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Bipolar Episode Triggers Everyday Health MenuNewslettersSearch Bipolar Disorder
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By Mary Elizabeth DallasMedically Reviewed by Allison Young, MDReviewed: January 18, 2021Medically ReviewedControlling stress, getting enough sleep, and practicing other healthy habits can help reduce your risk of bipolar episodes.Kkgas/StocksyBipolar disorder is a mental health condition that affects millions of people in the United States. According to the National Institute of Mental Health (NIMH), an estimated 4.4 percent of American adults experience bipolar disorder at some point.
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The disorder, which can cause extreme shifts in mood, energy, activity levels, and the ability to think clearly, can affect individuals differently, and the severity and types of symptoms can vary from one person to another. Although the exact cause of bipolar disorder is unknown, it is thought that several factors, such as genes, brain structure, and stress response and management, could play a role in how often symptoms occur, how severe they become, and how long they last, according to the National Alliance on Mental Illness (NAMI).
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Certain lifestyle and environmental factors can also trigger or aggravate the extreme highs and lows, known as bipolar episodes, which are a hallmark of the condition. Once you’re aware of these triggers, you can gain better control over your disorder.
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Types of Bipolar Episodes
The main difference between bipolar disorder and conditions such as depression is the possibility of experiencing the overly excited state called mania, says Amit Anand, MD, a professor of medicine at the Lerner College of Medicine, vice-chair for research for the Center for Behavioral Health, and the director of the Mood and Emotional Disorders Across the Life Span program, all at the Cleveland Clinic in Ohio. People who are manic are unusually outgoing or happy. In some cases, mania also causes intense irritability and restlessness.
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During depressive episodes, intense sadness or hopelessness may lead to fatigue, trouble concentrating, and thoughts of suicide. But bipolar mood swings are not always extreme, Dr.
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Anand notes. For instance, some people experience a less severe form of mania, known as hypomania. Those who are hypomanic may not feel anything is wrong, making diagnosis more difficult, he adds.
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Complicating matters is that it’s possible to experience both mania and depression at the same time, known as mixed features. When this happens, you may feel overly energized yet be extremely irritated, sad, hopeless, or empty.
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Understanding and Managing Bipolar Triggers
Bipolar episodes can be triggered by lifestyle and environmental factors. Recognizing your triggers and avoiding them, Anand says, is often key to managing the condition.
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Factors that may worsen bipolar symptoms or trigger an episode include:Stress In many cases, a major life change or stressful event, such as losing a loved one or having financial troubles, can trigger an initial episode. How you cope with stress can also affect how your bipolar disorder progresses.
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According to a meta-analysis published in January 2017 in the Journal of Affective Disorders, people with bipolar disorder having a relapse of their condition reported experiencing more stressful life events compared with those who were in a more stable mood phase. The researchers concluded that individuals with bipolar disorder tend to be more “sensitive” to stressors, suggesting that psychosocial treatments are an important component of successfully managing your condition. (Psychosocial treatments include psychotherapy, support groups, and education on the disease for loved ones so they can assist with coping strategies and spot the signs of relapse, according to NAMI.)Childbirth The link between childbirth and bipolar disorder has been well documented in a number of scientific studies.
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A systematic review of nine papers published in October 2016 in the journal BMC Pregnancy and Childbirth found that the risk for mood disorder episodes increases during pregnancy in the postpartum period in women with bipolar disorder. In one of the studies included in the review, researchers found that nearly 50 percent of women with bipolar disorder experienced at least one mood episode during pregnancy or within 12 months after childbirth.
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It’s also worth noting that both men and women with bipolar disorder may be triggered by childbirth. While there is very limited research examining the effect of a new baby on fathers, a study published in May–June 2017 in American Journal of Lifestyle Medicine found that available evidence suggests fathers with bipolar disorder may have an increased risk of hypomanic episodes after the child is born.Medication Treatment for bipolar disorder includes medications, such as mood stabilizers, antipsychotics, and antidepressants, according to NAMI.
