Bipolar Early Warning Signs: Build Your Own List

2026-09-28 · 9 min read

Early warning signs are the small changes that turn up before a bipolar episode does — and the ones that matter are yours, not a list off the internet. Sleeping less without feeling tired, talking and thinking faster, spending in a way you wouldn't normally, getting irritable over nothing, going quiet on people: those are common examples, but the useful version is written from your own past episodes. This piece covers where warning signs tend to show up, how to assemble your own list, and what to decide in advance about what you'll do when one appears.

What counts as an early warning sign?

It's the stretch before a full episode, when something has started shifting but the episode hasn't arrived. Clinicians call that period a prodrome. The encouraging part is that this is mostly learnable: in a systematic review of manic and depressive prodromes covering 17 studies and 1,191 people, at least 80% of people with a mood disorder could identify one or more early symptoms.

And it's worth learning. In a randomised controlled trial published in the BMJ in 1999, 69 people with bipolar disorder either had seven to twelve sessions teaching them to recognise early symptoms of relapse and seek treatment quickly, or routine care alone. In the group that learned to spot their own signs, the 25th centile time to a first manic relapse was 65 weeks, against 17 weeks in the control group, with about 30% fewer manic relapses over 18 months, and better social functioning and employment at the end.

The same trial deserves reading honestly, though: it made no difference to depressive relapse — not to how soon it came, not to how often. Recognising your signs is a real tool, and a much better-evidenced one on the way up than on the way down. It sits alongside your medication, your therapy and your clinician, never instead of them.

Where do warning signs show up?

Warning signs are usually a quieter, earlier version of the symptoms of an episode. The NHS lists the symptoms of high and low mood in bipolar disorder — the table below sorts those into the areas people most often find their own early shifts in, in everyday wording. Treat it as prompts for your memory, not as a checklist to score yourself against.

The categories are shared; the specifics aren't. "Reorganising the kitchen at 2am", "replying to emails in three words", "listening to the same song forty times" are the kind of signs people actually recognise in themselves, and they appear on no official list. And a quiet weekend means nothing on its own — a quiet weekend when you'd normally have been out, after a stretch of four-hour nights, is information.

How much warning do you get?

Enough to act, usually, and more on the way up than on the way down. In the review of prodromes, manic prodromes averaged more than 20 days across studies and depressive ones under 19 — but the ranges are the real story: 1 to 120 days for manic prodromes, and 2 to 365 days for depressive ones. Your own timing is the only timing that will help you.

That review also found the most robust early symptom of mania is sleep disturbance, reported by a median of 77% of people, while early symptoms of depression were inconsistent from person to person. Both findings point the same way: write sleep down first, and for the depressive side expect nobody else's list to work — only a record of your own.

How to build your own list

1. Start from your last episode, not from a list. Pick the most recent one you can remember reasonably well, and work backwards from when it became undeniable. What was different a week before that? Two weeks? What was the first thing that was off?

2. Use the evidence, not just memory. Memory after an episode is patchy and unkind. Your messages, bank statements, photos and calendar from those weeks are plain records of what was happening, and they often place the first shift earlier than you'd have guessed.

3. Ask one person who was there. Irritability, speed of speech and a change in how you write to people are frequently visible to others well before they're visible from the inside. Ask what they noticed first, and write it down even if you disagree.

4. Write it in your own words. "Elevated mood" won't ring any bells at 1am. "I start emailing people I haven't spoken to in years" will.

5. Keep two short lists, and order them. Up and down are different lists. Five to eight lines each is plenty — short enough to actually read, with the earliest signs at the top, because those are the valuable ones.

6. Note your triggers beside them. The NHS advises that with bipolar disorder "it's important to know what can trigger your high and low moods", and names stress, not getting enough sleep and being too busy. Signs and triggers next to each other turn a list into something you can act on: not just "I'm sleeping less" but "I'm sleeping less, and I've had three weeks of deadlines".

7. Treat it as a draft. The first version will be wrong in places. You revise it after the next difficult stretch — that's the point of it.

