Someone with bipolar disorder might first have an episode of depression and they might be labeled as someone with a major depressive disorder. Then, say, ten years into it, they get a manic episode and then you look back and say, "Oh, actually this person is bipolar and not just depressed." Then, treatment would have to be tailored because treatment for depression is obviously different. The problem is that patients with bipolar disorder, run into manic times and depressive times, and antidepressants, which are used to treat depression, can sometimes trigger a manic episode. So it's a very careful balance in deciding what treatment is required.
What can trigger episodes?
Life stresses can trigger an episode. And not taking medications will trigger an episode. Compliance can become an issue because it is a chronic illness. To prevent episodes, you need to be vigilant in taking your medications every day. It's hard for patients to continue that over decades, especially when they're feeling better. That's when you can run into some problems with people that stop medications on their own.
But also disruptions in sleep, related to things such as seasonal changes, can perhaps trigger episodes.
How does seasonality affect bipolar disorder?
If you look across the general population, people might complain of differences in their mood and behaviors across the different seasons. Our study looked bipolar disorder patients and how they feel their moods and behaviors fluctuate across the changing seasons. And we found that they do experience significant difficulty. We measured their mood, sleep, social activity, weight, appetite and energy [over one year]. In our survey, bipolar disorder patients reported that these items would fluctuate according to the changing seasons. The spring and summer would be times when you're more likely to see patients with a manic episode whereas the depressive episodes are less likely during this time.
