Sandra Rosenthal, PhD, began experiencing racing thoughts, sleepless nights, unbridled energy, and emotional turmoil several decades ago.
Ultimately, her symptoms led to an episode of psychosis, a hospitalization, and, finally, after five years, a diagnosis — bipolar disorder, a mental health condition that causes extreme shifts in mood, alternating between unusually elated, energetic, or irritable moods (mania or hypomania) and deeply sad and hopeless moods (depression).
It would take several more years before Dr. Rosenthal, who is now the Jack and Pamela Egan Professor of chemistry at Vanderbilt University in Nashville, Tennessee, would realize that her symptoms were worse in the spring, when she would feel a burst of energy, or mania, that led to sleeplessness.
Rosenthal, it turned out, also had seasonal affective disorder (SAD), an umbrella term meaning that someone's mood disorder follows a seasonal pattern. This shift toward mania in the spring is also known as “spring mania,” and it’s not uncommon in people with bipolar disorder.
As many as 25 percent of people with bipolar disorder have symptoms that follow a seasonal pattern, according to MedlinePlus. Most commonly, it manifests as an increased risk of depressive episodes in the winter and mania or hypomania in the spring and summer.
The length and severity of spring mania varies from person to person. In Rosenthal’s experience, the heightened arousal is normally at its peak for at least one week but can persist for months.
Spring mania can be dangerous or even life-threatening — manic episodes can lead people to do risky or reckless things they wouldn’t ordinarily do, say Mayo Clinic experts. “They may spend money wildly, engage in sexual activity with people they barely know, or walk right into traffic,” says Jonathan E. Alpert, MD, PhD, who is the Dorothy and Marty Silverman Chair in psychiatry and the chair of the department of psychiatry and behavioral sciences at Albert Einstein College of Medicine in the Bronx, New York .
Troublingly, the rates of mania and suicide tend to be highest during the spring months, according to a report published in March 2018 in Psychiatry Investigations.
What Causes Spring Mania?
Experts don’t know for sure why some people experience spring mania, but there are some hypotheses for why it happens.
One such hypothesis: People with bipolar disorder are thought to have disrupted circadian rhythms — the body’s natural 24-hour clock, according to experts at Harvard University.
The changes in daylight that happen as winter ends and spring begins may make this worse. In a review published in the August 2020 issue of Neuroscience & Behavioral Reviews, Rosenthal and her research team theorized that the increase in daylight at winter’s end pushes people with bipolar disorder to their limits.
“The really important idea in spring mania is that it’s not just longer days, but how fast that change occurs that matters,” says Rosenthal.
This may be due in part to the brain region called the suprachiasmatic nuclei (SCN), also known as the biological pacemaker of the body’s circadian rhythms, according to Rosenthal and her colleagues in the aforementioned review. The SCN may be genetically less able to accommodate rapid changes in darkness and daylight among people with bipolar disorder.
Some researchers believe that melatonin — a hormone produced by the body in response to darkness to help you sleep — may also play a role in spring mania. The increased sensitivity to light among people with bipolar disorder may result in less melatonin produced by the body, according to research published in the Journal of Psychiatric Practice. When daylight lengthens in the spring and summer, this may disrupt sleep and circadian rhythms, which in turn could trigger mania.
9 Ways to Head Off Spring Mania
If your bipolar disorder tends to follow a seasonal pattern, you may have an increased risk for spring mania. But fortunately, awareness, medication, and lifestyle changes can help reduce its risks and consequences.
“Some people learn to recognize their increasing restlessness in early spring and then take steps to prevent the feelings from escalating,” says Dr. Alpert.
Here are experts’ top strategies for managing spring mania:
1. Stick to Your Medication Plan
Your medications help keep your bipolar symptoms, including mania, in check. Always talk to your doctor before making any changes to your treatment regimen, and don’t stop taking your meds without their guidance. Doing so can cause you to experience withdrawal symptoms, as well as new or worsening symptoms like mania, according to Mayo Clinic.
2. Consider Trying Interpersonal and Social Rhythm Therapy
Interpersonal and social rhythm therapy (IPSRT) is a type of talk therapy in which mental health professionals help people with bipolar disorder understand and manage their biological and social rhythms, including sleep and wake times and meal times.
Together with other therapies, medication, and lifestyle strategies, IPSRT can help people detect impending mood changes and reduce their risk of future mood episodes. Specifically, it appears to reduce symptoms of anxiety, depression, and mania among people with bipolar disorder, as well as improve how well they respond to mood-stabilizing medications, according to a study published in March 2020 in the Annals of General Psychiatry.
