PRECIPITANTS

“We must regard all alleged injuries as possible sparks for the discharge of individual attacks, but…the real cause of the malady must be sought in permanent internal changes, which at least very often, perhaps always, are innate.
…The attacks of manic-depressive insanity may be to an astonishing degree independent of external influences.”
-Kraepelin

Often environmental factors play a role in the onset of an episode of MDI. This is commonly found early in the course of MDI, less often after the illness has followed his course for many years.

Losses, like deaths, romantic break-ups or disappointments, or career changes can be linked to an episode. For example, powerful environmental factors include the changes of season, the effect of drugs or medications, as well as the amount of stimulation or stress. Stimulants and all the conditions affecting sleep (shift work, jet lag) or traumatic events have a destabilizing effect on the fragile balance of a patient with MDI.

Sleep deprivation has been hypothesized as a common pathway to decompensation in Mania, but episodes of Depression, Mixed States or a psychotic episode can also be precipitated. The term Funeral Mania was coined to describe the onset of a manic episode following the death of a loved one.

When the illness has established a pattern of recurrence the role of life events in recurrences is not clear. Research seems to suggest that the role of a precipitant in later episodes is not as firmly established as for initial or earlier episodes. (McPherson)

The effect of hormones on mood has been well known since antiquity. Menarche or the onset of menstrual cycles can be a dramatic change in the overall chemical and hormonal balance.

The period post-partum, with the combined effect of powerful emotions and sudden hormonal changes, is a powerful precipitant for women predisposed to mood swings. (Krucksman)

Temperament and/or family history of MDI can sometimes help identify women at risk for the onset of a mood disorder, especially MDI.

Menopause, once again exposing a vulnerable disposition may result in the precipitation of mixed or agitated Depression

A medical illness, like Multiple Sclerosis or the pharmacological treatments for an independent medical condition (steroids for asthma), can be sufficient to precipitate an episode. Sometimes, it is another psychiatric condition that requires treatment with antidepressants (OCD, Panic Disorder) and this can precipitate an episode.

Substance abuse can have a powerful destabilizing factor for someone with a predisposition to MDI. This is especially true for stimulants such as cocaine and amphetamines. The onset of psychotic episodes of MDI associated with the use of hallucinogens like LSD and PCP has been well documented.