Combating Common Triggers

Two triggers common to both manic and depressive episodes are stress and stopping or reducing medication, Basco said. Even everyday stress or excitement can incite an episode. Most startling to people is how seemingly low-stress the event can be, Brondolo said.

Triggers for mania include sleep loss — whether it’s pulling an all-nighter or skipping several hours — different time zones and seasonal changes (typically springtime). Fall and winter tend to trigger depression. Substance abuse can also encourage, extend and exacerbate mania.

In addition to these common triggers, every person has a unique set of stressors, said Basco. If certain life events, such as relationship or financial problems, seem to trigger your depression, then you know these are your unique stressors. At first, these triggers might seem arbitrary; however, you can learn to anticipate episodes. Here are several strategies:

  1. Even if you aren’t sure why a previously simple task is now a stressor, consider the reasons it was so tough or unnerving for you, Brondolo said.
  2. Try to maintain the same sleep schedule every night. Remember the importance of keeping a regular routine for all daily activities.
  3. “Don’t abruptly reduce your medication, unless you work out a safe way to do this with your doctor,” Basco said.
  4. Learn how to problem solve, so when a stressor comes up, those skills are ready, Basco said. It’s also good to learn techniques to relieve tension and calm your thoughts and emotions.
  5. Know yourself well enough to identify the early signs and get help quickly; don’t try to tough it out, Basco said. Controlling mild symptoms increases the chance they won’t become major ones.


Suicidal thinking is common in bipolar disorder, particularly during deep depressions and mixed states, when a person is agitated, depressed and energized. Though suicidal ideation can be tough to ascertain, some indicators that an individual is at imminent risk include: being depressed, a history of attempts, talk of harming oneself, putting affairs in order and an active plan, Dr. McInnis said.

If you’re experiencing suicidal thoughts, this means your symptoms are getting worse. Call your doctor, therapist or loved one immediately or go to the ER. It’s important to take such thoughts seriously and to realize that suicide is a permanent solution to a temporary mood.

General Tips

  • Think tasks through. Tasks that seemed simpler in the past might be much tougher now, partly because of bipolar’s strain on information processing. Brondolo’s student patients notice they have more difficulty taking tests, even though previously they had no trouble. She suggests using a scale from 1 to 10 to think through the difficulty of the task. If the task is over a 4, consider what it is about the task that trips you up and anticipate what you need to do to complete it successfully.
  • Become an expert. Educate yourself about bipolar disorder by reading everything you can, looking at valuable Web sites like and Psych Central and attending support groups. You can find many books with excellent tips and tools. The key is to become informed and active, Basco said.
  • Recognize your own courage. “Give yourself credit and respect for managing your illness” and acknowledge your hard work, said Brondolo. She notes the “tremendous courage and strength” it takes to live with bipolar disorder.
  • Focus on your health. Every healthy lifestyle requires regular exercise, a wholesome diet and adequate sleep.
  • Avoid caffeine and cigarettes. Whether it’s an energy drink, cup of coffee or anything with nicotine, stimulants can change your mood and cause sleep loss.