Tuesday, August 7, 2012

Triggers for Mania and Depression

Today I’m excited to share another post from the 8th Annual Mood Disorders Clinic at Stanford. One of the most interesting presentations was from Sheri Johnson, PHD, Professor of Clinical Psychology, University of California Berkeley. She discussed the symptom triggers in bipolar disorder for both mania and depression and explained how they’re unique and very different from one another.

(Please note that this is my interpretation of the information presented.)

In depression, some known triggers are major negative life events, lack of social support, negative thoughts about oneself, family conflict and negative moods. When bad stuff happens, depression can follow.

When it comes to mania, the list of triggers is very different. Mania can be triggered by a change in meds, having too much caffeine, using certain cold medications, exciting events, quitting bipolar meds and any behavior that disrupts normal sleep.

A disruption in sleep patterns seems to be a major trigger. Dr. Johnson stressed the importance of establishing good sleep habits, then “protecting them like a religion!” She pointed out that people with bipolar disorder should aim for a minimum of 8 hours of sleep and that they should go to bed and wake up at the same time everyday to establish a healthy circadian rhythm. She stressed that one should never disrupt this pattern, even for special events or holidays since this can trigger the onset of mania.

Another interesting trigger presented was the “exciting events”. Those with bipolar disorder are reward sensitive, she called this type of trigger “activating stimuli”. Just as negative events can bring on depression, events that are rewarding can trigger mania. Such events can be a graduation, a marriage or even winning an award. Often these events start out with the individual appearing very ambitious with lots of goals. They start to get more busy and more active, appearing overly optimistic and under estimating risks. This behavior can go into overdrive triggering mania.

During the onset of this period. it’s important for the family and doctor to be on high alert. If they can help support the individual by encouraging them to stick to good sleep patterns and not take on every new project, it may help. If anything, being aware that these types of exciting events can trigger mania, will allow those around the individual to be prepared for the onset of mania.

For me, I was fascinated with this information. I immediately thought about my son and how he goes through intense, highly focused creative periods where all he can think and talk about are his plans for building some new game, invention or creation. It made me wonder if there was any correlation to negative moods and high irritability following periods of intense, project oriented creativity. I’m definitely going to start charting this “creative mode” period to see if I can in the future predict the onset of other behaviors.

Please check back as I finish this series of posts with my review of the Q&A breakout session for children with mood disorders and what I learned from Kiki Chang.

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In case you missed it, here is my first post about what I learned at the Stanford Education Day:


  1. Agreed. Without regular, restorative sleep, nothing else works.

  2. This is good! The info about sleep is so true. Everyone teases me about how strict I am with my son's sleep schedule, but I know what will happen if I don't keep that schedule, even for holidays and summer! Thanks for sharing!

  3. Hey Mama!
    Stopping medication can trigger depression too, not just mania. Othertimes, medication that was keeping the depression at bay can stop working properly. I'm not sure of this also happens with mania as I have unipolar depression, but it really sucks when it does! A regular sleep cycle is also important for warding off a depression relapse.

  4. Thank you so much for sharing all of this, Mama Bear--I almost feel like I was there! This all sounds so familiar. We've been paying the price lately for letting Bug's sleep routine slip a bit due to trips and having out of town visitors. And I know exciting events also trigger her mania. Look forward to your next post.

    1. I feel your pain, we broke our routine a few weeks ago and the week that followed brought a lot of negative moods and behavior. It seemed out of nowhere, but when I took into account how the weekend was prior it all made sense. Also, once we got back into our routine, things have improved 100%. It still amazes me how sensitive our kids are to any changes.

  5. Nice post and get awareness about sleeping points. thanks foe sharing this info.