May 26, 2021


stressed out woman

Wouldn’t it be great if you could stop a depressive or manic episode from coming on?

Fortunately, for many people with bipolar disorder, they can learn how to sense a relapse beginning, which is the first step in preventing a full episode. What we are talking about here is the “prodrome:” a set of early signs of a manic or depressive episode.

For people with bipolar disorder, and those in their support network, knowing how to recognize the prodrome is an important part of bipolar management.


What Do the Studies Show?

Researchers reviewed 17 studies in 2003, looking at more than 1,000 people with bipolar disorder. They looked at the prodromal symptoms and duration before a depressive or manic relapse. These were their main findings:

  • Sleep disturbance was one of the key indicators of an impending manic episode
  • The average length of the prodrome was 11–19 days for depressive episodes and 1–120 days for manic episodes

In 2016, another review of 11 studies that included more than 1,000 people concluded that prodromes occurring before recurrent episodes were much shorter than those before first episodes. Additionally, the symptoms in the prodrome period were similar to those symptoms that a person would experience during an episode. For example, low mood creeping up before a depressive episode.


What Does This Mean for Me?

It is helpful to know that if you are able to pick up on any early warning signs, it could mean you may prevent a relapse altogether; or at least that the episode will be milder and more manageable.

If you are well enough to think back on your previous episodes, it can be helpful to make some notes on what your early signs were.

Although there isn’t a definitive test or list of symptoms that applies to everyone, the good news is, there is some evidence that your warning signs are a useful marker for you. About half of people with bipolar disorder are able to identify at least three symptoms that indicate impending mania or depression.

When making your list, try to be as specific as you can. Here are some examples based on category of symptom:

Mood: Low / irritable / elevated. “I felt so happy and confident, like I could do anything. I was invincible.” “I would cry at the drop of a hat…even seeing a sad TV ad and I’d break down.”

Sleep: Broken / need for less or more sleep. “I remember being up til 4 a.m. and waking at 7 a.m. for work, feeling totally refreshed.”

Activity: Pacing or fidgeting (can’t sit still) / sluggish / hypersexual. “I was speeding up and down the corridors at work but there was no need to hurry.” “I lay in bed most of the time, no energy to do anything but cry.”

Appetite: Reduced / increased. “I knew I should be eating, but I kept skipping meals, I was so busy with my vlogging.”

Interest / ideas: Loss of interest in usual activities / thoughts racing / obsessive interest in new projects / unhealthy risk taking. “I totally neglected my work as I had to attend to my spreadsheet of 20 different projects, which were going to make me rich.” “I got into online poker and nearly lost my home.” “I was totally wrapped up in my depression. I thought there was no point in anything, no joy in the world, no way out…everything and everyone was fake.”

Speech: Speech is fast, hard to follow / speech is slurred. “I kept getting annoyed with my friends because they wouldn’t let me finish what I had to say. When I recovered, they all told me I never drew breath, and I was rambling.”

Appearance: People around you may notice you are dressing with less attention to your appearance or in a completely different style. “I spent thousands of dollars online for a brand-new wardrobe. The clothes were totally not my style, looking back, and sometimes really inappropriate.”


What Should I Do If I Am Heading Toward Relapse?

Get help from your doctor, whether that is your family physician or psychiatrist. They might need to review your medications. It could be that your sleep cycle is out of balance, or perhaps there are stressors that need to be managed.

If you are getting worse, and feeling like you can’t cope on your own, ask for support from your partner, family and/or friends. The most important thing is to seek help early on so that your symptoms do not escalate to a crisis state.


Dr. Alice Lam has worked as a GP both in the UK and Australia and has advocated for countless patients. To find out more about her health writing service, please go to

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