Triggers for Mood Swings in Bipolar Disorder

Why they may occur, and what you can do about them.

Much is still unknown about bipolar disorder. But avoiding highs and lows — the primary symptoms— can help manage it.

One important tool for managing your health involves actively watching for changes and events that trigger mood swings, which often occur spontaneously. It’s not easy, but you can become more aware of when a mood swing may be coming.

Dr. William Marchand, a professor of psychiatry at the University of Utah, is the author of the forthcoming “Solving the Bipolar Puzzle: Discover How Mindfulness Is the Powerful Missing Piece in Managing Your Bipolar Disorder Symptoms” (New Harbinger, available May 1, 2105 (http://williamrmarchandmd.com/books/whats-next/). In it, he distills his experience with mindful meditation — he’s an ordained Zen monk — for people with bipolar disorder.

Mindfulness meditation focuses on simple awareness of your breath and the present moment, encouraging nonjudgmental acceptance of whatever is passing through your mind, even strong emotions (such as anger, depression, or jealousy).

Mindfulness can “absolutely” help you manage bipolar disorder, Marchand says. “Added to appropriate treatment, it can make a big difference.”

Practitioners say mindfulness helps them better regulate emotions and learn to be nonreactive. There’s growing evidence to support these reports — brain-imaging studies show mindfulness meditation increases the size of the brain area involved in complex decision making, known as executive function.

Simply being more aware of moods seems to be key.

“It's really that awareness,” Marchand says. “A lot of times what happens is that we don't really pay enough attention to our mood state and our stress level, and so we don't get those very early warning signs when we might be able to do something … to prevent a mood episode from coming on.”

Marchand urges people with bipolar disorder to have a plan in place before something goes wrong. Discuss what to do with your treatment providers and support system, such as friends and family. Providers might help adjust medication or increase psychotherapy visits. Then, reach out at the first sign of a mood episode.

Increasing awareness doesn’t take the place of treatment, Marchand cautions. “But if someone can start to notice when they're getting in a situation that can lead to a mood episode, and take action at that point, it can make a big difference for them. That's for sure.”

Consider adding a few minutes of meditation to your daily routine, then try keeping a journal to track your moods. A few mood swing triggers to keep an eye on:

Sleep patterns. In depression, needing unusual amounts of sleep is common, but if you start needing less sleep, it may be a sign of mania onset. Be sure to keep to a regular sleep schedule — and if you start to veer from it, pay attention.

Energy level and self-esteem. Are you feeling more hyped up than usual, as if you can do anything, or struggling to get out of bed in the morning and feeling down on yourself? Marchand suggests notifying your support system if severe or heightened feelings last for longer than a day: “These mood episodes can sometimes come on very rapidly, so it's not something to wait around about.”

Alcohol or drug use. Stimulants and depressants can exacerbate bipolar symptoms or even cause a shift into full mania or depression. Never take street drugs, and use alcohol only in moderation — two drinks a day for men, one a day for women. If your desire to drink or use drugs increases precipitously, it’s a sign to seek help.

Sex drive. As with other mood shift triggers, mania can be accompanied by increased sex drive, while depression is often characterized by lack of it. If you’ve lost interest after having a healthy appetite, or suddenly feel much more interested in sex than usual, consider seeking help.

Concentration. Watch for hypomania — a form of lower-level mania that may improve concentration — since it can escalate to mania or be followed by depression. If you’re having trouble concentrating or getting things done, common symptoms in depression, reach out to your support system.

Stress levels and significant relationships. Let’s say you’re working overtime, or have upcoming final exams. Too much stress is hard for anyone. Meanwhile, a breakup, divorce, or even funeral is often a major life event. Take extra time to monitor your moods when things are tough.

Ultimately, the best way to manage mood swings is to prevent them. To help stabilize moods, keep a regular schedule that includes plenty of time for sleep, and eat nutritious, healthy foods. Marchand also recommends exercise, since it has significant antidepressant effects on bipolar disorder.

“Bipolar disorder is a very difficult condition to treat,” Marchand says. “People do the best if they have the most tools in their toolbox — so not only professional treatment, but exercise, a good diet, meditation.”

“That's what we're trying to do, is have as many tools as possible for people to stay as well as possible.”