8 Expert Tips to Anticipate and Cope With Bipolar Mood Episodes

Fortunately, mental health professionals have identified steps you can take to prevent mood episodes and help you cope if one occurs. Here are eight proven strategies to try.

1. Take Your Meds as Prescribed — No Ifs, Ands, or Buts

Most people with bipolar disorder are prescribed medications to manage their condition. Failure to take those medications can trigger severe discomfort via withdrawal symptoms, as well as increase your risk of mood episodes, says Cara Gardenswartz, PhD, a clinical psychologist in private practice in Los Angeles and New York City.

It’s simple: Don’t skip doses of your medication, decrease your dose, or add a dose without first talking to your doctor, Dr. Gardenswartz says.

If you’re experiencing negative side effects, reach out to your prescriber right away to check that you’re taking your medication correctly. They may also change your dose or switch you to a different medication.

2. Nurture and Grow Your Support System

The support of family and friends is key to staying well with bipolar disorder.

Deepen your bonds by reaching out to people you already trust and enjoy spending time with, says Emily Carol, PhD, the clinical director of the support, treatment, and resilience program at McLean Hospital, a psychiatric hospital in Belmont, Massachusetts.

You might start by telling friends and family how much you appreciate them and making it a point to stay in touch with phone calls, texts, and emails. Share as much as is comfortable about your diagnosis, treatment plan, and how you’re feeling right now. Foster openness by asking your loved ones to share how they feel, not just about your news but about what’s happening in their lives, too.

One very important tip: When friends and family offer to help, let them, and try to be specific about what you need. For example, ask them to learn more about bipolar disorder by reading articles and books. Or maybe you’d like them to be more active in your treatment by checking in with you every day or helping you set up reminders for taking your medication. “Support can look different for different people,” says Dr. Carol.

Also, consider joining a support group for people with bipolar disorder. Meeting regularly with others who know firsthand what you’re going through can make you feel less alone and make it easier to address problems and find solutions quickly. Organizations like the Depression and Bipolar Support Alliance offer online support groups.

3. Plan to Be Physically Active Most Days of the Week

Exercise does wonders for people with bipolar disorder by stimulating the release of mood-stabilizing brain chemicals such as dopamine and serotonin, Gardenswartz says.

Need help getting started? Set a goal. “Instead of just saying you will exercise more, it’s more likely to happen if you say, ‘I plan to exercise three times a week for 20 minutes at a time,’” Carol says. Follow the SMART method to do that, she suggests:

• Specific Zero in on which activities you will do.
• Meaningful Choose activities you enjoy. For example, is exercise more fun for you if you’re outdoors or indoors? Is the activity muscle building or fat burning? Will you do it alone or with others?
• Achievable and Realistic Choose activities that fit well into your daily routine and your fitness level. Even a 10-minute walk around the block can have a positive impact on your mental health.

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• Time Set limits on when and how long you’ll exercise.

Another way to create an exercise routine, says Gardenswartz, is to have an exercise buddy, whether it’s a friend, a trainer, or even an in-person or online exercise class. A buddy “holds you accountable,” says Gardenswartz.

Be sure to check with your doctor before you start a new exercise routine.

4. Set Up and Stick to a Sleep Schedule

“A sleep schedule is beyond important,” says Gardenswartz. “It might be one of the most important factors in preventing manic episodes because the first indicator of a manic episode for most people is decreased sleep.”

• Go to sleep and wake up at the same time every night and every morning, even on weekends. This helps program your body to feel drowsy at bedtime and to wake up refreshed.
• Budget an hour before lights out to wind down. Spend the time doing anything to soothe your busy mind, whether it’s reading a book, listening to calming music, doing light stretches, or anything else that works for you.
• Keep your bedroom dark so that light doesn’t interrupt your sleep. Try hanging heavy blackout curtains or using an eye mask. Natural light sneaking into your bedroom can make you wake up extra early.
• Shut off electronics two hours before bed, and keep them out of the bedroom. Doing this routinely can help your brain know it’s time to prepare for bed. More importantly, light from screens — whether it's your phone, tablet, computer, or television — can make your brain think it’s still daytime, which can make it harder to fall asleep.

