Bipolar disorder is a mental illness, predominantly characterized by changes in mood. Although this differs from person to person, many people with bipolar disorder experience periods of time feeling very low, which is called a depressive episode, alternating with a very high or elated mood, called a manic episode [1]. Episodes typically last for two weeks or longer, although some people may experience slightly shorter episodes. People may also experience a different severity of episodes, such as hypomania, which may go unnoticed, or only episodes of mania with few to no depressive episodes [2]. This can sometimes make diagnosis more challenging, and bipolar disorder can sometimes be undiagnosed or misdiagnosed because of these differing experiences and symptoms. During a mood episode, you may experience severe changes in your mood, behavior, and sleep. As such, bipolar disorder can be hugely disruptive, or even destructive, to your quality of life. While the exact cause of bipolar disorder is not known, there is evidence to suggest that certain chemicals in the brain, as well as family history and genetics, can play a part in the development of the medical condition, while environmental and social occurrences can contribute to episode triggers [1][2][3].

Types of bipolar episode

Bipolar disorder is typically categorized by episodes of depression and episodes of mania. As mentioned, this varies from person to person; some may experience episodes of under a week, while others may experience a single episode lasting for a period of months.

Manic episode

During a manic episode, it is common to experience a decreased need for sleep, while also feeling very active and alert. Many people don’t feel the need to sleep at all while in the midst of a manic episode, and they do not feel tired, despite their lack of sleep.

A manic episode may cause you to become extremely talkative, have many ideas and thoughts, be unable to relax or stop activities, be impulsive, and experience feelings of grandiosity, such as feeling especially important, clever, or invincible [1].

Sometimes during a manic episode, a person may spend huge sums of money, or engage in reckless and dangerous behavior, so medical intervention might be required. A severe manic episode may require hospitalization if behaviors become unsafe [2][4].

On the other hand, bipolar symptoms might be mild, even occasionally going unnoticed by others. In some cases, manic symptoms such as increased productivity may be desirable. In these instances, a diagnosis may not be discovered, or a person may skip their medication, for fear of losing productivity or feelings of elation, which may result in a worsening of the condition.

Depressive episode

During a depressive episode, it is common to experience low mood, either insomnia or a large increase in need for sleep, thoughts of suicide, feeling hopeless and worthless, and a lack of enjoyment in usually enjoyable activities [1][2].

A depressive episode may cause you to withdraw from others, avoiding social events and activities. This can have a severe impact on personal and professional relationships, thereby contributing to a worsening of depressive symptoms.

A depressive episode may last between two weeks and several months, could occur rarely or regularly, and there may be no pattern as to when or how long the episode will be present [2].

Common bipolar triggers

A manic or depressive episode may be triggered by a number of things, often differing for each person. However, research does suggest that there are specific events or circumstances that can contribute to an episode occurring.

Sleep

There is a great deal of evidence to suggest that a lack of sleep can cause an episode (most often mania) in people with bipolar disorder, whether this is due to poor sleep hygiene, working shifts, insomnia, jet lag, or substance use [5][6].

For all people, and especially those with bipolar disorder, a regular sleep cycle is imperative to mental well-being. Research suggests that sleep helps to regulate emotions and the ways in which they are processed in the brain. Therefore, a lack of sleep can greatly contribute to emotional instability, causing a bipolar episode.

Unfortunately, sleep is often greatly affected by bipolar episodes, so it can be very difficult to manage once a manic or depressive episode has begun [1][6]. As such, it is important to form and maintain a healthy and regular sleep cycle, and to be aware of any mood changes commencing after a period of disturbed sleep.

Life events

There are many events in life that can contribute to the occurrence of a bipolar episode, due to stressors and changes [7][8][9]. Often, negative life events cause a depressive episode, while positive life events can cause a manic episode [7].

For example, losing your job, the death of a loved one, or a relationship breakdown could contribute to an increase in stress and emotional instability, leading to a period of low mood and a depressive episode.

Similarly, getting a new job or promotion, beginning a new relationship, and even going on a vacation could contribute to feelings of elation, leading to a manic episode. Some people even find that negative life events cause a manic episode.

This varies for everyone, as people cope with stressors and big events in different ways, and often have different responses to different circumstances. What may trigger an episode for one person might not have the same effect on another.

Medication

Unfortunately, while antidepressant medication may be helpful in managing depressive episodes, it has been found that it may also trigger a manic episode [1][3][8].

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline, are often very helpful for lifting mood during a period of depression, but for people with bipolar disorder, they can cause a dramatic mood swing from depression into elation, thereby causing a manic episode.

