Bipolar disorder alters your mood, energy, and activity levels, characterized by “high” (manic) and “low” (depressive) episodes. If your bipolar isn’t well controlled, certain stressors or changes to your daily routine may lead to a manic or depressive episode. “Common triggers include lack of sleep, abusing alcohol or illegal drugs, pregnancy, financial stressors, and medications such as steroids or antidepressants,” says Julian Lagoy, MD, a psychiatrist with Mindpath Health. Learn how to cope with these triggers so you can stay mentally healthy, whatever life has in store.
What causes bipolar disorder?
Though the specific causes of bipolar disorder are unclear, several factors play a role, according to the National Alliance on Mental Illness. An imbalance of brain chemicals is believed to lead to dysregulated brain activity. And while a brain scan can’t diagnose bipolar disorder, scientists have identified differences in the brain structure of people with the condition. Genetics may also play a part. If your parents or siblings have the disorder, your chances of developing it are higher. However, someone with a family history of bipolar disorder may never develop it themselves.
Stressful life events
One of the most common triggers for a depressive or manic episode is stress. “This may be a single major stressful event, such as the death of a loved one or a medical emergency, or a series of smaller life stressors, like increased pressure at work or conflict at home,” says Caleb Lack, PhD. To manage your stress in a healthy way, try meditation, visualization, breathing exercises, and yoga.
Bipolar disorder can affect your sleep pattern—but skimping on sleep can also be a trigger, says Lack. He recommends interpersonal and social rhythm therapy as one of the most effective preventive measures. IPSR, is designed to help you establish a healthy schedule of sleep, diet, and exercise habits. To relax before bed and sleep better at night, you could also try taking a warm bath, or reading.
Any type of relationship issue—be it with a partner, family member, friend, or colleague—can cause stress. “Psychosocial stressors with family and friends are common triggers for a bipolar episode,” says Dr. Lagoy. In one study, negative social experiences were among the events that triggered suicidal thinking. Other research found that people with bipolar disorder have higher rates of divorce. Working with a therapist can help you and your partner navigate life with bipolar disorder together.
Drug and alcohol misuse
Alcohol and illicit drugs can make manic or depressive symptoms worse, says Lack. “This is particularly true for stimulants, even caffeine in high amounts,” he adds. More than half of people with bipolar disorder (56%) have a history of drug abuse, while 44% have abused alcohol, according to The National Alliance on Mental Illness. Research suggests that drug and alcohol misuse can increase the risk of bipolar disorder; other studies suggest that people with the condition use substances to cope with symptoms.
Prescribed drugs can also trigger a bipolar episode. Antidepressants aren’t recommended as a monotherapy (single treatment) for bipolar disorder because they increase the risk for mania, says Dr. Lagoy. However, an antidepressant may be prescribed to someone with bipolar disorder alongside a mood stabilizer or antipsychotic. Speak to your doctor if you have concerns about how your meds are affecting your bipolar symptoms.
Seasonal affective disorder (SAD), characterized by mood fluctuations when the weather changes, affects about 25% of people with bipolar disorder. Episodes may be linked to a specific season, with mania more common during spring and summer and depression during early winter. A 2021 review found that hospital admissions for bipolar depressive episodes peak in early winter and hospitalizations for manic episodes are more common in spring and summer. Your doctor can advise you on treatments for SAD, such as light therapy, psychotherapy, vitamin D supplements, and antidepressants.
We don’t know for sure how or why pregnancy can trigger a bipolar episode—there’s just not enough research. But studies have shown that women with the condition have a 50% risk of recurrence of symptoms during pregnancy and after giving birth.
Financial difficulties are often tied to episodes in people with bipolar disorder, and it can become a vicious cycle. Compulsive buying may increase money worries, leading to more anxiety and stress. Adhering to your bipolar disorder treatment plan will help keep episodes of mania under control, but if you need additional help to change your financial habits, consider making an appointment with a therapist.