy For Bipolar Disorder: A Story (Part 2: First Two Months)

In the 1990s, I discovered that if I see faces on TV early in the morning, I feel better (happier, more eager, more serene) the next day, but not the same day. Faces Monday morning, for example, make me feel better on Tuesday but not Monday. I studied this effect extensively. The results suggested that a circadian oscillator controls our mood and sleep and needs morning face exposure to work properly. Absence of morning face exposure, this theory says, increases your risk of depression — a view not compatible with the “chemical imbalance” explanation of depression but one supported by the strong association between depression and insomnia.

I told friends about this. One of them had devastating bipolar disorder. As he describes here and here, he got great benefit from looking at faces in the morning. After I posted his account of his experience, a man I’ll call Rex wrote me that he was going to try it. At 29, he was diagnosed with bipolar disorder. At 32, he slit his wrists. He is now 37.Since then he’s been in and out of mental hospitals. Now he lives at home. I wanted to follow his use of morning face therapy “prospectively” — before knowing what would happen. I posted this, about his background, around the time he started.

Treatment details. He began about two months ago. He gets up naturally (no alarm) at about 8 am. He starts watching faces on TV — Squawk on the Street (CNN) — soon after he gets up. He watches for 1-2 hours on a 43-inch high-definition TV; the faces are roughly life-size. He sits 10 feet away.

Mood. Before starting the faces, he was in a depressed mood 5-7 days per month. During those days he had low energy, low motivation, and a bad attitude. The low phases would last a few days, then he’d start feeling better. Now, he says, “my mood is better first thing in the morning. I feel ready to go, turn the TV on, watch something. I feel a little lighter. I no longer feel the early morning doom that I used to feel. I’ve never been a morning person, but I feel that way more now than any time I can remember. I haven’t had any depressed moods since I started the faces. I haven’t had any really adverse or negative emotions. Things are going very smoothly. I have less worries, I feel a more uplifting, upbeat tempo throughout the day. Everything seems better.” (Note: Morning faces likewise shifted me toward being a morning person.)

Medication. He used to take an antidepressant every day (Simbalta, 60 mg/day). Now he takes 30 mg once every 3 to 4 days. He’s tried to stop taking it entirely but gets withdrawal symptoms (headache, nausea) when he does that. Note that he still had 5-7 days/month of depressed moods every month even when taking the antidepressant. In the spring his depression was better so he cut back slowly on the medication.

Sleep. For a long time he has had great difficulty falling asleep. He would lie in bed for an hour without falling asleep. He took sleep medication, usually Lunesta or Ambien, very often. “Lots of times in the past I would give up [after lying in bed a long time] and go watch TV. Or start to read, stay up to 2:30. That’s always been a problem — ever since I was in college. In college, my sleeping schedule went nuts. When I got into the working world, it continued to where I would stay up late and couldn’t sleep.” Since he started the morning faces, his sleep is much better. He usually falls asleep within 20 minutes of lying down, a very noticeable difference. He has taken much less sleep medication — about 20% of what it was before. (He still takes it when he knows he has to get up early or he feels wired.) At one point, when he took antipsychotics, he did fall asleep quickly “but the side effects were awful,” he said. “Grogginess, foggy head all day. I didn’t have as much mania and depression but I would sleep 11 hours per night and I couldn’t get out of bed in the morning. I couldn’t concentrate. I couldn’t go back to college, because I couldn’t think clearly.”

At the same time he started the faces, he started getting blue light exposure in the morning from a blue light box called the Apollo Health goLITE. He started with 20 minutes of exposure. It did seem to improve his mood and make him feel tired earlier. However, it also made him feel anxious and tense. To try to get rid of this effect, he reduced the exposure: 10 minutes, 5 minutes, 2 minutes. After a week, he stopped using it altogether.

“I’m just ecstatic about the results,” he said.