What triggers a bipolar episode
Pro Research Analysisby 
Searched over 200M research papers
Triggers of Bipolar Episodes: A Comprehensive Overview
Pharmacologic and Non-Pharmacologic Interventions
Antidepressants and Mood Stabilizers
Certain pharmacologic interventions, such as tricyclic antidepressants, have been associated with a higher risk of triggering mood episode switches in bipolar disorder patients. The switch-inducing potential of other antidepressants remains unclear, but tricyclics are a notable exception due to their higher risk1. Additionally, dopaminergic agonists and exogenous corticosteroids have been identified as potential triggers for mood switches1.
Sleep Deprivation
Sleep deprivation is a significant non-pharmacologic trigger for mood episodes in bipolar disorder. It has been shown to induce both manic and depressive episodes, with individual differences in vulnerability based on gender and bipolar subtype. Women and individuals with bipolar I disorder are particularly susceptible to high mood episodes following sleep loss4.
Psychosocial and Environmental Triggers
Stress and Life Events
Stressful life events are commonly associated with the onset of depressive episodes in bipolar disorder. These events include general stress, physical injury or illness, and significant life changes2. The kindling hypothesis suggests that while major life stress is required to trigger initial episodes, successive episodes may become progressively less tied to stressors and occur autonomously7.
Goal Attainment and Behavioral Approach System (BAS) Dysregulation
Events involving goal attainment and goal striving can trigger hypomanic or manic episodes. This is consistent with the BAS dysregulation model, which posits that individuals with bipolar disorder are hypersensitive to cues signaling reward opportunities and failure9. However, individuals with bipolar spectrum disorders experience increased rates of BAS-activating and BAS-deactivating events, which can place them at double risk for developing episodes9.
Biological and Neurobiological Factors
Inflammation and Immune Response
There is a growing body of evidence supporting the role of inflammation in bipolar disorder. Tumor necrosis factor-alpha (TNF-α) inhibitors, while being investigated for their potential therapeutic effects, have been reported to trigger manic episodes in some patients5. Chronic stress and inflammation are primary biological mechanisms behind bipolar disorder, driven by contemporary Western lifestyles8.
Circadian Rhythms and Seasonal Patterns
Disruptions in circadian rhythms are another significant trigger for mood episodes. Seasonal patterns have been observed, with manic episodes peaking during spring and summer, and depressive episodes peaking in early winter3 10. These findings suggest that climatic conditions and changes in daylight exposure may influence the onset of bipolar episodes.
Unique Triggers in Young Adults
Lifestyle and Social Activities
In young adults with bipolar disorder, specific triggers for manic/hypomanic episodes include falling in love, recreational stimulant use, starting creative projects, late-night partying, and listening to loud music. Conversely, depressive episodes are often triggered by fatigue, sleep deprivation, and decreases in physical exercise2.
Conclusion
Understanding the diverse range of triggers for bipolar episodes is crucial for early intervention and effective management of the disorder. Pharmacologic interventions, sleep patterns, stress, goal attainment, inflammation, and circadian rhythms all play significant roles in triggering mood episodes. By identifying and mitigating these triggers, individuals with bipolar disorder can better manage their condition and reduce the frequency and severity of mood episodes.
Sources and full results
Most relevant research papers on this topic
The neurobiology of the switch process in bipolar disorder: a review.
The neurobiology of mood episode switches in bipolar disorder is poorly understood, with interventions like sleep deprivation, exogenous corticosteroids, and dopaminergic agonists triggering mood changes.
Systematic Review
Highly CitedTriggers of mania and depression in young adults with bipolar disorder.
Young adults with bipolar disorder have unique triggers for mania/hypomania and unique triggers for depression, which can help identify episodes earlier, enhancing early intervention opportunities.
Observational Study
Rigorous JournalThe precipitants of manic/hypomanic episodes in the context of bipolar disorder: a review.
Goal attainment events, antidepressant medication, disrupted circadian rhythms, seasonal conditions, and stressful life events may precipitate bipolar mania/hypomania in susceptible individuals.
Systematic ReviewHighly CitedSleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender
Gender and bipolar subtype may increase vulnerability to high mood following sleep deprivation, which should be considered in situations like shift work and international travel.
Observational StudyHighly CitedSecondary Mania induced by TNF‐α inhibitors: A systematic review
TNF- inhibitors may trigger a manic episode in patients with or without affective disorders.
Systematic ReviewRigorous JournalCorrelates of first-episode polarity in a French cohort of 1089 bipolar I disorder patients: role of temperaments and triggering events.
Temperamental predisposition and illness onset triggering events significantly influence first-episode polarity in bipolar I disorder patients, potentially aiding early preventive interventions and identifying genetic risk factors.
Observational StudyLife stress and kindling in bipolar disorder: review of the evidence and integration with emerging biopsychosocial theories.
The kindling hypothesis in bipolar disorder is inconsistent with current evidence, and emerging biopsychosocial models suggest a changing relationship between life stress and episode initiation over time.
Literature ReviewHighly CitedBipolar disorder: An evolutionary psychoneuroimmunological approach
Bipolar disorder is linked to chronic stress and inflammation, driven by contemporary Western lifestyles, and reducing these factors through lifestyle changes is crucial for effective treatment.
Increased rates of events that activate or deactivate the behavioral approach system, but not events related to goal attainment, in bipolar spectrum disorders.
Bipolar spectrum disorders are associated with increased rates of events that activate or deactivate the behavioral approach system, but not with goal attainment.
Observational StudySeasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms.
Seasonal patterns in bipolar disorder are observed, with climatic conditions potentially triggering symptoms or episodes.
Systematic ReviewRigorous JournalHighly Cited