Decide now what happens when a sign turns up

A list without a plan attached mostly produces worry. The point of noticing early is that there's time to act, and the deciding is far easier done while you're well.

NICE's guideline on bipolar disorder recommends that a person's care plan include "a crisis plan indicating early warning symptoms and triggers of both mania and depression relapse and preferred response during relapse". That's a conversation to have with your clinician, and your list is the material you bring to it. A shape that works for many people: one sign turning up means keep a closer eye and protect sleep; two or three means tell the person who knows and get an appointment moved forward; the top-of-list ones mean contact your clinician today.

One thing never belongs in the plan: changing your medication yourself in response to a sign. Whatever the record shows, dose and timing are decisions for the person who prescribes them.

Why a daily record is what makes the pattern visible

Nearly everyone who describes their warning signs says the same thing: it was obvious afterwards. In the moment each change has a perfectly good explanation — the sleep was the deadline, the spending was a one-off, the silence was a busy week. A daily record removes the reconstructing: it just shows four short nights sitting next to a week of rising energy.

This is well-trodden ground. NICE says psychological interventions for preventing relapse should "include self-monitoring of mood, thoughts and behaviour" and "develop plans for relapse management and staying well". Bipolar UK puts the practical case for tracking your mood as recognising patterns in mood, spotting symptoms and early warning signs of an episode, preventing relapse, and gathering information to share with your healthcare team. A paper mood diary does this perfectly well — Bipolar UK's is free to download and print.

If you'd rather it lived on your phone, that's what KiwiKowa's daily check-in is for — mood, stress, energy and sleep, a note about what was behind it, and a fourteen-day trend line, free to try. To be exact about what it does and doesn't do: it doesn't predict, detect or prevent anything. It keeps what you tell it, so the shift is there to see when you go looking. The noticing stays yours.

Whichever you use, what decides whether you'll have a pattern to read in three months is how small the daily habit is. Two minutes, attached to something you already do, survives a bad week; a detailed log doesn't. Our piece on a gentle daily routine for bipolar disorder covers how to build one with a floor low enough to keep, and if you'd rather compare the options first, we've written an honest comparison of mood tracker apps for bipolar and ADHD, including where ours falls short.

FAQ

How do I tell a genuinely good mood from hypomania starting?

Often you can't, in the moment — that's the whole difficulty, and it's why a written list and a couple of trusted people are worth more than introspection. The clue many people come to trust is sleep: a good mood doesn't usually come with needing much less sleep and not feeling tired for it. Sleep disturbance is the most consistently reported early sign of mania in the research. Whether a stretch counts as hypomania is a judgement for your clinician, not for an app or an article.

What if I can't remember my last episode well enough to list the signs?

Then build the list forwards instead of backwards. Start recording sleep, mood, energy and a line about the day from today, and ask one person who was around last time what they noticed before you did. Old messages, bank statements and photos from that period are also plain evidence of what was happening, and they're often more honest than memory. A first list of two lines is still a list.

Can a mood tracker predict or detect an episode?

No. No app can predict, detect or prevent a bipolar episode, and you should be wary of any that suggests otherwise. What a daily record does is more modest and more useful: it holds what you told it, so a change you'd have explained away day by day is visible when you look back across weeks. The noticing is still yours, and what it means is still a question for your clinician.

Should I share my warning-sign list with my clinician?

Yes, and it's worth asking for it to be written into your care plan. NICE recommends that the care plan include a crisis plan naming the early warning symptoms and triggers of both manic and depressive relapse, along with the response you'd prefer. A list agreed in advance means that when things start moving, nobody has to work out what to do from scratch.

What if watching for warning signs just makes me anxious?

That's a real risk, and constant self-surveillance isn't the goal. The list exists so you can stop scanning: you check it now and then, or when something on it turns up, rather than interrogating every mood. Two minutes a day to record how you are, and a glance at the list once a week, is enough for the pattern to show. If checking has become its own worry, that's worth saying out loud to your clinician.