Warning signs and a crisis plan

Your signs are your own

Almost every episode gives warnings before it peaks. The hard part is that those warnings differ from person to person. One person starts tidying cupboards at two in the morning. Another starts sending long voice notes to everyone, takes up smoking again or plays music at full volume. Books have lists, but what protects you is your own list, built from what has already happened.

Think back to your last episode and wind the clock back. What changed two or three weeks before? And the week before? Ask the people who were around, because often a partner, a parent or a friend saw it first. People who learn to recognise their own early signs, and know what to do about them, have fewer manic relapses and get help sooner.

Common signs of a high

The most reliable warning is usually sleeping less without missing the sleep. A night of four or five hours after which you wake up full of energy says more than almost anything else. Close behind come racing thoughts, faster speech, the feeling that everyone else is slow, irritation at small things and the urge to start lots of projects at once.

Other signs show up in money and relationships: big purchases or instalment plans without thinking, loans, betting, more interest in sex, more drinking, less patience at work. A practical test helps. If an idea feels brilliant and too urgent to wait until tomorrow, wait until tomorrow and show it to someone you trust before acting.

Common signs of a low

The slide down is usually quieter. You stop answering messages, put off showering, cancel plans, sleep more or lie awake at night going over things. What you used to enjoy goes flat. Your appetite changes, up or down, and your mind slows, full of lines like "I cannot cope" or "I am just in the way".

In this phase, the risk is waiting for things to get worse to be sure. Two or three of these signs lasting more than a few days are already reason enough to tell whoever looks after you. If thoughts of death appear, even vague ones, they are not something to keep until the next appointment.

A plan agreed before the crisis

The best time to plan for a crisis is when you are well, because in the middle of one your judgement changes. Talk with your psychiatrist and with one or two people you trust about concrete questions. What are my first three signs of a high and of a low? Who can tell me they are seeing those signs, and how can I best hear it? Who do I call, and what has my doctor advised in that case?

Include practical decisions too: who holds on to the cards if a high starts, who looks after the children or the dog, which health service to go to, what you allow others to do if you are not able to decide. Keep the plan somewhere easy, such as a note on your phone, with a copy held by the person you trust, and go over it together after every episode.

For the person alongside, talking about the signs works best with facts and without blame. "You have slept three hours a night lately and bought two plane tickets, and we agreed I would say something if I saw that" is much easier to hear than "you are losing it again".

When a high is an emergency

Get seen the same day, at an emergency department or a health service, when there have been two nights or more with almost no sleep and sky-high energy, ideas of a special mission or of being persecuted, hearing voices, spending or decisions that are wrecking money, work or relationships, dangerous driving, aggression, or agitation mixed with despair. At times like these you cannot wait for the person to come round.

If you are the one in a high and someone in your plan says they are worried, the agreement you made back then is worth more than how certain you feel right now. And if there is a risk of hurting yourself or someone else, use the support step of this track now, which shows the crisis contacts.