If you are prescribed antidepressant medication for depressive episodes within bipolar disorder, it is likely that your doctor will also prescribe medication with a mood stabilizing effect, to help prevent a manic episode from your antidepressant medication. Many people with bipolar disorder are prescribed a combination of medications, to increase the likelihood of a beneficial outcome [1][2].

Alcohol and drugs

Alcohol and substance use can have drastic impacts on the mental well-being of all people, but particularly those with bipolar disorder. Alcohol and recreational drugs can greatly impact the way your brain functions and cause changes in the way brain chemicals called neurotransmitters are released and utilized in the brain, contributing to emotional instability [2][8][10].

This alone can cause manic and depressive episodes, but especially when combined with certain prescribed medications, such as mood stabilizers. Street drugs and medications can interact poorly with each other, causing a decrease in the effectiveness of your medication, and an increase in the risk of serious side effects.

Therefore, it is highly recommended that people with bipolar disorder avoid the use of alcohol and drugs, taking only the medications that are prescribed to them by their doctor.

Childbirth

Many studies have suggested a link between pregnancy and childbirth, and bipolar episodes.

It has been found that the risk of a bipolar episode is much higher in the four weeks following childbirth, with slightly increased risks during pregnancy. This can be the case in women with a previous diagnosis of bipolar disorder, as well as those with no prior mental health history [2][11].

The reason for this is not entirely clear, but may be due to several factors, such as hormonal changes, life changes, and sleep deprivation.

It is especially important for women with bipolar disorder who are pregnant or planning to become pregnant to regularly consult with their doctor about the safest and most effective treatment plan during this time. Bipolar disorder and the associated medications can cause many risks to mother and baby, but there are ways to manage and alleviate certain risks.

Menstrual cycle

Some women experience body and mood changes prior to the commencement of their menstrual cycle. Some women with bipolar disorder have an increased risk of experiencing an episode during this time, especially a depressive episode [12].

While hormonal changes are expected during the menstrual cycle, it is possible to manage these changes, so they do not result in extreme changes in mood. A doctor can advise on how to treat mood symptoms related to the menstrual cycle, to reduce the risk of a mood episode.

How to deal with triggers and manage bipolar disorder

Regular appointments with a medical professional

It is hugely important to attend all appointments with the medical professional who helps you manage your mental health condition, whether this is a general practitioner, psychiatrist, mental health nurse, or social worker.

This person, or persons, is trained to help you manage your condition, notice any concerning changes in your mental state, and advise you on your treatment. You can utilize their knowledge and advice and ask them questions about your condition or treatment.

Medication

If you are prescribed medication for your condition, it is important that you take it exactly as it is prescribed to you. Missing doses, taking extra, or suddenly stopping your medication could have a serious impact on your mental and physical health.

If you have questions or concerns about your medication, consult with your doctor, as they can advise you on the benefits and side effects of your medication, or discuss any alternatives, should you or they consider it necessary to change or add a medication.

Bipolar disorder often requires lifelong treatment, so you may need to take medication on an ongoing basis, to best manage your condition.

There are several types of medication used to treat bipolar disorder, such as lithium, anticonvulsant medications, antipsychotic medications, and benzodiazepines, along with antidepressants.

Pregnancy and breastfeeding may require changes in your dosage or type of medication, so ensure you discuss this with your doctor, to keep you and your baby safe, while continuing to manage your symptoms.

Therapy

While medication can help to alleviate some of the symptoms of your condition, it does not cure it. Various types of therapy are available to help you understand your condition and learn ways to cope with the symptoms you may experience, providing you with the tools you need to live a good quality of life [1][2].

Cognitive behavioral therapy can help with symptoms of depression and anxiety, helping you to manage and cope with negative thoughts, and to learn helpful behaviors and coping strategies for difficult or triggering events and circumstances. This could allow you to encounter a triggering situation without an episode occurring.

Other useful therapies include family therapy, group therapy, and psychotherapy, all of which can help you and your loved ones better understand and manage your condition, focusing on helpful coping strategies, support, and self-care.

Consistent sleep patterns

Having a consistent sleep cycle can provide huge improvements to your mental well-being. Sleep is mentally and physically restorative, and having a regular and substantial rest period can prevent severe bipolar episodes from occurring [5][6].

Aim to go to sleep and wake up at the same time each day. If you struggle to sleep, you can practice good sleep hygiene, by forming routines for bedtime, avoiding caffeine and TV or phone screens, and doing something to help you wind down before bed, such as reading a book, meditating, or other calming activities.

Your body has an ingrained clock, called a circadian rhythm or sleep-wake cycle, that determines when and how long you should sleep within a 24-hour period. Disrupting this cycle can have negative effects on physical and mental health, so a consistent sleep cycle is one of the most important things to add to your treatment plan [13].

