Bipolar disorder is characterized by unusual shifts in mood and energy. These shifts, called “mood episodes,” last at least a week in the case of mania (feeling extremely “up”), and at least two weeks in the case of depression (feeling extremely “down”).
Mania and hypomania share the same symptoms, according to Mayo Clinic, which include:
- Feeling unusually upbeat, euphoric, or irritable, with increased energy
- Elevated mood
- A decreased need for sleep
- Racing thoughts
- Trouble concentrating or distractibility
- Poor judgment
In cases of mania, these symptoms are severe enough to cause significant problems in your day-to-day life. For instance, you might be unable to go to work or school, or you may be compulsively spending money.
Hypomania is considered a less severe form of mania. In cases of hypomania, your daily functioning isn't significantly impacted. For example, you’re usually able to work and socialize.
Symptoms of depression can disrupt people's daily lives, too. According to Mayo Clinic, the symptoms include:
- Loss of interest or pleasure in most or all activities
- Sleep issues
- Difficulty concentrating
- Restlessness or slowed behavior
When mood episodes are severe enough, they can have an even more profound effect on your life. Some episodes of depression and mania are accompanied by loss of reality or psychosis, characterized by hallucinations or delusions. "And unfortunately, suicide is common," says the psychiatrist Jeffrey Bennett, MD, an associate professor of clinical psychiatry at the Southern Illinois University School of Medicine in Springfield.
Suicide deaths are 10 to 30 times more common among people with bipolar disorder than the general population, according to research published in July 2021 in Translational Psychiatry.
What’s more, with recurrent episodes, some people with bipolar disorder may experience less complete periods of remission and a greater likelihood of relapse, either to depression or mania, Dr. Bennett says.
Can these episodes be avoided? Perhaps not. But if you're aware of certain triggers you may find it easier to manage bipolar disorder. Watch out for these common culprits.
One of the most common bipolar triggers is stress. In a study published in the Journal of Affective Disorders, negative or stressful life events were associated with subsequent mood episodes. It appears that earlier in their course, episodes of depression or mania in bipolar disorder are triggered more often by stressful life events.
While causes of stress are highly individual, certain life events and lifestyle patterns — such as sleep or relationship issues — may act as triggers.
Changes in Sleep Patterns or Lack of Sleep
A change in your sleep pattern is a hallmark symptom of bipolar disorder — but it can also be a trigger.
Shift workers, people who work long and variable hours, and students who are short on sleep are all at risk for a recurrent mood episode related to a lack of sleep. "In addition, travel beyond one's time zone can be another trigger for a mood episode," says Bennett.
Interpersonal and social rhythm therapy (IPSRT) is one of the most effective preventive measures, Bennett says. This treatment approach, available in group as well as individual sessions, helps you develop an orderly life schedule of sleep, diet, and exercise habits to help you more effectively manage your bipolar disorder.
Other forms of therapy, including psychoeducation and cognitive behavioral therapy (CBT), can also be helpful in managing the condition.
Blowout Arguments With Partners, Coworkers, or Friends
Broken relationships are too often the result of untreated bipolar disorder.
But getting into a spat with a loved one can also be a red flag: Your argument could be due to the irritability that often occurs during a manic or depressive episode, or could itself cause stress that becomes a contributing factor for a recurrent episode.
Any type of relationship conflict — whether it’s with your partner, coworker, family member, or friend — can trigger stress and send you over the edge. In another study published in the Journal of Affective Disorders, people with bipolar disorder said negative social experiences were among the events that triggered suicidal thinking for them.
Bad Breakups or Marriage Breakdowns
A number of people with bipolar disorder — especially those with a history of severe manic episodes — experience a breakdown in their marriages. If you’re going through a divorce, working with your therapist through what is often a drawn-out and extremely stressful process can help.
You might consider a durable power of attorney that allows someone else to make major decisions for you, such as financial ones, when you are going through an episode of depression or mania in relation to or during a breakup.
In fact, assigning a durable power of attorney could be useful for anyone who might be experiencing an episode of bipolar disorder.
