5 More Triggers of Depression in Bipolar DisorderIn Part One, five different triggers for depression in bipolar disorder were discussed. It’s important for individuals to identify our own triggers. Patients can do this by keeping journals or using mood tracking apps. Using these resources, it’s possible to go back over our history to detect patterns. What was happening in the days or weeks before an episode? Have the same factors been present before other episodes? With this in mind, here are five more common triggers of depression in bipolar disorder.

6 Fatigue
Fatigue is a symptom and a precursor of depression, but also has causes of its own. Sleep deprivation, another trigger for depression, is one of those causes. Some other causes include medication side effects, jet lag, unhealthy eating habits, too much or too little exercise or physical illnesses like the cold or flu, heart disease, thyroid disease, obesity, sleep apnea or chronic fatigue syndrome.

7 Hormone fluctuation
Hormones can affect mood overall and there is a link between polycystic ovarian syndrome and bipolar disorder. Some women also experience mood shifts prior to menstruation as well as during pregnancy. One study linked exacerbated premenstrual mood swings with a more severe course of bipolar disorder and another listed menstruation as a self-reported trigger for depression.

8 Season changes
About 25% of people with bipolar disorder follow seasonal patterns in regards to their mood shifts. In these cases it’s common for people to swing towards mania in the spring and summer and depression in the fall and winter. This is more common in people with bipolar II. Seasonal Affective Disorder is also thought to be a variant of bipolar disorder and major depressive disorder.

9 Travel
There are several ways travel affects those with bipolar disorder. There is some evidence that traveling east is more likely to trigger mania and traveling west can trigger depression, but the most likely trigger is the stress of traveling itself. Firstly, it disrupts routines. Keeping a routine is a key component of managing bipolar disorder. Changes in sleeping and eating patterns are also common in travel, both of which can trigger mood changes. The best way to attempt to avoid triggering an episode is to maintain a similar pattern no matter the location or circumstance.

10 Not taking medication
Taking medication for bipolar disorder is an effective way to avoid mood changes. Antidepressants should be avoided as they can induce manic or hypomanic episodes, but medications like lithium and other mood stabilizers improve depressive symptoms and lengthen time between episodes when taken as maintenance therapy. There is also some evidence that atypical antipsychotics can help improve depressive symptoms. Discontinuing medication altogether can not only involve withdrawal symptoms, but it can also trigger relapse.


People with bipolar disorder spend three times more days depressed than manic or hypomanic. Depression lasts longer and occurs more frequently, especially with bipolar II, so it’s important to make lifestyle adjustments to avoid any triggers, whether on this list or more personal ones.



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Image credit: Sarah Scicluna