Early Warning Signs

"How important is it to know when you are getting manic? One study indicated that there were two predictors of rehospitalization in bipolar disorder: not taking medications, and failing to recognize the early signs of relapse. On a more hopeful note, people with bipolar disorder who receive educational interventions, such as learning to identify early warning signs of mania and then seeking mental health services, are less likely to have full recurrences of mania and have better social and work functioning over 18 months than those who do not receive this kind of education."

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

From the study mentioned above: "Three retrospective studies and two prospective studies showed identifiable and consistent prodromal symptoms [warning signs] of manic or depressive relapse at two to four weeks before full relapse in most patients with bipolar disorder. These prodromal symptoms are idiosyncratic to both the patient and to the type of relapse (mania or depression)."

Patients were taught to identify their early warning signs and take action: "Three symptoms or life situations which reliably occur early in the manic or depressive prodrome constituted a warning stage for the patient to increase monitoring from weekly to daily. Three further symptoms or life situations occurring later in the prodrome constituted an action stage to seek help from a health professional of the patient's choice."

"This study found that teaching patients to recognise manic prodromes [warning signs] and seek early treatment significantly increased time to the next manic relapse (65 weeks compared with 17 weeks in the control group) and reduced the number of relapses." It also found that: "The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning and employment." The study concluded that: "Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment."

Perry, A, Tarrier, N, Morriss, R et al: "Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment." British Medical Journal 318:149-153, Jan. 1999. Full copy of paper.


Signs of the Times

It's not too hard to recognize a broken bone. I once broke my collarbone and didn't realize it for an entire day. But I knew something wasn't quite right shoulder-wise. The problem with recognizing an episode of mania is that the brain is broken. It is real hard to detect a broken brain using that very same brain itself to do the detecting, but it can be done.

After a couple of episodes it is possible to remember the thought patterns that characterize the onset of mania. They are quite different from one's normal patterns of thought. One typically has a couple of days, sometimes longer, during the onset of a manic episode with which to recognize it and take action. After these first few days the episode is too far advanced, one's thought processes too muddled, one's grip on reality too slender to take effective action oneself. Beyond the first few days you'll just have to hope the men in white coats turn up in time.

One of my major indicators is that the lyrics of my favorite rock music begin to speak to me, and about me, directly. I will begin collecting or listing rock songs that have hidden meaning regarding the experiences I am just beginning to enter. I will begin to "understand" this hidden meaning. Now you'd think this behavior would be pretty easy to detect. However, by this time your brain is somewhat addled, you are flooded with feelings of euphoria, and the ideas always present themselves as the "real thing" this time. Remembering that this thought pattern has occurred before, and that it was not real then, is just sufficient to inject enough doubt to raise an alarm. This one is a red alert.

Another favorite of mine is religious mania. It generally manifests itself in reading the bible. And, surprise, surprise! the words of scripture begin to speak to me, and about me, directly. I am no longer normally actively religious so this one is a lot easier to spot these days — another red alert.

Disturbed Sleep Patterns

"There are almost always changes in sleeping and eating habits in mania. Decreased need for sleep is in fact one of the first symptoms to develop in mania—often a clue for individuals who have been manic before that another episode may be starting."

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

"A survey by Grace Wong and Dominic Lam (1999) asked people with bipolar disorder to describe their early warning signals prior to previous manic episodes. The most frequent signals reported were reduced sleep and an increase in activity, both reported by over 40% of the respondents."

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


Disturbed sleep patterns are a good indicator. If I find myself waking up bright and alert early in the morning and raring to go on some project or another it is time to reach for the medicine cabinet. My normal waking pattern is groggy and grumpy and requires two alarm clocks.

The desire to stop taking the tablets is a major indicator. If you find yourself flushing your supply of medication down the toilet — declare a red alert. It's a dead give-away.

I have an ex-US Air Force flying suit I bought once during a manic episode. I tend to like to wear it when an episode takes hold. I suppose it projects the way I feel about myself at such times. I never wear it at other times (well, Halloween maybe). A number of my friends recognize it now, which helps detect an episode. Another red alert.

At the beginning of a manic episode I will be much more outgoing than is normal for me. I will have a greatly increased desire to be with people. Other signs that are fairly easy to notice include an increased desire to spend money, reduced need for sleep, and an increased appetite. These are less certain indicators because they can also occur during normal periods. However, they are sufficient to cause a yellow alert and reference to the emergency pill drill.

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