You may be able to short-circuit a developing mood episode through early intervention, but to do so, you must first be able to identify the early warning signs. In this post, I point out some common early warning signs of an oncoming bipolar mood episode (depression, mania, or mixed) and ask you to share your early warning signs.
One of the most challenging aspects of bipolar disorder is that those who have it often lack insight, meaning that in the midst of a major mood episode, their mood radar stops working. Consider teaming up with a loved one you trust to offer the objective insight you need. Remember: The earlier you intervene, the better chance you have of keeping a full-blown mood episode at bay.
Major depression is usually easy to recognize. You’re exhausted. You feel a deep sense of despair. Perhaps you even feel achy. You’re dragging your body through this thing called “Life.” The early warning signs, however, can be difficult to detect:
- Loss of interest in activities you generally find pleasurable
- Fatigue or decreased energy
- Doing any little thing feels unbearably difficult
- Diminished activity or social withdrawal
- Sleeping too much or not able to sleep
- Unexplained aches and pains
- Weight loss or gain or decreased or increase appetite
- Unexplained sadness that won’t go away
- Feelings of guilt, worthlessness, or indifference
- Lowered self-esteem or heightened self-criticism
- A sense of hopelessness or despair
- Irritability, anxiety, or anger
- Slowed thinking, movement, or speech or inability to concentrate
- Disorganization or inability to make a decision
- Impaired memory
- Increased focus on death or mortality
- Suicidal thoughts or ideation – thinking about or planning how the suicide would be committed
The early warning signs of mania are typically labeled “hypomania” and often result in feelings of euphoria and power – not exactly the sorts of things people typically seek treatment for. However, this is exactly the phase of a manic episode that requires early intervention.
One of the most objective symptoms to monitor is sleep – needing less sleep is a huge red flag and often easier to see than the mood changes of mania. Routinely keeping track of how much sleep you are needing and getting can be valuable in tracking mood states – impending, existing, and receding.
Common warning signs of an impending manic episode include the following:
- Increased energy or a sense of restlessness
- Decreased need for sleep
- Rapid, pressured speech (can’t stop talking)
- Inappropriate/impulsive speech or behaviors – like being overly honest and open
- Overspending on shopping sprees, vacations, and so on
- Taking on many new tasks and projects – thinking of and entering into lots of schemes and grand ideas
- Increased sexuality, possibly including inappropriate sexual behavior or promiscuity
- Impaired concentration
- Racing thoughts, typically jumping from idea to idea (flight of ideas)
- Excitability or irritability
- Anger or hostility
- Inflated self-esteem – feeling like one is special or better than others – having special powers or insights (commonly called grandiosity)
When mania begins to escalate, loved ones can lose their insight, as well, especially if they feel threatened or hurt. It’s important to keep in mind that this is the disorder saying or doing hurtful things and not the person who has bipolar. This can be extremely difficult, but do your best to get your loved one the medical help he or she needs.
Notice that irritability and anger come up in both poles – these are common signs of both mania and depression. Because these feelings are so generic, they can be hard to use as a marker of a specific type of mood episode, but they are markers of brewing mood changes. Similarly, impaired concentration is often part of both depression and mania; the difference typically centers on the quality of the thinking – slowed and dulled in depression versus racing and feeling exceptionally clear in mania.
A mixed episode is the worst of both worlds. It includes symptoms of both depression and mania occurring every day for at least one week. If you notice the early warning signs for depression and mania alternating or co-existing over the course of a typical day, it’s usually a sign that a mixed-mood episode has arrived or is fast approaching. One minute you feel as though you can conquer the world, and the next you feel as though the weight of the world is crushing you – or you feel both sensations at the same time – a horribly disorienting and painful experience.
Bipolar disorder presents itself differently depending on the type of mood episode and the person. What sorts of early warning signs do you typically experience? Which signs do you stay on the lookout for? If you have bipolar, do you have a friend or relative on call to help you keep watch? Whether you have bipolar or have a loved one with bipolar, please share your insights and experiences in dealing with the early warning signs
by Candida Fink MD