Understanding Bipolar Disorder Triggers and How to Prevent Them
The mood episodes inherent to bipolar disorder can often seem random and uncontrollable, but in reality, they may be triggered by a broad range of identifiable phenomena. Sleep, negative life events, drug and alcohol use, seasonal changes, the reproductive cycle, as well as goal attainment and positive events can all have a deleterious impact on your stability, triggering a destructive cycle of mood switching. By understanding these bipolar disorder triggers and discovering ways of proactively coping, you can minimize the risk of experiencing mood episodes and protecting your psychological health. If you find that your mood episodes are not effectively managed with your current level of care, however, you may need more advanced treatment.
As the discourse on mental illness in mainstream channels continues, celebrities are increasingly coming forward to share their struggles with mental health disorders. Their goal: to give voice to their experiences and help to dismantle the dangers stigmas the still loom over these conditions. Most recently, Mariah Carey opened up about her own bipolar II diagnosis in an interview with People, shedding light on both her personal struggle and the condition in general.
“Until recently I lived in denial and isolation and in constant fear someone would expose me,” she said. “It was too heavy a burden to carry and I simply couldn’t do that anymore. I’m grateful to be sharing this part of my journey with you. I’m hopeful we can get to a place where the stigma is lifted from people going through anything alone.”
Part of what makes Carey’s disclosure remarkable is that she shares not just the fact of her bipolar disorder, but also its evolution. At first, she explains, she did not recognize her symptoms as a mood disorder, but thought she was experiencing a sleep disorder due to her inability to sleep. This touches on not just what bipolar disorder is like for so many, but also on a phenomenon that can act as both a symptom and a trigger of bipolar mood episodes: sleep.
Bipolar disorder is often misunderstood as a capricious state, characterized by unpredictable and sudden mood switching. However, as many people living with the condition know, this is far from the case. While mood episodes can indeed appear to come out of nowhere, they can also be triggered by experiences and environmental influences that cause your mood to shift, whether suddenly or over time. This can happen even when you are in remission, pulling you back into a cycle of mood switching that compromises your well-being and functionality. Understanding and identifying bipolar disorder triggers is, therefore, key to creating strategies for staying stable and healthy.
Trigger #1: Sleep
As Carey notes, sleep disturbances can arise as symptoms of mood episodes. However, sleep disruptions can also act as a trigger for mood episodes and mood switching. In fact, researchers have found that “sleep loss [is] the most commonly reported trigger of mood episodes in individuals with bipolar disorder.” While sleep loss is more likely to trigger mania or hypomania, particularly in people with bipolar I, it has also been found to trigger depressive episodes in about 12% of patients and people with bipolar II are more likely to experience these depressive responses. Regardless of bipolar I or bipolar II diagnosis, women are more likely than men to report mood dysregulation after sleep loss and may be particularly vulnerable to experiencing mania or hypomania.
Due to the overwhelming evidence that sleep is perhaps the strongest of bipolar disorder triggers, it is essential that people with bipolar disorder practice good sleep hygiene. Ideally, you should go to sleep and wake up in a regular, predictable pattern and avoid activities that interfere with this schedule, including staying up late, drinking alcohol, and consuming caffeine. In order to promote a restful and regular sleep, create a ritual for yourself to get your mind and body prepared for bed. If you struggle to sleep, be sure to talk to your doctor about it so you can identify whether these sleep disturbances are a symptom of a mood episode and gain control over your sleep cycle before it triggers mood switching. In addition, you should be extra cautious to try to maintain a healthy sleep pattern when travelling, as jet lag can induce potentially dangerous sleep dysregulation.
Trigger #2: Negative Life Events
Negative life events, such as interpersonal conflict, loss of a relationship, job loss, financial stress, or death of a loved one can be both stressful and profoundly painful even for people who do not struggle with a mental health disorder. For people with bipolar disorder, however, they can have serious psychiatric consequences; negative life events are tied to the emergence of depressive episodes and may increase the severity of existing depression. According to one longitudinal study of 149 participants diagnosed with bipolar I disorder, for example, “negative life events predicted increases in depressive symptoms over several months even after controlling for baseline levels of depressive symptoms.” It is also possible that negative life events may trigger or augment mania or hypomania. While this may appear to be counterintuitive, some theorize that the mechanism behind this phenomenon is “manic defense,” which posits mania as a “flight from painful feelings.”
Not all negative life events are possible to avoid. However, maintaining a good social support network, maintaining a regular schedule of self-care, and connecting to mental health resources can ensure you have the stability and support you need when difficult events arise. Make a plan for how to cope with the event and know that you don’t have to manage it alone; friends, family, mental health professionals, and peer support groups are all available to help you weather the storm. Remember to be proactive and don’t be afraid to admit that you need support.
Trigger #3: Drug and Alcohol Use
Recreational drug and alcohol use are known bipolar disorder triggers that can cause manic, hypomanic, or depressive episodes due to a variety of neurological mechanisms. While heavy, long-term use is of particular concern for people with bipolar disorder, even casual and occasional use can be triggering for some, both because drugs and alcohol affect the delicate neurochemical balance and because they may interfere with the efficacy of psychotropic medications. Unfortunately, while many recognize that recreational drugs can be dangerous, it is common to discount the potential dangers of alcohol. “We tend to look at alcohol as a beverage, but it is a drug,” says substance abuse counselor Beth Letterman. “Alcohol can cause someone to be elated or depressed. If they are down, they will go lower. If they are high, they’ll go higher.” As such, it is best for people with bipolar disorder to avoid both drugs and alcohol altogether.
