Bipolar Disorder Health Center

The more you know about bipolar disorder, the better you will be able to cope with this lifelong illness. There are many steps that you can take-or help a loved one take-to recognize and better manage manic episodes.

• Learn the warning signs of a manic episode and get early treatment to avoid disruption in your life.
• At the same time each day, record your mood and any symptoms.
• Take medicines as instructed by your doctor to help reduce the number of manic episodes.
• To help prevent a manic episode, avoid triggers such as caffeine, alcohol or drug use, and stress.
• Exercise, eat a balanced diet, get a good night's sleep, and keep a consistent schedule to reduce minor mood swings that can lead to more severe episodes of mania.
• Have an action plan in place so that if you do have a manic episode, those who support you can follow the plan and keep you safe.

One of the most important parts of managing a manic episode is recognizing the early warning signs. You may have unique warning signs, although many will be common among all people with bipolar illness. It is important to know your warning signs so that you can start treatment early, perhaps preventing a more severe manic episode. Charting your mood is one way you can begin to identify your patterns and symptoms.

A journal, where you can record how you feel each day, will help you recognize patterns in your mood and identify early warning signs. At about the same time every day, ask yourself, "How did I feel today?" Use a scale from –5 (depressed) to +5 (manic), with 0 being normal, and give yourself a daily score. If you have any new or different symptoms, write them down. Also note anything stressful or unusual that disrupted your routine. Did you take your medicine properly? Did you sleep well, eat regular meals, or exercise? Did you drink alcohol? You might discover certain things that trigger a change in your mood, which can lead to more severe symptoms, and avoid those things in the future.

As you chart your mood, ask your friends and family to let you know if they notice any signs of a mood change. Record those in your mood journal as well.

Common early warning signs of a manic episode include:

• Needing less sleep.
• Being more active.
• Feeling unusually happy, irritable, or energetic.
• Making unrealistic plans or focusing intensely on a goal.
• Being easily distracted and having racing thoughts.
• Having unrealistic feelings of self-importance.
• Becoming more talkative.

Most people who have bipolar disorder take medicine every day, usually a medicine called a mood stabilizer. But you can still have a manic or depressive episode despite being on these medicines. During a manic episode, you may need another medicine to help manage your symptoms until they pass. Be sure to see your doctor when you first notice symptoms so that you can start treatment right away and perhaps avoid a more serious episode.

For many people with bipolar disorder, the early symptoms of a manic episode feel good. It is not uncommon to feel up and energized, confident and creative. These feelings may seduce you into thinking that you don't need your medicine. This is when it is important to have a support system in place. You may need family or friends to help you stay with your treatment plan.

Getting early treatment allows you to manage your illness in a proactive way. And you benefit by having fewer disruptions in your life. By avoiding impulsive and often destructive or dangerous manic behaviors, you will have fewer long-term repercussions. Behaviors like spending too much money, having unprotected sex, or driving recklessly can have serious consequences for both you and your loved ones. Learning the early signs of a manic episode may help you avoid these problems.

The best way to manage bipolar disorder is to prevent manic episodes. Although that is not always possible, you can identify and try to avoid the triggers that may lead to a mood swing. One of the most important aspects of managing your illness is to stay on a routine, particularly keeping a stable sleep pattern.

• Maintain a stable sleep pattern. Go to bed about the same time each night, and wake up around the same time each morning. Too much or too little sleep or changes in your normal sleep patterns can alter the chemicals in your body, which can trigger mood changes or make your symptoms worse.
• Stay on a daily routine. Plan your day around a fairly predictable routine. For example, eat meals at regular times, and make exercise or other physical activity a part of your daily schedule. Also, perhaps, practice meditation or another relaxation technique each night before bed.
• Set realistic goals. Having unrealistic goals can set you up for disappointment and frustration, which can trigger a manic episode. Do the best you can to manage your illness. But expect and be prepared for occasional setbacks.
• Do not use alcohol or illegal drugs. It may be tempting to use alcohol or drugs to help you get through a manic episode. But this can make symptoms worse. Even one drink can interfere with sleep, mood, or medicines used to treat bipolar disorder.
• Get help from family and friends. You may need help from your family or friends during a manic episode, especially if you have trouble telling the difference between what is real and what is not real (psychosis). Having a plan in place before any mood changes occur will assist your support network in helping you to make good decisions.
• Reduce stress at home and at work. Try to keep regular hours at work or at school. Doing a good job is important, but avoiding a depressive or manic mood episode is more important. If stress at work, school, or home is a problem, counseling may help improve the situation and decrease stress.
• Learn to recognize your early warning signs. One of the most important ways to avoid a manic episode is to identify early signs and seek treatment.
• Monitor your mood every day. After you know your early warning signs, check your mood daily to see whether you may be heading for a mood swing. Write down your symptoms in a journal. Or record them on a chart or a calendar. When you see a pattern or warning signs of a mood swing, seek treatment.
• Continue treatment. It can be tempting to stop treatment during a manic episode because the symptoms feel good. But it is important to continue treatment as prescribed to avoid taking risks or having unpleasant consequences from a manic episode. If you have concerns about treatment or the side effects of medicines, talk with your doctor. Do not adjust the medicines on your own.

Learning how to manage your bipolar disorder can help you live a healthy and productive life.

Talk with your doctor

If you have questions about this information, take it along with your mood journal or symptom chart when you visit the doctor. You may want to use a highlighter to mark areas or make notes in the margins of the pages where you have questions.

Be sure to let your doctor know when you notice changes in your behavior. Talk with your doctor about what might be triggers for you and discuss ways to avoid them.