4 Common Bipolar Triggers and How to Manage Them

About 7 million American adults have been diagnosed with bipolar disorder, a condition that causes changes in mood. About 83 percent of people with bipolar have a severe case. Bipolar disorder affects men and women equally. While it can occur at any age (even during childhood), the average age of onset is 25.

There is no single known cause of bipolar disorder, but experts agree that certain factors, like genetics, stress, and brain structure, may increase a person’s risk. Even though there are many treatments for bipolar disorder, certain life events and habits can make bipolar episodes worse or can cause a relapse, which is a reoccurrence of episodes.

There are three different types of mood episodes associated with bipolar disorder. Most people experience things like sadness, sleeplessness, and lack of concentration during their lifetimes. But people with bipolar disorder experience these moods with greater intensity and in cycles.

The types of episodes include:

• Manic: These episodes can bring about insomnia, concentration problems, racing thoughts, or the feeling that you can conquer the world. A manic episode may also make you feel irritable.
• Hypomanic: These episodes involve symptoms similar to manic episodes, but with less severity and lasting for a shorter duration of time. (While a manic episode may last a week or more, a hypomanic episode may last for a few days.)
• Depressive: During this type of episode, you may feel a strong sense of sadness and hopelessness for at least two weeks at a time and you may feel a loss of interest or pleasure in things you once enjoyed.

In addition to the various episode types, there are different types of bipolar disorder.

• Bipolar I disorder is when a person has a manic episode that lasts at least a week or is extremely severe. Having a depressive episode is also common with bipolar I.
• Bipolar II disorder is diagnosed when a person has at least one depressive episode and one hypomanic episode.
• Cyclothymic disorder usually involves a combination of mild depressive episodes and hypomanic episodes that last for at least two years. This is considered the milder form of bipolar disorder.

Regardless of the bipolar type, it’s important to be on the lookout for everyday triggers.

“Bipolar disorder can be exacerbated by many different factors,” says Cesar Figueroa, MD, a psychiatrist in Macon, Georgia. Read on for information on bipolar episode triggers, common treatments, and ways to avoid these episodes.

In general, people with bipolar disorder have a more difficult time managing stress than people without the condition. They have trouble coping with situations and may interpret otherwise insignificant events as stressful. High stress levels can cause depressive, manic, or hypomanic episodes, as well as anxiety and anger.

To avoid stress-related bipolar issues, try incorporating stress reduction techniques into your lifestyle. Recognizing patterns in your episodes will help you partner with your healthcare provider (HCP) in identifying the best treatment plan. Psychotherapy, a treatment where your mental health provider will help you build healthy habits, is often the preferred method of treatment.

Journaling—describing stressors or other things on your mind—may be one of the exercises your therapist suggests, says Dr. Figueroa. Taking note of the events, people, or places that cause you stress may help you understand the triggers that might go unnoticed otherwise.

Try to surround yourself with people who lift your mood. A healthy relationship with a relaxed friend or loved one can help you stay calm, as opposed to a friend who constantly causes drama or stress, which can exacerbate bipolar episodes. 

A significant change in sleep patterns is a symptom of bipolar disorder. Changes to your sleep-wake cycle, or circadian rhythm, can also trigger a bipolar episode. For those with bipolar disorder, shift work, travel, and restless nights may lead to an increased risk of unstable mood episodes.

According to one small 2015 study in the Journal of Affective Disorders, researchers from Penn State College of Medicine and the University of Michigan Medical School found that lack of sleep can trigger undesirable mood in women with bipolar disorder, and can specifically influence the number and severity of depressive and manic episodes. Furthermore, one 2009 study in BMC Psychiatry found that problems with circadian rhythm may be related to genetic causes of bipolar disorder.

On the other hand, getting too much sleep can cause your energy levels to drop. It’s best to aim for seven to nine hours per night. Here are some ways to keep your sleep-wake cycle consistent:

• Maintain a regular schedule, waking and sleeping at the same time every morning and night.
• Get some sunlight first thing in the morning; opening your blinds or taking a quick walk around the block will do.
• Exercise daily.
• Limit caffeine and alcohol consumption.

If you notice any changes in your sleep, talk with an HCP about what may be causing the interruption.

It’s difficult to pinpoint exact numbers, but according to American Addiction Centers, research shows that approximately 50 percent of people with bipolar also have alcohol use disorder. In many cases, those with bipolar disorder may use drugs or alcohol to try and ease symptoms like anxiety, pain, depression, and sleeping problems. In general, alcohol and drugs cause more emotional instability. And mixing drugs or alcohol with other antidepressants or antianxiety medications can cause issues that include:

• Unusual behavior
• Weakened motor control
• Increased feelings of sadness
• High blood pressure
• Memory issues
• Liver damage

Marijuana, opiates, and alcohol may temporarily ease mood swings but will likely make things worse later on. Stimulants like amphetamines and cocaine can send people with bipolar disorder into a manic episode, followed by depression. Hallucinogens such as LSD and PCP can trigger symptoms, too.

Alcohol depresses the central nervous system and contributes to depressive symptoms. Because alcohol alters a person’s awareness and inhibition, it’s especially dangerous for people with bipolar disorder. If you have bipolar disorder, it’s best to abstain from alcohol completely. If you do choose to drink, stick to one glass a day or less. And if you’re taking any medications for bipolar disorder, consult with an HCP about whether you can have a drink.

If you find yourself reaching for alcohol or drugs when times get difficult or when you’re in situations that make you feel uncomfortable, it’s a sign to seek treatment from a mental health professional. You can also contact the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-HELP to learn about treatment centers and local support groups near you. 

Every year, about 500,000 pregnant women have or develop psychiatric conditions like major depression, bipolar disorder, or anxiety. Some studies have shown there is a 32 percent to 67 percent chance that a woman who has bipolar disorder will relapse after their child is born.

But a study from 2021 in the Journal of International Bipolar Disorders questioned this assumption. Researchers found that more pregnant women with bipolar disorder did fall into a moderately ill category, as opposed to being symptom-free. But the mood states of pregnant women with bipolar disorder didn’t vary more than the nonpregnant women. In other words, pregnant women with bipolar disorder didn’t have more days with symptoms, more frequent mood changes, or longer bipolar episodes.  

During pregnancy, most women experience worries or anxieties about things like becoming a parent, the health of their baby, and the financial commitment it takes to raise a family. Fatigue and changes in hormone levels or metabolism can contribute to such feelings. These same anxieties may continue (or even escalate) after a baby is born, triggering a relapse of bipolar episodes.

In general, it can be difficult to weigh the risk and benefits when it comes to treating mental illness during pregnancy. That’s why it’s important to talk with an OBGYN and mental health professional to determine the right treatment plan. Common bipolar medications—like lithium, valproic acid, paroxetine, and carbamazepine—are associated with an increased risk of fetal abnormalities and problems, so experts recommend that other pregnancy and postpartum treatments be considered before conception, in consultation with an HCP.

You can also try these natural ways to help control bipolar-related mood swings:

• Take time to relax.
• Get regular exercise.
• Take naps when you’re feeling tired.
• Try yoga or meditation classes.
• Practice healthy eating habits.

Remember that bipolar disorder is manageable both during pregnancy and postpartum. Following your treatment plan and minimizing your exposure to triggers as much as possible can help you prevent more frequent, severe, and longer episodes.