Research indicates that a variety of factors can be associated with the onset of depressive symptoms for people with bipolar disorder. It is important to recognize such potential triggers, because avoiding or reducing exposure to them can reduce the likelihood that depressive symptoms will occur, or can reduce their severity if they do occur. As with mania, such triggers can be of two types: psychosocial and physical or biological. We will review each type of trigger in turn.
PSYCHOSOCIAL STRESS AND DEPRESSIVE SYMPTOMS
When you look back over depressive episodes you’ve 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 depressive episode. Recall that 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 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 depression or depressive episodes.
PHYSICAL OR BIOLOGICAL FACTORS AND DEPRESSIVE SYMPTOMS
It is well established that a variety of physical or biological stresses can cause depressive symptoms, and the evidence is even stronger than the evidence for stress triggering mania (Bauer 2008a). The most prominent of these factors is abuse of drugs like cocaine or amphetamines. However, alcohol can also be a potent trigger for depression. Even caffeine or certain prescribed medications can have this effect.
Examples of prescribed medications that might be triggers include antidepressants and corticosteroids. Sometimes medical conditions themselves, and the pain that accompanies them, can trigger depressive symptoms. As with mania, for some people there can also be a seasonal component to depression, with a very regular seasonal pattern of depression occurring in the winter (Goodwin and Jamison 2007). Although you can’t stop the seasons (except maybe by moving to the tropics), identifying seasonal changes as triggers allows you to increase your watchfulness and, if necessary, seek a change in treatment with your provider during those times.
The following table lists a number of medications that may trigger a depressive episode.
MEDICATIONS AND DRUGS THAT MAY TRIGGER DEPRESSION
High blood pressure medications
* Alphamethyldopa (e.g., Aldomet)
* Clonidine (e.g., Catapres)
Ulcer medications
* Cimetidine (Tagamet)
* Ranitidine (e.g., Zantac)
Psychotropic agents
* Benzodiazepines
* Neuroleptics
Drugs of abuse
* Alcohol
* Sedatives
* Amphetamines (withdrawal)
* Cocaine (withdrawal)
* Nicotine (withdrawal)
Hormones
* Corticosteroids
* Oral contraceptives
* Anabolic steroids
WHAT ARE YOUR TRIGGERS?
We have begun by listing some examples relevant to bipolar disorder in general. The key next step is to explore your own specific experience of depression triggers. This will then allow you to manage your own pattern of symptoms more effectively and to work through the condition to reach your life goals.
Although depression may occur spontaneously with no apparent cause even when you’ve been following your plan of care, learning your personal triggers for a depressive episode will help you develop prevention strategies to cope with, limit, or prevent a full depressive episode from occurring. You can ask trusted friends or family 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.