Bipolar disorder causes dramatic shifts in mood and behavior called “episodes.” People living with bipolar suffer from either manic episodes, depressive episodes, or both. It can lead to things like job loss, substance use, or lack of a fulfilling social life. Fortunately, many people who are diagnosed with bipolar learn how to manage the symptoms. Still, the unpredictability of bipolar disorder can be unsettling. What triggers these manic and depressive episodes? Is there a way to prevent them from happening?
The answer to this question is yes – and no. You can learn to manage and recognize the things that trigger your bipolar episodes, but you can’t always prevent them from happening. With time and practice, you can learn how to predict when they’re going to happen so that you can be prepared.
When someone with bipolar has gone for an extended period without an episode, the occurrence of mania or depression is called bipolar relapse. For a bipolar relapse to happen (or for an episode to occur), something needs to trigger it. To understand those triggers, we first need to understand the types of bipolar episodes.
Episodes from a bipolar relapse fall into two main categories: manic and depressive.
Manic episodes are characterized by sudden feelings of happiness, invincibility, or high energy. When someone has a manic episode, they’ll usually speak so fast that people will have trouble understanding them. They might be tempted to create lists of unrealistic goals or grand plans. They may get so caught up in their feelings of joy or enthusiasm that they neglect basic needs like sleep or food. This leads to harmful decision-making like spending large sums of money or taking dangerous risks.
When someone is feeling manic, they’ll often drop everything to focus on what’s inspiring them or what plans they need to make. During a manic episode, people may say or do things that are out of character or alarming. Depending on the type of bipolar disorder, manic episodes can last anywhere from a few days to six months.
A depressive episode is the polar opposite of a manic episode. Instead of feelings of happiness and joy, someone experiencing a depressive episode feels hopeless, defeated, and alone. They’ll feel almost no energy, lose interest in their hobbies and friendships, and struggle with crippling self-doubt. A depressive episode can change someone’s personality – they can go from fun-loving and charismatic to irritable and snappy. Self-loathing becomes a prominent part of their life.
Someone who’s experiencing a depressive episode may find it hard to continue working or spending time with family or friends. This puts them at risk for homelessness, substance misuse, or even suicide. Similar to a manic episode, a depressive episode can last anywhere from a couple of days to six or more months.
Note: a trigger is not the same thing as a cause. Often, there is no real “cause” for a bipolar episode. Someone experiencing a trigger will not necessarily experience a bipolar episode. A trigger can be a catalyst for a cause, but it’s not a certainty.
A sleep disturbance doesn’t necessarily mean a lack of sleep. It could mean a simple change in sleeping patterns. An example of this would be jetlag – going to bed or waking up at times you’re not used to. Other things can cause sleep disturbances. Alcohol, for example, doesn’t allow for quality sleep. Insomnia, stress, substance use, a change in routine – any of these things can be categorized as a change in your normal sleeping patterns. Sleep disturbances are one of the most significant triggers reported by those who have manic episodes.
How to manage this: Stick to a routine. Don’t stray from it, even on special occasions. If you’re traveling in a different time zone, stick with your regular sleep patterns. Make sleep a priority in your life. Your evening routine will give you the predictability that your mind needs. If you have a chance to sleep in, try not to. Go to bed at the same time every night and wake up at the same time every morning.
Getting a great new job, falling in love, getting married, having a child – all of these things can trigger a manic episode. Why? Individuals who have bipolar have sensitive reward responses. Their mind could take a positive feeling and magnify it, which is what causes mania.
How to manage this: Take care of yourself. Make sure you’re eating healthy foods and getting plenty of exercise. Remember that a trigger doesn’t mean you will absolutely slip back into a manic episode. It’s only something to look out for.
The use of alcohol, opioids, cannabis, and even nicotine can be a mania trigger. People living with bipolar are sensitive to neurochemical imbalances. Substances interact with the chemicals in the brain. For some, substances interact with the brain only while present in their system. For those with bipolar, the brain can be triggered into an episode by the introduction of these chemicals. Substance use can trigger both manic and depressive episodes.
How to manage this: It’s difficult to avoid alcohol or other substances, especially in certain social circles. Surround yourself with friends who place importance on healthy lifestyle choices. Keep your mental health care routine in place – make sure you’re attending therapy, journaling, and practicing healthy coping strategies.
Everyone is probably familiar with seasonal depression. The sun goes away, you spend less time outside, you start losing vitamin D, and it makes you feel sad. When the sun comes out again and summer hits, most people are elated. For people with manic bipolar, the joy that comes from the summer weather can trigger a manic episode. Again, this is due to the bipolar sensitivity of reward responses.
How to manage this: Keeping up with exercise and vitamin D in the winter will prepare your mind for the summer months. Exercise, sunlight, and vitamin D all have one thing in common: a feel-good chemical called serotonin. Vitamin D helps encourage serotonin release, while exercise naturally increases serotonin production. If you’re keeping up with these things in the winter months, your mind won’t feel as shocked by the summer months.
Having a large fight with someone you’re close to is never a pleasant experience. For many, it can cause some anxiety or the occasional sleepless night. For people struggling with bipolar, one of these large fights can trigger a depressive episode. A study published in The National Library of Medicine found that social distress was one of the most significant depression triggers for people with bipolar disorder. For some, it can even lead to suicidal thinking.
How to manage this: You can’t avoid arguments forever. They happen. What you can do is learn healthy coping strategies for when they occur. During and after an argument, practice deep breathing, taking space, or journaling. Remember that one argument does not mean the end of a relationship. Arguments can be constructive.
Loss of any kind can trigger a bipolar relapse. This means the loss of a job, a relationship, a loved one, a car, or anything of personal value. When someone with bipolar disorder experiences loss, they’re transported back into the mindset of their last depressive episode caused by loss. This is called state-dependent memory.
How to manage this: Loss can be devastating. Lean on the people you trust, and make sure you’re in contact with a good therapist. Extra therapy during a loss can prevent or lessen the severity of a depressive episode. Make sure you’re surrounding yourself with kind, encouraging people who make you feel strong.
Similar to substance use, medication prescribed by a doctor can and will interact with chemicals in the brain. People with bipolar disorder are sensitive to these interactions. Because of this, a new medication can trigger an episode – even if it’s common bipolar medication. The change in brain chemistry can be problematic for some, especially at the beginning of a new medication regimen.
How to manage this: Always keep in contact with your doctor during a medication change. Do not hesitate to email or call them if you start to feel “off.” Sometimes, knowing that your doctor can be contacted during mood changes can be helpful.
At Sun Behavioral Health Houston, we know how overwhelming bipolar disorder can be. Treatment can help you avoid or manage your relapse triggers. Call us at (713) 796-2273 today to learn more about our bipolar disorder treatment options or set up an appointment.
What causes bipolar episodes?
There is no set cause for bipolar episodes, just like there is no set cause for bipolar disorder. Sometimes, they happen for no reason at all. However, there are triggers you can watch out for. Some of these include disturbances in sleep patterns, medication changes, substance use, life changes, or even arguments with loved ones.
How can you prevent bipolar disorder triggers?
You can’t always prevent triggers, but you can prepare for them and manage them once they happen. You can also learn to avoid certain triggers like substance use or staying up late etc. If you can manage a trigger after it has happened, your chances of experiencing a bipolar relapse or an episode decrease.