Unfortunately, self-medication and shared biological vulnerabilities cause high rates of co-occurring substance use disorders amongst people with bipolar disorder. If you are not able to stop using drugs or alcohol on your own, it is imperative that you seek the help of experts who understand the unique needs of people struggling with bipolar disorder and addiction. Recovering from a substance use disorder is essential for gaining control over your bipolar disorder and your overall health.
In addition to recreational substances, prescription medications may also act as bipolar disorder triggers. In particular, antidepressants may cause manic or hypomanic episodes, which is why people with bipolar disorder are generally advised not to take them. Corticosteroids are also known to induce mood episodes in some patients and should be used with caution.
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Trigger #4: Seasonal Changes
Seasonal changes are most commonly associated with unipolar depression, but they can also have a significant impact on experiences of bipolar disorder. In fact, according to some research, seasonal fluctuations are more common in people with bipolar disorder than in those with unipolar depression. For those whose mood episodes are triggered by these seasonal changes, winter is typically associated with depressive episodes and manic or hypomanic episodes are more prevalent in the spring and summer, possibly due to both the effects of sunlight and seasonal behavioral differences. However, mood episodes do not necessarily follow these patterns. For some, summer triggers depressive episodes and winter triggers mania or hypomania.
It’s important to recognize seasonally-triggered mood episodes for what they are, rather than writing off a depressive episode as garden-variety winter blues or regarding mania as part of the rejuvenation of spring. These mood episodes are serious conditions that must be treated in order to keep you safe and healthy. At the same time, acknowledging the triggering effects of seasonal changes allows you and your treating clinicians to take preventive action and be watchful for early warning signs of mood disturbance. For example, if winter triggers depression, you may want to take a vitamin D supplement and begin using a lightbox in late fall. Additionally, it can be particularly important to maintain a healthy routine during times of increased vulnerability in order to give yourself as much stability as possible.
Trigger #5: The Reproductive Cycle
For many women with bipolar disorder, the hormonal changes brought on by the reproductive cycle can act as important triggers. Up to 68% of women report “menstrual cycle-related mood changes,” particularly the emergence or exacerbation of depression during the premenstrual phase. Additionally, pregnancy and the postpartum period can have a profound impact on mood symptoms and cause recurrence in otherwise stable patients, likely owing treatment changes made to accommodate pregnancy, the impact of hormonal fluctuations, and the stressors of changing life circumstances. Of particular concern is postpartum psychosis, which is strongly tied to sleep loss-induced mania and experienced by approximately a quarter of patients.
If your bipolar symptoms appear to be tied to your menstrual cycle, talk to your psychiatrist about it in order to explore treatment options and coping mechanisms. If you are pregnant or planning to become pregnant, seek the care of a psychiatrist with expertise in pregnancy and psychiatric health who can formulate the best treatment plan for you during this vulnerable time and after birth, taking into account both your health and the health of your child. If you do find yourself experiencing mood symptoms during or after pregnancy, do not be afraid to disclose; you are not alone and there are many resources available to help you. “People think that once you’re pregnant, you’re not entitled to your body, but what happens to the mother happens to the fetus,” says Dr. Katherin Wisner, professor of obstetrics and gynecology at Northwestern University. “A mentally healthy mom is critical for fetal and infant development.”
Trigger #6: Goal Attainment and Positive Events
While many bipolar disorder triggers center around stressors, goal attainment and other positive events can also elicit mood episodes, particularly mania or hypomania. Events such as winning an award, getting a promotion, falling in love, or even going on vacation may act as triggers, initiating a dangerous cycle. Some researchers believe that this is caused by dysregulation of the behavioral approach system, which “promote[s] increases in positive affect, energy, goal pursuit, and attention toward cues of reward.” In other words, people with bipolar disorder have particularly “high reward responsiveness.” For some, this heightened responsiveness translates into manic or hypomanic episodes.
If you or those around you notice symptoms of mania or hypomania following a positive event, it is important to talk to your doctor about it as soon as possible. While this kind of mood episode may appear to be a positive experience initially, it can ultimately be destructive both in and of itself and due to the risk of switching to a depressive episode once the mania or hypomania resolves. This does not mean you should not enjoy your successes, but it does mean that you should be sure to take care of your health at the same time.
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Coping With Bipolar Disorder Triggers Through More Advanced Treatment
Bipolar disorder is a chronic condition that must be continuously monitored and managed over a lifetime. Even if you have achieved remission and are high-functioning, it is critical to remain vigilant to identify and cope with potential triggers and work closely with your treating clinicians to maintain stability. However, if you find that your mood episodes are not being effectively managed with outpatient care, it may be time to consider residential treatment.
In a residential treatment setting, you will have the time and space to fully devote yourself to healing in a warm, intimate environment. By working closely with a group of expert clinicians, you can examine your symptoms, identify your triggers, and develop the insight and skills necessary to more effectively manage your condition. This includes not only implementing an appropriate medication plan, but deeply exploring your emotions, thoughts, and behaviors through a range of therapies designed to address your individual needs. With the support of compassionate mental health professionals and peers who understand what you are going through, you can open up the door to more durable relief from symptoms and a restored sense of wellness.
Successful bipolar disorder treatment, however, goes beyond treating acute symptomatology. Rather, it supports you as a whole person, helping you to recognize your strengths, abilities, goals, and passions in order to nurture lasting recovery. By providing a multidimensional treatment experience, these programs can help you see yourself beyond your bipolar disorder and create a richer, more fulfilling future.
Bridges to Recovery offers comprehensive treatment for mental health disorders as well as co-occurring process addictions. Contact us to learn more about our renowned Los Angeles and San Diego-based programs and how we can help you or your loved one start on the path to healing.