Stress, poor sleep, and hormonal changes are just a few triggers of bipolar I mood episodes. Managing these triggers can help you better navigate this condition.

Bipolar disorder is a mental health condition featuring extreme changes in mood, activity, and energy levels. It’s characterized by cycling periods of depression and mania, a state of agitation and heightened mood that can lead to impulsivity and restlessness.

Bipolar I disorder is one of several types of bipolar disorder. It involves full episodes of mania, with or without depressive periods.

If you live with bipolar I disorder, managing energy shifts can be challenging. Even if you’re doing everything according to your treatment plan, certain triggers can spark a mood episode.

Facing emotionally charged times can contribute to mood symptoms when you live with bipolar disorder.

A 2016 review of longitudinal research confirmed that negative life events predicted increases in bipolar depression. An older study from 2014 found that this effect was strongest amongst those living with bipolar I disorder compared to bipolar II disorder.

Death of a loved one, natural disasters, relationship breakups, and job loss are all examples of major life events that might have this effect.

It’s not only negative events that can trigger a bipolar I episode.

Caroline Onischak, a psychiatric nurse practitioner in Chicago, Illinois, points out that even positive life events or stress can cause mood cycling.

“Even good stressors such as starting a new job or moving into a new home can disrupt the person’s equilibrium and lead to unstable moods,” she explains.

Bipolar I disorder can disrupt sleep, but disrupted sleep can also impact bipolar disorder.

In a 2017 study of more than 3,000 people with bipolar disorder, sleep loss was associated with increased episodes of mania, particularly in women and those living with bipolar I disorder.

Working night shifts, parenting, and frequent travel between time zones are all things that can impact the quality and quantity of your sleep.

The change of seasons has been documented as a common environmental trigger for mood episode switches in bipolar disorder.

About 25% of people with bipolar disorder have seasonal affective disorder. This is a type of depression related to changes in seasons.

How much sunlight you’re exposed to may play a role. But that’s only part of the puzzle.

According to the authors of a 2020 study, changes in temperature, rainfall, atmospheric pressure, and cloudiness are all factors that may contribute to bipolar mood cycling.

According to the Substance Abuse and Mental Health Services Administration, 30% to more than 50% of people with bipolar disorder will develop a substance use disorder at some point. Substance use can worsen symptoms of bipolar I disorder.

Alcohol and recreational substances create chemical changes in your body.

Dr. David Feifel, an emeritus professor of psychiatry at UC San Diego, explains, “Perhaps the most powerful triggers are certain psychoactive drugs, both illicit and prescribed, such as antidepressant medications, steroids, hallucinogens, and even heavy cannabis ingestion.”

Certain prescription medications used to treat bipolar disorder or other conditions may also trigger a bipolar mood episode. For instance, antidepressants may trigger an episode of mania in some people with bipolar disorder. To reduce this risk, they’re often prescribed along with mood stabilizers.

You may speak with your doctor about how your treatment for bipolar disorder or other conditions affects your symptoms.

Extreme hormonal changes can be a natural part of life, such as with pregnancy or menopause.

According to a small 2015 study of 56 women, hormonal changes during menopause were associated with both increased depressive and mania episodes in bipolar disorder.

A more recent study from 2017 of 158 women found that hormonal changes at menstruation, after childbirth, and during menopause were all linked to a worsening of bipolar mood symptoms for many of the participants.

Reproductive hormones aren’t the only ones that may trigger bipolar I mood episodes.

“Insufficient levels of thyroid hormone can lead to depression,” states Onischak. “Extremely low thyroid levels, a condition termed myxedema, can precipitate mania and even psychosis. Thyroid levels should be checked for anyone presenting with a first episode of mania.”

Living with bipolar disorder can be complicated by other conditions that come with their own sets of symptoms.

Candace Kotkin-De Carvalho, a licensed social worker from Morris Plains, New Jersey, says, “The most common mental disorders that co-occur with bipolar disorder are anxiety disorders, personality disorders, and substance use disorders.”

David Tzall, PsyD, a clinical psychologist from Brooklyn, New York, adds that physical illness or injury may also trigger depression or mania.

If you’re managing bipolar disorder and another condition, speak with a doctor about a treatment plan that can help you manage your symptoms.

Even though bipolar I disorder is a mental health condition, what you eat (or don’t eat) can influence your mood.

“Sometimes deficiencies in vitamins, particularly vitamins B12 or D, can put a person at risk for depression or mood instability,” says Onischak.

You may work with your doctor or a registered dietitian to develop a meal plan that will help you meet your nutritional needs.

Bipolar disorder without triggers

Tzall explains that not everyone with bipolar disorder will have specific triggers for their episodes, and episodes can occur without any apparent triggers.

Triggers aren’t a requirement for the diagnosis of bipolar disorder. You can experience depression or mania without any specific cause.

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Knowledge is power when it comes to coping with bipolar I disorder mood triggers.

Onischak says that one of the most important things you can do is monitor your moods and their patterns.

“Providers often use diabetes as a metaphor,” she explains. “Just as individuals with diabetes should learn to monitor their blood sugar and know what can lead to high or low blood sugar, individuals with bipolar disorder should learn to monitor their moods in order to identify triggers and maintain their mental health.”

While you may not be able to avoid all your triggers, there are steps you can take to help manage them.

Practice stress management and relaxation

Strategic stress management can help during high-stress experiences or major life events, says Kotkin-De Carvalho.

“To help deal with stressful situations, people with bipolar disorder can learn to practice relaxation techniques and develop healthy communication strategies with the help of a therapist,” she says.

Sleep hygiene

Tzall recommends managing sleep disturbance triggers through good sleep hygiene.

“Maintaining a consistent sleep schedule, avoiding caffeine and electronics before bed, and creating a relaxing bedtime routine can help regulate sleep patterns,” he explains.

Support brain health

What’s good for your brain is often good for mood regulation.

Onischak recommends talking with your healthcare team about omega-3 fatty acids, which she says may protect against mood shifts by strengthening the phospholipid membrane that surrounds all cells, including neurons.

“Anything that promotes brain health, such as exercise, a healthy diet, and opportunities for relaxation and restoration, such as yoga or other enjoyable hobbies, can make the risk of mood episodes less likely,” she says.

Avoid drugs and alcohol

Drugs and alcohol can worsen bipolar disorder symptoms and interfere with treatment. If you feel drugs or alcohol are impacting your bipolar disorder, talk with a doctor about ways to reduce or stop your use.

Talk with a doctor about treatment

Treatment for bipolar disorder may include a combination of medications, psychotherapy, brain stimulation therapies, and lifestyle changes. A doctor can help you develop a treatment plan to help you manage your symptoms.

You should also talk with a doctor about any medications you take for other health conditions to make sure they won’t affect your bipolar disorder treatment.

Bipolar I disorder is characterized by episodes of extreme shifts in mood from mania to depression. A number of factors can trigger a bipolar mood episode, such as stress, hormonal changes, and drug and alcohol use. Some people may experience mood episodes without any apparent triggers.

Keeping track of your moods can help you identify potential triggers. You may not be able to avoid your triggers altogether. But making lifestyle changes, such as getting good sleep and practicing stress management, and following your treatment plan, can help you manage your bipolar I disorder symptoms.