Alcohol Misuse and Drug Intoxication, and the Aftereffects
Misusing drugs and alcohol doesn’t cause bipolar disorder, but it can cause an episode to suddenly occur, or it can worsen the underlying illness. What’s more, about one in five people with bipolar disorder have a substance abuse disorder, according to an analysis of data on young adults with mental illness published in the journal Social Psychiatry and Psychiatric Epidemiology.
Intoxication with drugs such as cocaine and amphetamines can cause or worsen manic symptoms, while the aftereffects of cocaine or alcohol use are associated with worsening depressive symptoms.
Antidepressants, Corticosteroids, and Other Medication
Can antidepressants make you manic?
The treatment of bipolar disorder can trigger episodes of mania by further setting off unstable moods and behaviors. Many psychiatrists say they've seen patients enter a manic phase after starting antidepressants — and some feel uncomfortable prescribing them to people with bipolar disorder.
What should you do about bipolar depression? Until more research is available on long-term safety, Keming Gao, MD, PhD, a professor of psychiatry at Case Western Reserve School of Medicine in Cleveland, and the director of the mood disorders program at the University Hospitals Cleveland Medical Center suggests the following: For bipolar I depression, antidepressants should be used only with a mood stabilizer or stabilizers after symptoms haven't responded to FDA-approved treatment options (such as mood stabilizers).
Dr. Gao says that while some recent studies suggest that antidepressants alone are as effective as lithium taken alone for some people with bipolar II (those who haven't experienced a manic episode), they should never be used alone for bipolar I depression, and patients and doctors should consider discontinuing use of antidepressants once symptoms have improved.
Other drugs that have been linked to manic symptoms include corticosteroids, thyroid medication, and appetite suppressants, says Gao.
A Brand-New Season and Abnormal ‘Clock Genes’
About 20 percent of people with bipolar disorder experience fluctuations in mood when the weather changes. Specifically, they're more likely to undergo seasonal depression during the early winter, and mania or hypomania during the spring or summer, according to a research review published in the Journal of Affective Disorders.
Experts chalk this up to sunlight: Your circadian rhythm, the body’s internal response to changes in a 24-hour day, is affected by the amount of sunlight you get each day. This response is controlled by a complex set of genes commonly referred to as “clock genes.” If some of these genes are abnormal, you could be at risk for seasonal bipolar disorder.
Pregnancy Along With Altered Sleep Patterns and Shifting Hormones
People with bipolar disorder have an elevated risk of a mood episode in the postpartum period — the weeks and months after giving birth — according to research published in the Lancet.
Changing sleep patterns, altered medication prescriptions, and shifting hormones after delivery can combine to serve as risk factors for a postpartum mood or psychotic episode, the researchers wrote.
Bipolar disorder is also strongly associated with postpartum psychosis, a severe mental illness characterized by an inability to respond emotionally to one's newborn, or by thoughts of harming one's baby, according to the Cleveland Clinic.
During your pregnancy, be sure to work with your entire medical team — your bipolar disorder specialists and your ob-gyn — on treatment approaches you can try during and after pregnancy to help prevent postpartum depression, postpartum mania, or postpartum psychosis.
Financial and Emotional Issues Caused by a Job Loss
One of life’s most unpredictable stressors? Losing your job.
And the emotions you may feel about your job loss can be equally unpredictable. People who weren’t satisfied with their work may find it liberating. For others, the financial and emotional strains involved can trigger major stress. Either way, the dramatic shift in emotions could trigger a bipolar episode.
It may be a good idea to try to put away three to six months' worth of savings to help with the transition in case you lose your job.
The Death of a Loved One and Bereavement
The death of a loved one may be the most stressful life event anyone faces. Many people continue managing bipolar disorder successfully through their mourning, but it may have extreme consequences for others, who can develop “funeral mania,” says Bennett.
This occurs when someone whose bipolar symptoms are stable attends a funeral and develops a manic episode over the course of the following week. The period of bereavement should be one of increased monitoring and heightened support, advises Bennett.
Additional reporting by Christina Vogt.