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How to Predict Your Next Bipolar Episode

photo of a young girl next to window glassIf you’ve been diagnosed with bipolar disorder I, II, or III, you know that your mood goes up and down, with manic and depressive cycles. For most of us, that means using medication to manage the ups and downs, taking care to schedule our lives around when we will have energy, and fitting our lives around the disorder. Bipolar disorder changes your entire life, but it’s not unmanageable or unpredictable. While bipolar disorder will never behave like clockwork, you’ll always be a bit surprised, and you’ll occasionally be caught off guard, learning to predict your cycles of ups and downs can help you to take control of your planning, your life, and how you interact with others.

These tips should help you to judge when your next bipolar episode will occur, how likely it is, and how to react to it.

Bipolar Cycles are Cycles

Bipolar disorder is diagnosed based on the average length and duration of cycles of manic and depressive episodes as well as the time between them. While this isn’t a strictly good way to predict when cycles will be, it gives you time to assess how often they are likely to occur based on your current diagnosis. That can always be wrong, as bipolar disorder can shift significantly, but having an indicator in place is always helpful.

Bipolar 1 – Your manic episodes last 7 days or more with depressive episodes that last 2 weeks or more. Here, depressive episodes may not occur at all.

Bipolar II – Bipolar II or hypomania typically experiences major depression following or preceding hypomania. Here, hypomania normally lasts at least 7 days and may last up to several months. Depressive episodes normally last at least 14 days.

Cyclothymic Disorder – Cyclothymic disorder includes long-term hypomania and depressive disorders, typically lasting up to 2 years in adults. Symptoms are milder but last a significant period with long gaps in between.

Rapid Cycling – Rapid cycling is the process of rapidly moving between one depressive episode and another – normally entailing at least 4 episodes in 12-month period. This normally involves shifting from one episode directly into the opposite episode (e.g., from depression to hypomania and then back to depression) or with remission of up to 2 months in between episodes.

In each case, it’s difficult to use the diagnosis to predict when the episode will start but it can be used to predict how likely it is and how much time you normally get between episodes. For example, with Bipolar 1, you’re unlikely to experience a depressive episode immediately following a manic one. You’re also highly likely to have breaks of 2 months or more between episodes. If you have rapid cycling bipolar disorder, you know that you normally have at most, 2 months between episodes.

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Can You Sense Upcoming Bipolar Episodes?

photo of a sad unhappy handsome man with bipolar disorder sitting on the sofa and holding his forehead while having headacheWhile the answer isn’t “Definitely yes”, for many people, the answer is, “often”. In one 2003 review of 17 studies of bipolar symptoms before and after manic and depressive episodes, it was shown that 82% of participants could identify prodromal or “Early” symptoms before and after bipolar episodes. These prodromal symptoms lasted anywhere from 1-120 days before a manic episode and 11-49 days before a depressive episode. That’s certainly not enough time to warn you that an episode is about to happen ‘right now’, but it does give you some warning. Another study, which included over 1000 people, suggested that average early symptoms last between 15 and 45 days.

Of these, the single most common early warning sign for both depressive and manic episodes were sleep disturbances. However, most people experience lighter versions of the symptoms of their bipolar episode.

For example:

  • Mood goes up or down and is more extreme than usual but not manic or depressive
  • Sleep changes are noticeable, and you need more or less sleep than usual
  • Activity levels shift and you might have no energy or feel invigorated
  • You might eat more or start skipping meals to focus on activities
  • Interest in work or hobbies goes up or down
  • You become more or less talkative
  • You pay more attention to your appearance, or less

Eventually, most data shows us that bipolar episodes don’t suddenly turn on overnight in most cases. However, sometimes they do. Outlier cases have early warning signs just a day in advance of a manic episode. That can be incredibly difficult for anyone to notice or predict, especially if your brain is already ‘acting up’ in other ways.

But, if you have two weeks of noticeable shifts, you can definitely predict that you’re about to have an episode, and likely in line with the symptoms you’re currently experiencing.

Journaling and Recording Episode and Mood

The best way to predict how and when your bipolar episodes start is to keep a record. You can start this on your own but it’s always a good idea to do so as a project with your mental health professional. They can properly diagnose and interpret data and can tell you what to pay attention to. However, in most cases, recording your mental health means:

  • Writing down your mood and any mood changes occurring during a day
  • Tracking your sleep (A Fitbit or similar device may help)
  • Paying attention to and recording interest levels in activities and how much you focus on those activities
  • Keeping track of mental highs and lows, such as how often you are sad or depressed in a day or how often you are hyper and on top of the world
  • Tracking when bipolar episodes actually start and keeping up with how long they last

Once you have a good record of how your bipolar disorder behaves over the course of a year or even two, you’ll have the information you need to better predict when something is a warning sign of an episode or not. That’s important because everyone responds to bipolar disorder differently, most of us experience bipolar disorder differently, and only you can really know what your warning signs are – despite the fact that you’re very often likely to overlook them if you aren’t keeping careful records.

Eventually, bipolar disorder will never be completely predictable. However, you can work to improve your ability to notice when things are changing, so you are better equipped to get help, better able to make adjustments to your schedule, and better able to move into treatment if you need it.