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• Keep your bedroom cool. The ideal temperature for sleep is around 60 to 67 degrees F, but this can vary from person to person.
• Shut out noises that might keep you awake. If you live in a noisy area, try using a white noise machine or fan to drown out unwanted sounds.
• Skip the nightcap. Don’t be fooled: Although alcohol may help you fall asleep, it typically disrupts sleep as the night wears on. What’s more, bipolar disorder and alcohol use disorder often occur together, so it’s best to avoid drinking altogether.

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• Cut out caffeine after noon. Consuming too much caffeine in the afternoon and evening can keep you from falling asleep in the first place.

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• Stop eating three hours before bedtime. An active digestive system can make it harder to sleep. You might also experience acid reflux, which can be uncomfortable.

5. Start a Mood Journal

A mood journal — whether it’s a plain notebook that you write in or a structured journal with specific spaces to record your mood, sleep, exercise, and other factors — allows you and your therapist to track your mood each day and develop a record of mood episodes over time. This awareness helps you identify triggers, activities, and even people that may negatively affect you, Carol says.

“By keeping a journal, we know that if all of a sudden, a person’s mood on a 1 to 10 scale is a 55, we can try to make an adjustment in treatment such as talk therapy or medication before it turns into a full-blown [manic] episode,” she says.

Set up a weekly chart to note symptoms such as increasing irritability, how severe those symptoms are (using your own words or on a scale from 1 to 10), and when and where the symptoms occurred. There are several free, downloadable charts, including one from the Depression and Bipolar Support Alliance.

With your therapist, you can use your journal to identify patterns, so you can recognize when a future mood episode is building. Once you’re able to recognize these patterns, like changes in sleep, for example, you can come up with ways to avoid your triggers or take control of a mood episode preemptively before it impairs you, says Carol.

6. Prepare for Seasonal Change

7. Reduce Stress Whenever and However You Can

While stress isn’t always avoidable, planning how to handle it when it happens can prevent or lessen shifts in your mood, Carol says.

• Taking medication as prescribed, including mood stabilizers, which help reduce how vulnerable you are to stress
• Exercising regularly
• Cutting back on caffeine
• Identifying and avoiding behaviors that worsen stress, like social isolation
• Engaging in behaviors that help you deal with stress, like learning to prevent rumination (overthinking)
• Learning techniques such as progressive relaxation, deep breathing, and meditation

If a stressful event is on the horizon, such as moving, surgery, or a job change, plan in advance with your therapist to use specific strategies to manage that stress. And when unexpected stresses pop up, keep your therapist in the loop.

Also, try to limit time spent with (or completely avoid) people who stress you out or who are a negative influence, especially if spending time with them often includes alcohol or causes you to disrupt your sleep schedule, Carol says.

8. Just in Case, Plan for Emergencies

It’s critical for people with bipolar disorder and those who support them to know what to do in a crisis situation. Coping strategies can go a long way in heading off a severe mood episode, but they can’t guarantee that one will never happen.

Ask your friends and family to plan how to handle a mood episode if one happens and let them know which behaviors might mean you need immediate professional help.

“Have a written agreement with everyone about what the plan of care will be, such as going to the hospital,” Carol says. Doing this in advance allows you to have a say now in any decisions made if you’re experiencing an emergency.

• Contact information for doctors, therapists, and other medical professionals involved in your treatment
• Your current diagnosis and medications
• Your basic medical history, including any history of crises, drug use, hospitalizations, psychosis, or suicide attempts
• The addresses of nearby walk-in crisis centers and emergency rooms
• Phone numbers of family members and friends who would be helpful in a crisis
• A list of possible triggers, as well as strategies or treatments that helped in the past

• Aggressive, destructive, or self-injurious thoughts or behaviors, including threats of suicide
• Psychotic symptoms, in which you cannot distinguish between what is real and what is not (possibly marked by bizarre or paranoid ideas or by hearing, seeing, smelling, or tasting things that aren’t real)
• Severe mood swings that could lead to dangerous or harmful behaviors
• Out-of-control use of alcohol or recreational drugs