Daily structure

Having a plan or structure for each day can help to prevent stress, as well as provide consistent times to eat and sleep. It doesn’t need to be complex and could just consist of very basic goals for your day, such as getting out of bed, eating, taking your medication, or showering at set times.

Consider creating a consistent daily structure that works for you. Consistency and goal setting can help to prevent severe changes in your mood, decreasing the chance of an episode occurring. It may also help you to feel grounded and in control, should you feel your mood beginning to change.

Exercise

Exercise, fresh air, and sunshine can all contribute to stabilizing mood and preventing severe changes that lead to an episode [1][2].

Consistently engaging in exercise, whether it is for short or long periods of time, alone or with others, can help to prevent negative changes in your mental state.

How you exercise is up to you; you might like to go and play a sport with your friends, or you might prefer to work out alone at home or in the gym. Alternatively, you may prefer to do an online yoga video in your bedroom. Any and all exercise can be beneficial, so choose something you enjoy.

Try to get outside regularly, as vitamin D (from sunshine) has been shown to improve mood. If you don’t feel up to doing a big work out, going for a walk outside can be just as beneficial to your mental well-being.

Mood diaries or tracking

You might find it useful to track your mood in a diary. This doesn’t have to be extensive, and if you don’t want to write a long journal, you can simply chart your mood (happy, sad, irritated, tense, etc.).

Keeping track of your mood can help you to understand triggers, notice certain things that improve or worsen your mood, and make it easier to avoid or increase certain activities or situations that impact you. All of this helps you to manage your symptoms and prevent an episode from occurring [1][2].

Resources:

  1. National Institute of Mental Health. (Reviewed 2022). Bipolar Disorder. NIMH. Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder
  2. The National Alliance on Mental Health. (Reviewed 2017). Bipolar Disorder.NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Bipolar-Disorder
  3. Proudfoot, J., Doran, J., Manicavasagar, V., & Parker, G. (2011). The Precipitants of Manic/Hypomanic Episodes in the Context of Bipolar Disorder: A Review. Journal of Affective Disorders, 133(3), 381-387. Retrieved from https://doi.org/10.1016/j.jad.2010.10.051
  4. Dailey, M.W., & Saadabadi, A. (2022). Mania. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493168/
  5. Lewis, K.S., Gordon-Smith, K., Forty, L., Di Florio, A., Craddock, N., Jones, L., & Jones, I. (2017). Sleep Loss as a Trigger of Mood Episodes in Bipolar Disorder: Individual Differences Based on Diagnostic Subtype and Gender. The British Journal of Psychiatry, 211(3), 169–174. Retrieved from https://doi.org/10.1192/bjp.bp.117.202259
  6. Gold, A.K., & Sylvia, L.G. (2016). The Role of Sleep in Bipolar Disorder. Nature and Science of Sleep, 8, 207–214. Retrieved from https://doi.org/10.2147/NSS.S85754
  7. Johnson S.L. (2005). Life Events in Bipolar Disorder: Towards More Specific Models. Clinical Psychology Review, 25(8), 1008-1027. Retrieved from https://doi.org/10.1016/j.cpr.2005.06.004
  8. Kvarnstrom, E. (2018). Understanding Bipolar Disorder Triggers and How to Prevent Them.Bridges to Recovery. Retrieved from https://www.bridgestorecovery.com/blog/understanding-bipolar-disorder-triggers-and-how-to-prevent-them/
  9. Lex, C., Bäzner, E., & Meyer, T.D. (2017). Does Stress Play a Significant Role in Bipolar Disorder? A Meta-Analysis. Journal of Affective Disorders, 208, 298-308. Retrieved from https://doi.org/10.1016/j.jad.2016.08.057
  10. Sonne, S.C., & Brady, K.T. (2002). Bipolar Disorder and Alcoholism. Alcohol Research & Health, 26(2), 103–108. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683827/
  11. Gilden, J., Poels, E.M.P., Lambrichts, S., Vreeker, A., Boks, M.P.M., Ophoff, R.A., Kahn, R.S., Kamperman, A.M., & Bergink, V. (2021). Bipolar Episodes After Reproductive Events in Women with Bipolar I Disorder, A Study of 919 Pregnancies. Journal of Affective Disorders, 295, 72–79. Retrieved from https://doi.org/10.1016/j.jad.2021.08.006
  12. Teatero, M.L., Mazmanian, D., & Sharma, V. (2014). Effects of the Menstrual Cycle on Bipolar Disorder. Bipolar Disorders, 16(1), 22–36. Retrieved from https://doi.org/10.1111/bdi.12138
  13. Gold, A.K., & Kinrys, G. (2019). Treating Circadian Rhythm Disruption in Bipolar Disorder. Current Psychiatry Reports, 21(3), 14. Retrieved from https://doi.org/10.1007/s11920-019-1001-8