Bipolar Disorder: 8 Tips to Keep Spring Mania at Bay
Sandra Rosenthal, PhD, began experiencing racing thoughts, sleepless nights, unbridled energy, and emotional turmoil several decades ago.
Ultimately, her symptoms led to an episode of psychosis, a hospitalization, and, finally, after five years, a diagnosis — bipolar disorder, a mental health condition that causes extreme shifts in mood, alternating between unusually elated, energetic, or irritable moods (mania or hypomania) and deeply sad and hopeless moods (depression).
It would take several more years before Dr. Rosenthal, who is now the Jack and Pamela Egan Chair of chemistry at Vanderbilt University in Nashville, Tennessee, would realize that her symptoms were worse in the spring, when she would feel a burst of energy, or mania, that led to sleeplessness.
Rosenthal, it turned out, also had seasonal affective disorder (SAD), an umbrella term meaning that someone's mood disorder follows a seasonal pattern. This shift toward mania in the spring is also known as “spring mania,” and it’s not uncommon in people with bipolar disorder.
About 25 percent of people with bipolar disorder have symptoms that follow a seasonal pattern. Most commonly, it manifests as an increased risk of depressive episodes in the winter and mania or hypomania in the spring and summer.
The length and severity of spring mania varies from person to person. In Rosenthal’s experience, the heightened arousal is normally at its peak for at least one week but can persist for months.
Spring mania can be dangerous or even life-threatening — manic episodes can lead people to do risky or reckless things they wouldn’t ordinarily do. “They may spend money wildly, engage in sexual activity with people they barely know, or walk right into traffic,” says Jonathan E. Alpert, MD, PhD, who is the Dorothy and Marty Silverman Chair in psychiatry and the chair of the department of psychiatry and behavioral sciences at the Albert Einstein College of Medicine in the Bronx, New York.
Concerningly, rates of mania and suicide tend to be highest during the spring months, research shows.
Experts don’t know for sure why some people experience spring mania, but there are some hypotheses for why it happens.
One such hypothesis: People with bipolar disorder are thought to have disrupted circadian rhythms — the body’s natural 24-hour clock — and may be more sensitive to light in general.
The changes in daylight that happen as winter ends and spring begins may make this worse. In a review, Rosenthal and her research team theorized that the increase in daylight at winter’s end pushes people with bipolar disorder to their limits.
“The really important idea in spring mania is that it’s not just longer days, but how fast that change occurs that matters,” says Rosenthal.
This may be due in part to the brain region called the suprachiasmatic nuclei (SCN), also known as the biological pacemaker of the body’s circadian rhythms, according to Rosenthal and her colleagues in the aforementioned review. Some researchers believe that melatonin — a hormone produced by the body in response to darkness to help you sleep — may also play a role in spring mania. The possibility of an increased sensitivity to light among people with bipolar disorder may result in less melatonin produced by the body. When daylight lengthens in the spring and summer, this might disrupt sleep and circadian rhythms, which in turn could trigger mania.
If your bipolar disorder tends to follow a seasonal pattern, you may have an increased risk for spring mania. Fortunately, maintaining awareness, consistently taking medication, and making lifestyle changes can help reduce the chances you’ll experience a manic episode, or help tamp down the negative effects if you do.
“Some people learn to recognize their increasing restlessness in early spring and then take steps to prevent the feelings from escalating,” says Dr. Alpert.
Here are experts’ top strategies for managing spring mania:
1. Stick to Your Medication Plan
Your medications help keep your bipolar symptoms, including mania, in check. Always talk to your doctor before making any changes to your treatment regimen, and don’t stop taking your meds without their guidance. Doing so can cause you to experience withdrawal symptoms, as well as new or worsening symptoms like mania.
2. Consider Trying Interpersonal and Social Rhythm Therapy
Interpersonal and social rhythm therapy (IPSRT) is a type of talk therapy in which mental health professionals help people with bipolar disorder understand and manage their biological and social rhythms. It aims to help people develop more consistent routines and build skills to cope with upcoming changes to day-to-day schedules, like switching jobs or taking a trip.
