Looking Inward at Bipolar Symptoms

Bipolar disorder self monitoring relapse strategy

/ Author:  / Reviewed by: Robert Carlson, M.D

A diagnosis of bipolar disorder, a disorder characterized by extreme highs partnered with extreme lows, can be an overwhelming one to receive.

However, there are ways patients can play an active role in their own treatment. By self-monitoring, or being on the look out for changes in mood and symptoms, patients can potentially help to prevent instances of relapse.

Self-monitoring should not be the only method of treatment or relapse prevention and it is important for those with bipolar disorder to get help from a doctor through prescription medication, therapy or other professional treatment. However, by self-monitoring effectively, patients can actively be involved in their own recovery.

Why Self-Monitor?

According to the Centre for Clinical Interventions (CCI) in Western Australia (a sector of the Government of Western Australia’s Department of Health), “If bipolar patients become more aware of their early warning signs that signal the onset of a mood episode, they can take steps to prevent a full-blown episode of depression and mania.”

To avoid these episodes, patients must get to know their own early warning signs that something has shifted. Signals can vary from person to person, but some are common for large numbers of patients.

Not only do patients need to become aware of these signs, they also need to be informed on how to take action when they notice them.

The CCI reports that, though it is common for patients to think that they are not able to predict episodes, researchers have found that after full-blown episodes occur, many patients can remember the symptoms that came before the episode struck.

And while these early warning signs and symptoms varied from patient to patient, they seemed to stay constant for individual patients from episode to episode.

“Thus, although some early warning symptoms may be unique to individual patients, it appears that they are quite accurate in predicting the onset of a mood episode for each patient,” said the CCI.

In an interview with dailyRx News, Jesse Wright, MD, PhD, and Director of the Depression Center at the University of Louisville in Kentucky, noted that spotting these early warning signs is not always an easy task.

"For example, the first stage of an upswing can include increased pleasurable feelings and spurts of productivity. These changes can be quite welcome, especially if you have been feeling down for a while," said Dr. Wright.

To help tell the difference between normal feelings and signs of a mood swing, Dr. Wright suggests looking for recurring patterns, a practice that will likely become easier and stronger with time. 

"You might recognize that patterns of staying up for an hour or two extra at night to work on projects or get tasks accomplished seems great at first," said Dr. Wright. "But soon you stay up even later and then are irritable and snappy at work the next day."

With more self-monitoring, patterns may become clearer. There are two main areas from which to approach this bipolar self-monitoring – mood monitoring and symptom monitoring.

Mood Monitoring

The CCI recommends that patients take a look at their mood each day.

“Ask yourself, ‘How did I feel today? Was my mood within the normal range, or was I feeling slightly low or high? How low? How high?’ Rate your mood between -5 (depressed) and +5 (manic),” suggests the CCI.

By doing this around the same time every day for a week, patients can begin to look for any patterns or changes in mood. Noting reasons or circumstances surrounding particularly high or low moods may be helpful.

Patients can bring these results to their doctor or therapist and discuss what is seen. Combining self-monitoring and professional opinion can help patients gain a deeper understanding of mood patterns and utilize self-monitoring tools effectively.

Symptom Monitoring

Another important step is becoming more aware of symptoms of a bipolar episode, be it manic, depressive or mixed.

Symptoms can vary, but may include trouble sleeping or sleeping too much, an increase or decrease in appetite, elevated or irritable mood, feelings of guilt or low self-worth, feelings of inflated self-confidence, racing thoughts or inability to concentrate, among others.

“If you experience a number of these symptoms over a few days, in such a way that they interfere with most of your day-to-day activities, you may want to consider taking some action,” suggests the CCI.

Dr. Wright told dailyRx that patients may want to ask trusted friends or family members for help thinking of early warning signs and symptoms.  These second parties may be able to point out signs that the patient hasn't noticed.

Again, it will be helpful for patients to also discuss these symptoms in depth with a mental health professional. Armed with advice and knowledge from their doctors, patients can better monitor themselves and understand their symptoms.

Taking Action

Once bipolar patients recognize that a change has occurred, they must take action for their self-monitoring work to be of benefit.

It can be very helpful for patients to develop an early intervention plan (with the help of a doctor) so that they can have specific steps to set into action. These plans may vary greatly from patient to patient, depending on their unique symptoms and issues.

“Plan what you will do, what you will say, what you will ask your friends or family to do for you,” suggests the CCI, “For example, your action plan may include a visit to your doctor when you recognize your energy level has increased and are feeling restless, or you may ask a friend to keep your credit card when you have the urge to shop for shoes, or request that a relative stop by when you stop calling them, etc.”

It is helpful to keep these plans in an easy-to-find place and fill them with plenty of details, so that they can be quickly accessed and utilized when necessary.

"Many of my patients with bipolar disorder have found that developing a list of early warning signs of mood swings gives them a powerful tool for feeling better," said Dr. Wright.  "Once the warning sign is identified, a coping strategy can be crafted to try to interrupt a slide into depression or an escalation into mania."

Dr. Wright often recommends The Bipolar Workbook by Monica Ramirez Basco to help patients along in this self-monitoring journey.

When used alongside therapy, medication, or whichever treatment a doctor prescribes, self-monitoring can prove to be very beneficial to bipolar patients.

Methods, moods, symptoms and early warning signs should all be discussed with a doctor, therapist or mental health professional.

By making the effort to self-monitor, bipolar patients can play an active role in their treatment and potentially catch signs of a relapse before a mood episode strikes.

Review Date: 
January 3, 2013