Research indicates that a variety of factors can be associated with the onset of manic symptoms (Johnson 2005; Goodwin and Jamison 2007; Bauer 2008a). It is important to recognize such potential triggers because avoiding or reducing exposure to them can reduce the likelihood that manic symptoms will occur, or can reduce their severity. Such triggers can be of two types: psychosocial and physical or biological. We will review each type of trigger in turn.
PSYCHOSOCIAL STRESS AND MANIC SYMPTOMS
When you look back over manic episodes you have had, you may be able to identify an event or factor that had some impact on you psychologically or socially and that may have triggered a manic episode. Although most of the research is on stresses that may trigger depression, stress may also trigger mania (Johnson 2005). Obvious examples are job loss or divorce or another significant loss that has some sort of psychological or social impact.
Although we tend to think of stress as being due to something bad or difficult, stress can be brought on by many changes, good or bad, in the regular routine of your life. So good things like getting married or getting a promotion can sometimes be as stressful as difficult things like getting a divorce or losing a job. Stress is part of life for everyone. But a person with bipolar disorder, faced with the same stress as someone else, may be less able to cope with or shrug off that stress, which can then sometimes trigger manic or depressive episodes. Some common psychosocial stressors, positive and negative, are listed in the following table.
SOME PSYCHOSOCIAL EVENTS THAT MAY TRIGGER MANIA
Some generally negative or difficult events
* Divorce
* Death of loved one
* Job loss
* Financial stress
* Forced job change or new work assignment
* Traumatic event
* Anniversary date for a traumatic life event
* Having an unwanted visit from family or friends
* Young adult child leaving home abruptly
Some generally positive events that are often not thought to be stressful
* Moving
* Job promotion
* Vacation
* Holidays
* Retirement
* Having a desired visit from family or friends
* Getting married
* Having a baby
* Young adult child leaving home as their next developmental stage
PHYSICAL OR BIOLOGICAL FACTORS AND MANIC SYMPTOMS
A variety of physical or biological stresses can cause manic symptoms (Bauer 2003, 2008a). The most prominent of these factors is abuse of drugs like cocaine or amphetamines. However, alcohol and a variety of other drugs can also be potent triggers for mania. Even caffeine and certain prescribed medications can have this effect. Examples of prescribed medications that might be triggers include antidepressants, as we mentioned in module 7, and corticosteroids. You can check with your care provider and even the pharmacist to see whether any over-the-counter medications you are taking may also affect your moods. Sometimes medical conditions themselves can trigger manic symptoms.
In addition, other physical factors can trigger manic symptoms. For instance, sleep loss, either purposeful or accidental, can trigger mania. It is not uncommon, for example, for students with bipolar disorder to study all night for exams and end up, unfortunately, becoming manic prior to the test.
For some people there can also be a seasonal component to mania. Research indicates that some are more likely to become manic in the spring or fall, when day length is changing rapidly, while others may have a very regular seasonal pattern, with depression in the winter and mania in the summer (Goodwin and Jamison 2007). If either of these is the case for you, you may have little control over these triggers, but identifying them means that increased watchfulness, and sometimes treatment change, as directed by your provider, may be helpful.
Some of these common physical or biological triggers are listed in the following table. Note also that there are some stresses that don’t fit into a single category and may truly be bio-psychosocial. For instance, moving to a new place may be a good or bad psychosocial stress, but may also involve long days of packing and moving and accidental sleep loss. Having a new baby is another obvious example where emotional reactions (psychosocial) and sleep loss (physical or biological) may both cause stress.
EXAMPLES OF PHYSICAL OR BIOLOGICAL FACTORS THAT MAY TRIGGER MANIC SYMPTOMS
Drugs of abuse
* Alcohol
* Cocaine
* Hallucinogens
* Caffeine
* Withdrawal from sedatives or alcohol
* Change in nicotine use
Other medical or physical conditions and factors
* Certain hormonal imbalances
(e.g., Cushing’s disease)
* Infections
* Sleep loss
* Menstrual cycle
* Seasonal cycle
Neurological conditions
* Dementia
* Head trauma
* Delirium
* Stroke
* Multiple sclerosis
Prescribed medications
* Antidepressants
* Decongestants
* Inhalers for asthma
* Stimulants
* Levodopa for Parkinson’s disease
* Corticosteroids
* Anabolic steroids
* Disulfiram (Antabuse)
WHAT ARE YOUR TRIGGERS ?
We have begun by listing some examples that describe bipolar disorder in general. However, the key next step is to explore the issue of what your own specific experience of this condition is. This then allows you to manage your own pattern of symptoms more effectively and to work through the condition to reach your life goals.
Learning your personal triggers for a manic episode will help you to develop prevention strategies to cope with, limit, or prevent a full manic episode from occurring. Perhaps you can’t remember what was going on before your manic episodes occurred. That’s okay; sometimes the episode starts so quickly that it’s hard to pinpoint what could have triggered it. And sometimes it can feel as though mania occurs spontaneously with no apparent cause, even when you’ve been following your plan of care. With time, you may be able to recognize the triggers. You can ask trusted friends or family members if they recall any clues. You may not recognize the triggers right away, but you might just surprise yourself one day and see a pattern that will help you to manage the next episode.
Excerpt from OVERCOMING BIPOLAR DISORDER: A Comprehensive Workbook for Managing Your Symptoms & Achieving Your Life Goals (New Harbinger Publications)
MARK S. BAUER, MD received his bachelor’s degree from the University of Chicago and his medical degree and psychiatry residency training from the University of Pennsylvania. He is an internationally recognized educator, researcher, and clinician, with particular expertise in bipolar disorder.
AMY M. KILBOURNE, PH.D., MPH graduated from the University of California, Berkeley, with a double major in molecular biology and rhetoric. She has both a master’s degree in Public Health with a concentration in Epidemiology and a doctoral degree in health services from the University of California, Los Angeles. Kilbourne’s research is focused on improving outcomes in individuals with mood disorders through integrated general medical and mental health care strategies, and translating effective treatment models for mood disorders into community-based settings.
DEVRA E. GREENWALD, MPH received her bachelor’s degree from Vassar College and her master’s degree in public health from Yale University. She conducts research in mental health at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System.
EVETTE J. LUDMAN, PH.D. received her bachelor’s degree from Brown University and her doctorate from the University of Oregon. She is a clinical psychologist and researcher at Group Health Cooperative. Her research concentrates on motivating people to make positive life changes in a range of areas from smoking to exercise to depression.
WITH LINDA MCBRIDE, MSN received her master's degree in nursing from the University of Rhode Island. She has lectured internationally and is a recognized educator, researcher, and clinician with expertise in bipolar disorder, patient education, and collaborative treatment for people seeking mental health care. She is affiliated with the Graduate Program in the College of Nursing at the University of Rhode Island. She was awarded the Administrator's Excellence in Nursing by the Department of Veterans Affairs.