Three Factors That Contribute To Mania

"Thus stress, genetic predisposition, learning, and social networks weave a dynamic tapestry in determining vulnerability to mood disorder. Usually it is impossible to identify a single factor as the incisive variable, for commonly all are necessary but each alone is insufficient to precipitate illness."

Peter C. Whybrow, "A Mood Apart."

"Specifically, the initial cause of the disorder is strongly influenced by genetic factors (having a family history of bipolar disorder or at least depressive illness). In contrast, new episodes that develop after the first one appear to be heavily influenced by environmental stress, sleep disruption, alcohol and substance abuse, noncompliance with drug treatments, and other genetic, biological, or environmental factors."

David J. Miklowitz, "The Bipolar Disorder Survival Guide."

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Figure Your Trigger

It is said that there are several factors that contribute to the occurrence of a manic episode: a genetic predisposition, biochemical influences, stress, and a triggering event. There's not much we can do about our genes. We can influence our biochemicals if we keep taking the tablets. But if we can figure out what triggers our episodes we have an increased chance of avoiding them. I have had some success at recognizing what triggers my episodes and I believe this has helped limit the time I spend weaving baskets.

Sleep Deprivation

"Probably many have noticed that after a night without sleep, during the next day one feels reasonably well, indeed quite happy and energetic, but on the second day there is a letdown and great tiredness. In those of bipolar predisposition this experience is magnified. There is no second-day letdown, but continued acceleration and then manic behavior. There are many clinical reports of the triggering of mania by sleep deprivation. A controlled study ... confirmed that manic-depressive individuals, especially those prone to switching from one state to another (rapid cycling), will develop mania if kept awake all night. Some individuals switched back into depression after sleeping, but in others the mania persisted for days or weeks."

Peter C. Whybrow, "A Mood Apart."

"Are sleep problems a symptom of bipolar disorder, or do they actually cause problems in mood? It appears that they are both symptom and cause. Most people, bipolar or not, have changes in mood when they have trouble sleeping, but bipolar people are particularly vulnerable to changes in the sleep-wake cycle."

David J. Miklowitz, "The Bipolar Disorder Survival Guide."

"The other relevant clinical observation about sleep in persons with bipolar disorder is that sleep deprivation can precipitate mania. This is a very well documented finding ... even one night of sleep deprivation can precipitate mania."

Francis M. Mondimore, "Bipolar Disorder A Guide for Families and Patients."

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First the easy one, sleep. For me, sleep deprivation is probably the most certain trigger of a manic episode. However, it is hard to separate the chicken from the omelette, because a manic episode will itself cause loss of sleep. Frequently I have believed sleep to be no longer necessary as an episode takes hold of me. But loss of sleep has certainly led to the onset of a manic episode. A single night with difficulty getting to sleep is nothing unusual. However, two sleepless nights in a row and it is time to consider reaching for the medicine cabinet. And never, never ever, is it permissible to keep on working through the night.

The other triggers are not so easy to recognize. Studying hard was certainly one. The frequency of episodes during my undergraduate and graduate studies was markedly higher than during the years of regular employment. But simply avoiding study is neither practical nor a solution I was willing to accept. I never isolated it to any particular aspect of study. However, I found that straining to be creative in my graduate studies was much more dangerous than just getting on with the day-to-day experimental work. I also found that overstimulation from interaction with others at a conference could precipitate an episode.

Religious belief was a trigger for me. Religious belief and manic depression go together like a Boy Scout and a box of matches. They make an explosive mixture. By its very nature religion encourages a belief in the supernatural. Equally, by its very nature, manic depression causes the "supernatural" to occur with all but predictable regularity. A healthy human mind has a capacity for doublethink that permits a belief in the supernatural to coexist with a firm grasp on reality. Those of us whose grasp on reality is more tenuous will begin to loose touch with reality as an episode progresses. At such times it is a considerable liability to believe in the supernatural.

One of my favorites was to believe that I had supernatural powers, sometimes to the extent that I believed myself to be a god, at least for a couple of days. (Reality has a way of catching up with us minor deities rather quickly at such times.) More insidious, however, was the belief that I had received some form of spiritual healing. This happened several times. The big problem with this is that one is likely to interpret the euphoria at the onset of an episode as confirmation of the healing. The warning signs will then be totally ignored or given some other spiritual interpretation. The men in white coats must arrive before anything is done about the episode. Much weaving of baskets will follow.

Without Any Discernible Trigger

"As many as 25 percent of us may suffer a mood disorder at some point during the life-span—given the right set of stressful circumstances—but for a vulnerable few, perhaps 4 to 6 percent of the population in the United States, the episodes of unipolar and/or bipolar illness repeat themselves, returning again and again without apparent cause. Frequently in such cases careful inquiry reveals that other family members suffer too. There is strong evidence that manic depression [bipolar disorder] is particularly likely to cluster in families, suggesting that the specific vulnerability to bipolar illness is passed down through the genes. Often the episodes of illness begin in late adolescence or early adulthood and increase in frequency with the passing years. ... We know from careful studies, undertaken late in the nineteenth century before our modern treatments were available, that if the illness is left unchecked, the periods of disorder lengthen over a lifetime until finally the individual is held hostage to the illness."

Peter C. Whybrow, "A Mood Apart."

"These observations have been borne out in later studies: initial and early mood episodes in patients with bipolar disorder are often related to psychological stressors, but after several episodes the illness can take on a life of its own, and episodes are more likely to arise spontaneously. This is now called the kindling phenomenon in bipolar disorder: a match held to a pile of wood will often start a small flame that quickly dies out, but if the process is repeated often enough, a fire is kindled, and no more matches are needed."

Francis M. Mondimore, "Bipolar Disorder A Guide for Families and Patients."

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There were other times when an episode just occurred without any discernable trigger. However, if you can come to recognize some of the events that trigger your episodes you have a better chance of spending less time weaving baskets.

I'm sorry, you can't go home until you're better.

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