3. Set a Consistent Daily Routine — and Make It Nonnegotiable
Chris Aiken, MD, encourages his patients to designate and stick to consistent times for meals, exercise, socializing, and sleep. “Sleep and wake periods in particular should be kept consistent,” says Dr. Aiken, who is an adjunct assistant professor in the department of psychiatry at New York University School of Medicine in New York City and the director of the Mood Treatment Center.
The reason: Having a consistent routine, especially for sleep and wake times, can help keep your mood stable and reduce the risk of manic and depressive episodes, according to the Substance Abuse and Mental Health Services Administration.
Aiken suggests leaning on digital calendars, voice reminders, or even Post-it notes to help you stick to your schedule.
4. Chart Your Moods
Some people with spring mania — like Rosenthal — say that soaring energy comes on suddenly. But for those who may experience a slower and more subtle build toward mania, journaling and smartphone apps can help function as an early warning system.
These tools chart the day-to-day direction of emotions, moods, and symptoms, allowing an individual to be mindful of what symptoms may signal an impending manic episode — such as a decreased need for sleep or a spike in energy. It’s helpful to chart your moods continuously throughout the year to help you recognize these patterns before a mood episode happens.
Some apps you could try are Daylio, MoodKit, Worry Watch, Mood Track Diary, and eMoods Bipolar Mood Tracker.
5. Limit Your Light Exposure During Spring and Summer
Light helps regulate the body’s circadian rhythms, as well as its release of melatonin, according to the Sleep Foundation. People with bipolar disorder are more sensitive to light and its effects on the circadian rhythm, Harvard University experts say. That’s why it’s critical for people with bipolar disorder to adjust their light exposure to the time of year to help keep their moods stable.
During spring and summer, when daylight is longer, heavy-duty blackout shades for work and home are a must for Rosenthal. “I enjoy the sun in spring and summer, but after the third week in May, I limit exposure to light after 3 p.m. ,” says Rosenthal. In the winter, when daylight is shorter, she reverses the process to make sure she gets enough sunlight before the sun sets.
Aiken suggests particularly light-sensitive individuals to include moonlight in their light calculation. A bright full moon on a clear night reflects a hefty dose of light, he says.
6. Make Your Bedroom a ‘No Screens’ Zone
Good sleep hygiene is critical for people with sensitive circadian rhythms. Aiken recommends keeping all electronic screens — including cell phones, laptops, and TV — outside the bedroom and enforcing quiet, cool temperatures, and complete darkness for optimal sleep. Light from electronic devices can confuse the brain and keep you awake longer, he adds.
7. Avoid ‘All-Nighters’
The energy that comes with mania makes it easy to stay up all night, but the consequences can be serious. “You just can’t allow that, even if you think you’d rather ‘be productive’ all night,” says Rosenthal.
One way to calm yourself before bedtime is to master mindfulness, says Rosenthal. Mindfulness is a type of meditation that involves intentionally focusing on the present moment rather than thinking about the past or future.
This practice has many health benefits, including potentially helping people with sleep issues get a better night’s sleep, according to a systematic review and meta-analysis of 18 studies, published in the June 2019 issue of the Annals of the New York Academy of Sciences.
Some smartphone apps that offer guided meditations like mindfulness are the Healthy Minds Program app, Insight Timer, and Headspace.
8. Steer Clear of Caffeine and Alcohol
Stimulants like caffeine could trigger manic symptoms, which is why it’s best to avoid them. Abrupt increases in caffeine intake appear to be associated with mania among people with bipolar disorder, according to a systematic review published in September 2020 in Bipolar Disorders. However, the researchers note, this evidence isn’t conclusive.
Be sure to avoid substances like alcohol too, because alcohol can also make bipolar symptoms worse, warn experts at Clearview Treatment Programs. What’s more, people with bipolar disorder have an increased risk of developing an alcohol use disorder compared with the general population, according to Mayo Clinic. Having both conditions is linked to an increased risk of mood episodes and suicide, Mayo Clinic experts say.
9. Eliminate Long-Distance Travel During the Spring
Rapidly traversing multiple time zones can send people with a sensitive circadian rhythm into a manic episode. Knowing that, Rosenthal skips far-away conferences during critical periods. “Air travel gets me even more jacked up than I normally am in spring, so there are events I don’t attend in person, even if I feel fine,” she says.