Some surprising factors can play a role in the severity of your bipolar symptoms. Find out what stress, poor sleep, and the time of year have to do with bipolar mood swings.

According to the National Institute of Mental Health (NIMH), around 5.7 million American adults have bipolar disorder — and the condition affects everyone differently.

Although doctors haven’t discovered one specific cause for bipolar disorder, a person’s genes, brain structure, and environment could all play a role in how often symptoms develop, how severe they become, and how long they last, according to the National Alliance on Mental Illness (NAMI). Certain lifestyle and environmental factors can also trigger or aggravate the extreme highs and lows that are a hallmark of the condition, known as bipolar mood episodes. Once you’re aware of these triggers, you can gain better control over your bipolar.

Types of Bipolar Episodes

The main difference between bipolar disorder and other conditions, like depression, is experiencing the overly excited state called mania, says Amit Anand, MD, a professor of medicine at the Cleveland Clinic Lerner College of Medicine, vice-chair for research for the Center for Behavioral Health, and director of the Mood and Emotional Disorders Across the Life Span program 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.

However, bipolar mood swings are not always extreme, Dr. Anand notes. Some people experience a less severe form of mania, known as hypomania. People who are hypomanic may not feel that anything is wrong, making diagnosis more difficult, he adds.

For those with bipolar disorder, extreme lows are often more frequent and last longer than manias, according to Anand. During depressive episodes, intense sadness or hopelessness may lead to fatigue, trouble concentrating, and thoughts of suicide.

Complicating matters is that it’s possible for people with bipolar disorder to experience both mania and depression at the same time — known as a mixed state.

When this happens, the person may feel overly energized yet be extremely irritated, sad, or uncomfortable.

Understanding and Managing Bipolar Triggers

Bipolar episodes can be triggered by certain lifestyle and environmental factors. Recognizing your triggers and avoiding them, Anand says, are often key tomanaging the condition.

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 aloved one or having financial troubles — can trigger an initial episode. As a result, how you cope with stress could also affect how your bipolar disorder progresses.

Childbirth. The link between childbirth and bipolar disorder has been well documented in a number of scientific studies, according to a 2012 review in JAMA Psychiatry. A study published in Bipolar Disorders in 2014 found that the transition from depression to bipolar disorder was up to 18 times higher for postpartum women compared to similar studies in men and women who weren’t pregnant. The researchers concluded that women affected by depression should be closely monitored for manic symptoms after giving birth.

Medication. Some antidepressants, such as fluoxetine and sertraline, may worsen bipolar symptoms and possibly even trigger a manic episode, Anand says. He says that people with bipolar disorder should not take an antidepressant without also taking a mood stabilizer or antipsychotic medication. Also, stimulants used to treat attention deficit hyperactivity disorder (ADHD) may also trigger a manic episode in people with bipolar disorder.

Seasonal changes. For some people with bipolar disorder, there’s a seasonal pattern to mood episodes. 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. Some people, however, experience the opposite effect. Closely monitoring your symptoms during seasonal changes can help manage bipolar.

Poor sleep. Lack of sleep is a frequent trigger of bipolar mood episodes, according to Anand. Poor sleep or a disruption of normal sleeping patterns, including jet lag, can trigger these intense mood swings.

Drug and alcohol use. According to NAMI, substance abuse is common among people with bipolar disorder. Anand cautions against using drugs or alcohol to “treat” symptoms of the condition. Drinking or taking drugs, he says, can actually worsen bipolar mood swings and lead to an increase in suicidal thoughts or behaviors.

Besides keeping in mind these possible culprits, it’s important to realize that episodes of bipolar disorder may occur even without a trigger. “Bipolar episodes can come out of the blue,” Anand says. Still, being aware of early warning signs of an episode — such as being restless at 3 a.m. or feeling euphoric every spring — can help you work with your doctor to better manage bipolar.

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