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Interestingly, some antidepressants, such as Prozac (fluoxetine) and Zoloft (sertraline), may worsen bipolar symptoms and possibly even trigger a manic episode, Anand says, adding that if you have bipolar disorder, you should not take an antidepressant without also taking a mood stabilizer or antipsychoticmedication. Stimulants used to treat attention deficit hyperactivity disorder (ADHD) may also trigger a manic episode. If you have more than one condition (such as obsessive-compulsive disorder or ADHD) that is treated with medication, NAMI recommends that you develop a treatment plan with your doctor to best manage both conditions and monitor your side effects.Seasonal changes For some people with bipolar disorder, there’s a seasonal pattern to mood episodes.
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Anand says there’s some evidence that more manias occur during the spring and summer months, while more episodes of depression take place in the fall and winter. But some people experience the opposite.
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According to an Austrian study published in January 2019 in the Journal of Affective Disorders, which examined data on over 60,000 people who were admitted to a hospital for a manic, depressive, or mixed featured episode between 2001 and 2014, seasonal patterns in hospitalization rates during manic episodes were found for both men and women. (Women were more likely to experience manic episodes in summer and autumn, depressive episodes in winter, and mixed features in summer, whereas men were more likely to experience manic episodes in summer.) Women under age 35 were also more likely to have this seasonal pattern in manic and mixed episodes. There may be a seasonal pattern to your shifts in mood because of changes in sleep, intensity of sunshine, and number of daylight hours, as well as changes in melatonin levels.
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Closely monitoring your symptoms during seasonal changes can help you manage your bipolar disorder.Poor sleep Lack of sleep is a frequent trigger of bipolar mood episodes, according to Anand. Poor sleep or a disruption in normal sleeping patterns, including jet lag, can trigger these intense mood swings. But there is evidence that psychological treatment may help.
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In a study published in June 2015 in the Journal of Consulting and Clinical Psychology, researchers treated half of the 58 study participants who had bipolar disorder and insomnia with a bipolar-specific modified form of cognitive behavior therapy that involved incorporating good sleep habits, relaxation, and dim lights at bedtime and reducing anxiety about sleep into daily routines. The other half of the study participants were given information about how sleep, stress, diet, exercise, and mood are related to each other but no plan or intervention designed to change behavior.
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The results were eye opening: Six months after these interventions, the people who received cognitive behavior therapy had experienced just 3.3 days in a bipolar episode compared with the 25.5 days experienced by those who were given only education materials. The cognitive behavior therapy group also had a lower rate of relapse and less severe insomnia.
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These results show that it may be beneficial for you to ask your doctor for a plan to ensure you’re getting enough quality sleep if you have bipolar disorder.Drug and alcohol use According to NAMI, substance abuse is common among people with mental illness as a way to cope with their symptoms. In fact, 30 to 50 percent of people with bipolar disorder will develop a substance abuse disorder, notes the Substance Abuse and Mental Health Services Administration (SAMHSA).
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Anand cautions against using drugs or alcohol to “treat” symptoms of the condition. Drinking or taking drugs, he says, can worsen your bipolar mood swings and lead to an increase in suicidal thoughts or behaviors.
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As SAMHSA notes, substance use or withdrawal can cause symptoms attributed to bipolar disorder, including agitation, anxiety, and paranoia. Drinking alcohol in particular can make you less likely to respond to treatment and more likely to be hospitalized.
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Try medication and psychosocial therapy instead.Caffeine Caffeine is a stimulant. As such, it may trigger manic episodes, change sleeping patterns, and affect the way your body breaks down the medications you take to treat your condition, according to a review published in September 2020 in the journal Bipolar Disorders.
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Talk to your doctor about your caffeine consumption and how it may affect your symptoms. While these culprits can lead to a bipolar episode, it’s also important to keep in mind that episodes can occur even without a trigger.
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“Bipolar episodes can come out of the blue,” Anand notes. Do what you can to manage your stress, get good sleep, and avoid using alcohol or any other substance, and work with your doctor to find the best strategies for you to manage your bipolar disorder.
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Additional Reporting by Jessica Migala
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