Bipolar Disorder: Knowing My Triggers and Warning Signs for a Manic vs Depressive Episode

Whether you have had your bipolar disorder diagnosis for many years or are more recently diagnosed, you’ve probably heard the recommendation to know what your triggers and warning signs are. Some of you likely have experienced a manic or depressive episode in your life, and others may have seen their loved one go through an episode. For many, it can seem scary, overwhelming, and unpredictable, especially if you don’t know what to expect or how to treat it properly. After working nearly a decade in inpatient behavioral health settings, for optimal treatment results, I realized how crucial it is for individuals with bipolar disorder to catch their manic or depressive symptoms before they get worse. This starts with knowing what may set you off, and what behaviors, thoughts, and feelings let you know you are heading towards an episode.

Common Triggers of Mania

• Lack of sleep

• Major life changes (divorce, marriage, job loss, moving, loss, affects from COVID)

• Substance use

• Medication adjustments, running out of medication, stopping medication on your own, or not being able to get an appointment in time

• Traveling

• Conflict with a friend or family member

• Bad day at work

• Disruption in routine

• Stimulating environments (loud noises, large crowds)

• A combination of many things adding up

Common Warning Signs of Mania

• Impulsivity

• Rapid speech

• Flight of ideas

• Racing thoughts

• Increased energy

• Easily irritable

• Grandiosity

• Decreased need for sleep

• Suicidal thoughts

• Delusions or hallucinations

• Starting projects and not finishing

Someone experiencing mania may look like they are functioning, despite averaging 3 hours of sleep for the past week. They may be feeling great and don’t think they need their mood stabilizer, so they may stop taking it without a medication provider’s collaboration. They may also make statements with fast-paced speech that can be hard to follow and often times don’t make sense, but will likely get irritated if someone questions them. Often times, they are impulsive with decisions to end or start a new relationship, move, quit or jump into a new job, or spend money. These are just some examples of what mania may look like.

Common Triggers of Depression

• Too much or too little sleep

• Poor appetite

• Substance Use

• Conflict with friend or family member

• Bad day at work

• Chronic pain

• Low self-esteem

• Disruption in routine

• Medication adjustments and side effects, running out of medication, stopping medication on your own, or not being able to get an appointment in time

• Childhood trauma

• Stressful life events (loss of a pet or loved one, divorce, losing a job, trauma, financial problems, affects from COVID)

• A combination of many things adding up

Common Warning Signs of Depression

• Isolation

• Negative thinking

• Low energy

• Poor appetite

• Impaired decision making

• Hopelessness

• Depressed mood

• Loss of interest in pleasure or activities

• Suicidal thoughts

Someone experiencing depression may seem exhausted all the time and doesn’t have energy to take basic care of themselves, which can result in missing meals, neglecting hygiene care, and laying on the couch or sleeping all day. They may be in a negative headspace and tend to spiral to worse case scenario, sometimes even leading to suicidal thinking. Someone who is depressed may not leave the house, cancel plans, isolate from any social interaction, miss work, and feel badly about themselves. They may also engage in self-mediating behaviors, such as drinking alcohol or using substances to try and numb or avoid their feelings.

You may notice some of the triggers for mania and depression are similar, but the warning signs are vastly different. Take a moment to see what you identify from the list. Did you connect with any of the examples describing someone with mania or depression?

What do you do with this now that you’re aware of your triggers and warning signs?

The first thing you want to do is to make sure you are safe and have a safety plan. If you are in active mania or experiencing depression with active suicidal thoughts, it’s recommended to seek a higher level of care and go to an emergency room to be assessed if you’re needing hospitalization, for instance. Stabilization, first and foremost, is key to be able to get back to your baseline and start working on prevention.

Next, Make a Plan!

If you are feeling safe and are not actively manic or suicidal, the best course of action is making a plan to try and catch your episodes before they get worse so you can be proactive instead of reactive!

Being proactive for someone with warning signs of poor sleep and substance use inform you to work on a better sleep hygiene plan and find ways to reduce or limit substance use. It sounds simple, but in practice it can be challenging. This could involve going to bed earlier, having a set bedtime and wake time, not napping during the day, and any other rituals you may do to help you get a good night’s sleep (e.g. turning off screens, drinking sleepy time tea, taking nighttime medication, avoiding late night snacks). For limiting substance use, this could include not keeping it in the home in the first place, letting others know your plan to help with accountability, and finding replacement coping skills you can do instead.

Keep in Mind

My number one piece of advice for those with bipolar disorder is to not be your own medication prescriber. What does this mean?

When we feel good, our brain may tell us that we don’t need medication, or we don’t need therapy. We can handle things on our own. While that is a lovely sentiment, it may not be the case for everyone. While working in the hospital, I saw many people with bipolar disorder get off their medications prior to admission, especially mood stabilizers because they felt better and didn’t like the side effects. However, a majority of these individuals were hospitalized for manic episodes because they didn’t work with their medication provider to titrate or make adjustments together. I cannot emphasize this enough: if you are unhappy with your current regimen, please consult with your medication provider. Unhappy with your medication provider? Please find a new one that specializes in treating bipolar and can help you with meeting your goals.

But Will I Have to be on Medication Forever?

I’ve seen plenty of individuals with bipolar disorder who can absolutely be stabilized, healthy, and happy without relying on medication or regular therapy, however, this takes a lot of practice, an extremely regimented routine, a vast support system, and strong coping skills. It’s not unrealistic to go without medication, but would be quite challenging to do without those other factors. It’s also perfectly okay to ask for help and support and admit when you need it. You can work towards goals of getting to a place that feels comfortable for you and how you want to live your life.

What to Bring to My Therapist

If you’re seeing a therapist, I strongly recommend going over some sort of safety plan where you discuss your specific triggers and warning signs for depression and/or mania. Talk about and become aware of what coping skills you can use when you’re starting to get elevated vs low. Make sure you share your past history of bipolar episodes, hospitalizations, medication treatment, medication compliance, suicidal or self-harm thoughts and behaviors, and past treatment. Let them know what approach is helpful for you and how you can create check-ins with yourself and loved ones outside of the therapy space for accountability to make sure your symptoms are staying at bay.

What’s Next?

If you’re looking for specialized therapy if you have bipolar disorder, please visit my bipolar disorder therapy page to learn more about how I can help!

If you are a family member with a loved one with bipolar disorder, I offer individual and family therapy for mental health caregivers supporting those with chronic mental illness.

I offer a free 15-minute consult to see if we’d be a good fit, so feel free to fill out my contact form here.

To learn and understand more about bipolar disorder, the National Institute of Mental Health does a great job breaking down the three different types of bipolar disorder, symptoms, risk factors, and treatment recommendations.

NAMI also has a quick one-minute video to explain bipolar, as well as a 2-part podcast series by NAMI Chief Medical Officer Dr. Ken Duckworth, offering insights from individuals, family members, and other mental health professionals. Learn more here!