Together with other therapies, medication, and lifestyle strategies, IPSRT can help people detect mood changes and reduce their risk of future manic or depressive episodes. Specifically, it appears to reduce symptoms of anxiety, depression, and mania among people with bipolar disorder, as well as improve their ability to stick with their medication regimens.
3. Set a Consistent Daily Routine — and Make It Nonnegotiable
Chris Aiken, MD, encourages his patients to designate and stick to consistent times for meals, exercise, socializing, and sleep. “Sleep and wake periods in particular should be kept consistent,” says Dr. Aiken, the editor-in-chief of the Carlat Psychiatry Report and director of Psych Partners in Winston-Salem, North Carolina.
The reason: Having a consistent routine, especially for sleep and wake times, can help keep your mood stable and reduce the risk of manic and depressive episodes.
Aiken suggests leaning on digital calendars, voice reminders, or even Post-it notes to help you stick to your schedule.
4. Limit Your Light Exposure During Spring and Summer
Light helps regulate the body’s circadian rhythms, as well as its release of melatonin. People with bipolar disorder seem to be more sensitive to light and its effects on the circadian rhythm. That’s why people with bipolar disorder can find that adjusting their light exposure to the time of year helps keep their moods stable.
During spring and summer, when daylight is longer, heavy-duty blackout shades for work and home are a must for Rosenthal. “I enjoy the sun in spring and summer, but after the third week in May, I limit exposure to light after 3 p.m.,” she says. In the winter, when daylight is shorter, Rosenthal reverses her efforts to make sure she gets enough light before the sun sets.
5. Make Your Bedroom a ‘No Screens’ Zone
Good sleep hygiene is critical for people with sensitive circadian rhythms. Aiken recommends keeping all electronic screens — including cell phones, laptops, and TV — outside the bedroom, keeping things quiet, and maintaining a cool temperature and complete darkness for optimal sleep. Light from electronic devices can confuse the brain and keep you awake longer, he adds.
6. Avoid ‘All-Nighters’
The energy that comes with mania makes it easy to stay up all night, but the consequences can be serious. “You just can’t allow that, even if you think you’d rather ‘be productive’ all night,” says Rosenthal.
One way to calm yourself before bedtime is to master mindfulness, says Rosenthal. Mindfulness in meditation involves intentionally focusing on the present moment rather than thinking about the past or future.
This practice has many health benefits, including potentially helping people with sleep issues get a better night’s sleep.
Stimulant medications are known to be potential triggers of manic symptoms, which is why many people with bipolar disorder choose to avoid them when treating conditions like ADHD. But even common stimulants like caffeine can be problematic. Abrupt increases in caffeine intake appear to be associated with mania among people with bipolar disorder, according to one systematic review. However, the researchers note, this evidence isn’t conclusive.
Be sure to avoid substances like alcohol too, because alcohol can also make bipolar symptoms worse, research shows. What’s more, people with bipolar disorder have an increased risk of developing an alcohol use disorder compared with the general population. Having both conditions is linked to an increased risk of mood episodes and suicide.
8. Eliminate Long-Distance Travel During the Spring
Rapidly traversing multiple time zones can cause jet lag, leading to mood changes in people with sensitive circadian rhythms.
Knowing this, Rosenthal skips far-away conferences during critical periods. “Air travel gets me even more jacked up than I normally am in spring, so there are events I don’t attend in person, even if I feel fine,” she says.
Research shows that people with bipolar disorder are at increased risk for manic episodes in the spring.
“Spring mania,” as it’s called, is a type of seasonal affective disorder (SAD), meaning that your mood changes follow a cyclical pattern.
The cause of spring mania is not yet proven, but the experience is linked to the disruptions in circadian rhythm common among people with bipolar disorder.
Research shows that sticking to your medication regimen, prioritizing a consistent routine, and making sure you get quality sleep — among other lifestyle modifications — can help people with bipolar disorder lower their risk of experiencing spring mania.
Read a personal story about one woman's experience with springtime mania on Everyday Health's network site bphope.com.
