Three Signs Your Mania Is Coming (The Manic Prodrome)

- What are the early signs that you're getting ready to have a manic episode? We call these the prodrome. That's what I'm going to talk about in this video.

I'm Dr Tracey marks a psychiatrist in this channel is about mental health education and self-improvement. I publish videos every Wednesday, so if you don't want to miss one click subscribe and the notification bell. This video is based on a viewer question from Kokkinomalli.

She says: thank you for the video, and thanks for mentioning that hypersexuality is an early warning sign. I'd love a video about the manic prodrome, I think that would be really useful. Thanks Kokkinomalli for your question.

Being able to detect early signs of a manic episode can be helpful in either preventing the episode from coming altogether or lessening the impact of it. It's kind of like preparing for a hurricane. Even if you can't stop the hurricane you can still board up your windows, you can stock up on bottled water.

And just like with a hurricane, bipolar disorder is progressive. The episodes build momentum. The prodrome is the period of milder symptoms that precede the more severe symptoms.

This period can be weeks to months. With bipolar disorder you can have a prodromal period that also comes before the depression as well as before the mania. The most common prodromal symptoms for mania tend to be an elevated mood, decreased need for sleep and increased activity.

These symptoms can build over several weeks or even months before it becomes an out-of-control, either manic or hypomanic episode. Let's take a look at these symptoms with a little more detail. But here's a disclaimer.

This is not for the purpose of diagnosing whether or not you have bipolar disorder. So I don't want you to think gosh I didn't feel the need for sleep last Thursday night, so does that mean I have bipolar disorder? No, not based on that one fact alone.

What I'm talking about are the symptoms in people who already know that they have bipolar disorder. So think of this as advanced topics in bipolar disorder and not signs to tell if you have bipolar disorder. Okay, elevated mood.

If you recently came out of a depression, this can feel like a relief. You finally feel really good. But one of the problems with the manic phase is that you usually don't see the early symptoms as a problem.

It will often take someone else close to you to recognize that your mood is elevated beyond what someone would expect normally from you. But even with this, it still may be hard to notice this particular symptom of elevated mood. Because remember, it's not just feeling great, it's feeling like you're invincibe, or having way more confidence or audacity than you usually do.

It's something that stands out it some way, so it's beyond just feeling good. What's usually much easier to recognize is the decreased need for sleep. This is different from disrupted or choppy sleep that you can have with bipolar disorder when you're in between episodes you can have a poor quality of sleep.

Examples of this would be taking longer to fall asleep or not being able to sleep straight through the night. Sometimes in between episodes you can even have day night reversal such that you can't go to sleep until very late in night or the early hours of the morning. So you're sleeping most of the day and up all night.

But even with this you still feel the need to sleep. You're just not doing a very good job of it. But in the prodrome phase, you don't really feel the need to sleep.

So it's not as though you really want to go to sleep but you can't slow your mind down. You may be oblivious to the fact that you even need to go to sleep or that it's even time to go to bed. You may stay up doing things during the night because you're not even tired.

If this happens to you, an early intervention could be to see your doctor and make medication adjustments. These adjustments could be increasing your mood stabilizer. It could mean taking you off an antidepressant if you were on one during a previous depressive episode.

It could mean keeping you on your medications except just adding something to help you sleep. These adjustments could halt the progression of your mania or it could lessen the severity of the episode. Another early sign would be increased activity.

I mentioned in a previous video that hypersexuality can be an early sign of a manic episode. This would fall under this category of increased activity. Also, increased activity could be things like having more of an interest in your work or putting in more hours.

If you're a student it could mean having more energy to study more. I had a patient with bipolar disorder who was a musician. He recognized that an early sign for him would be that he would start creating music tracks in his mind.

This might sound this good because after all he's a musician. But his talent was playing the instrument and it was not writing the music. It was only when he would become manic that he come up with these musical scores.

Then when he was out of the episode he thought the music that he created was terrible. So it's not as though the mania was this wonderfully, creative time for him to pump out some music. For him it was more like unproductive musical exploration that never resulted in anything usable.

But when he started thinking at that level of music creation, he knew then that it was time to come in and see me. Another way it can look to have increased activity is having the increased need to move around. We call this agitation.

This may look like pacing or being unable to sit still for long periods of time and feeling impatient. This kind of prodromal increased activity can build up to the irritability or angry manic symptoms that some people can get. Now the first time you have an episode you're not gonna notice any of these things coming on.

It's only in retrospect that you can look back and see the buildup. In fact even after you've had multiple episodes you still may have trouble seeing the symptoms as they play out. So what you have to do is after you've recovered from your last episode and you're in between episodes, you look back on what happened in the weeks and months leading up to your most recent episode.

Can you recognized any of the symptoms that fall into these three categories that fit you? Is there something that you tend to focus on? It could be having increased sexual desire.

Or it could be getting more involved in a club or a group that you normally don't have time for but now when you're manic, you start reengaging with it and really get over and super involved in it. These are just general examples, but take a hard look at your behavior. There's bound to be some patterns.

You may need your doctor, or your therapist or a close friend to help you really see this. Then write it down and let someone close to you know what you do so that they can help you look out for these behaviors as early signs. If you see this coming on again what do you do?

You should visit your doctor again for a follow up appointment. You may not need change any of your medication, especially if your sleep is good. But it's still good to be on alert, because with bipolar disorder, sometimes things can change very rapidly within a matter of weeks.

Also, If you're someone who doesn't have a regular sleep schedule, change that. I did a video where I talked about social rhythm therapy for bipolar disorder. People with bipolar disorder are very sensitive to changes in routine.

It's been shown that keeping a regular routine where you do certain things around the same time, shortens the recovery time from an episode and lengthens the time in between episodes. Another reason to have a regular sleep schedule is so that you can track when you're sleeping less. Adults need an average of seven to nine hours of sleep.

Many people with bipolar disorder have trouble sleeping more than six hours. But that's an absolute least amount of sleep that you should be getting. Less than six hours is a set up for problems and can trigger rapid cycling of your episodes.

Rapid cycling is having more than four episodes in a year. And I did a video on that as well. Let me know if you have any questions.

I like hearing about your experiences. See you next time.