Early Warning Signs

Early InterventionSince the treatment of mood episodes is imperfect and the consequences of a mood episode can be severe, identifying early warning signs is one of the most important steps that people can take to improve their mental health.

Begin with a list of problematic mood states. 

People with bipolar may experience hypomanic or manic episodes, depressed episodes and mixed episodes.

People with unipolar may have some episodes of depression that are associated with significant anxiety and other episodes that are marked by very low energy.

For each mood state go through a process of identifying potential early warning signs and symptoms.

For mixed episodes, review the list of potential manic and depressed warning signs below.

Find an Ally or Partner
Choose someone to help you on this project who understands about mood disorders, who is generally sympathetic, who you don’t often argue with, and who sees you almost every day.

Sit down with them to identify possible early warning signs.

Hypomanic or Manic Early Warning Signs

Choose any of these that apply to you when you are feeling energized. Choose

  • More physically active (sport etc.)
  • Feeling more energetic and more active
  • Seeming exhausting or irritating for others
  • Engaging in lots of new things
  • Doing things more quickly and/or more easily
  • Having a sense of restlessness
  • Wanting to travel and/or travelling more
  • Taking on many new tasks and projects – thinking of and entering into lots of schemes and grand ideas
  • Enjoying my work more
  • Mood being higher, more optimistic
  • Feeling excitability or irritability
  • Experiencing anger or hostility
  • Feeling more impatient and/or getting irritable more easily
  • Getting into more quarrels
  • Feeling OK with less sleep than usual
  • Waking up early and having the energy to clean the house
  • Being more talkative than usual
  • Feeling the need to keep talking
  • Talking faster (can’t stop talking)
  • Inappropriate/impulsive speech or behaviors – like being overly honest and open
  • Acting more sociable (making more phone calls, go out more)
  • Making more jokes or puns when I am talking
  • Writing longer emails or text messages
  • Posting more on Facebook, Twitter
  • Risky business investments
  • Having risky affairs
  • Tending to drive faster or take more risks when driving
  • Spending more money/too much money
  • Taking more risks in my daily life (in my work and/or other activities)
  • Being more interested in sex, and/or having increased sexual desire
  • Acting more flirtatious and/or being more sexually active
  • Feeling less shy or inhibited
  • Wearing more colorful and more extravagant clothes
  • Wanting to meet or actually meeting more people
  • Drinking more coffee
  • Smoking more cigarettes
  • Drinking more alcohol
  • Taking more drugs (sedatives, anti-anxiety pills, stimulants)
  • Racing thoughts, typically jumping from idea to idea (flight of ideas)
  • Thinking faster
  • Having to slow down to talk to others
  • Having trouble keeping track of your own thoughts
  • Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
  • Thoughts jumping from topic to topic
  • Impaired concentration
  • Inflated self-esteem – feeling like one is special or better than others – having special powers or insights (commonly referred to as grandiosity)
  • Feeling more self-confident

Depressed Early Warning Signs

Choose any of these that apply to you when you are feeling depressed.

  • Depressed mood most of the day, nearly every dayChoose
  • Feeling sad, empty, or hopeless
  • Crying frequently
  • Irritability, anxiety, or anger
  • A sense of hopelessness or despair
  • Unexplained sadness that won’t go away
  • Feelings of guilt, worthlessness, or indifference
  • Lowered self-esteem or heightened self-criticism
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  • Loss of interest in activities you generally find pleasurable
  • Increased focus on death or mortality
  • Suicidal thoughts or ideation – thinking about or planning how the suicide would be committed
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
  • Having to force yourself to eat
  • Food doesn’t taste good
  • Craving sweets
  • Raiding the refrigerator at night to deal with stress
  • Insomnia or hypersomnia nearly every day.
  • Sleeping too much or not able to sleep
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
  • Slowed thinking, movement, or speech or inability to concentrate
  • Disorganization or inability to make a decision
  • Impaired memory
  • Diminished activity or social withdrawal
  • Unexplained aches and pains

Edit the List

For each mood state your goal is to come up with 5 to 10 symptoms or signs that might be associated with a change in mood.

Ideally the ones you choose should:

  • be present for almost all episodes
  • be easily identifiable and the visible to yourself and others
  • occur early in the process of developing symptoms

Use the List

if you experience one or two of the potential early warning signs be more attentive to your mood, perhaps talk to those who know you to get feedback.

If you experience three or more early warning signs contact your doctor and definitely reach out to your support or ally to get there help managing your symptoms.