Why does bipolar cause emotional crashes after high energy?

Question

Hello doctor,

I am 43 years old and was diagnosed with bipolar disorder. I am currently taking Lithium and Quetiapine, but I feel like my emotions are becoming difficult to control.

After periods when I feel extremely energetic, productive, and motivated, I experience a severe emotional crash. During these low periods, I feel much worse than before, and the episodes seem to last longer. Even when my medications are stable, these mood changes continue to happen.

I am trying to understand why bipolar disorder at age 43 can cause such intense emotional lows after periods of high energy.

Could aging or changes in the body make bipolar symptoms harder to manage over time?

I also experience feelings of guilt and regret after the high-energy phases end, and these mood swings are starting to affect my work and relationships. I am worried that this cycle will continue and become harder to control.

Could you please help me understand what may be happening and what steps I can take to manage these mood changes better?

Please help.

Thank you in advance.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

I understand your concern, and it is completely understandable to feel confused and distressed when experiencing repeated changes between high-energy phases and emotional crashes.

During a manic episode (a period of unusually elevated mood, increased energy, reduced need for sleep, and impulsive or risky behavior), a person may not always be able to recognize that their thoughts, emotions, or actions are becoming unhealthy.

This happens because insight (the ability to understand one’s own condition and recognize that symptoms are affecting judgment) can become reduced during mania.

People experiencing mania may have impaired judgment, which means they may find it difficult to accurately assess situations, consequences, or risks. They may also experience difficulty with social and personal judgment, affecting relationships, work decisions, or daily activities. This reduced awareness of the illness is one of the reasons bipolar disorder often requires ongoing medical care and support.

In bipolar disorder, depressive episodes (low mood, loss of interest, tiredness, hopelessness, or reduced functioning) are often more long-lasting and may occur more frequently than manic episodes.

In bipolar disorder, depressive episodes (low mood, loss of interest, tiredness, hopelessness, or reduced functioning) are often more long-lasting and may occur more frequently than manic episodes. With appropriate treatment, many people improve greatly.

But some people may experience long-lasting or prolonged bipolar depression where symptoms continue for months, or sometimes longer, even with treatment.

As bipolar disorder progresses, some people may notice a change in the pattern of episodes. For some people, the time between episodes may shorten with increasing age, and the depressive episodes may become more frequent. That does not mean the symptoms cannot be managed, though. You can be stable with regular follow-up with a psychiatrist and treatment changes as necessary.

One helpful treatment for preventing relapse is interpersonal and social rhythm therapy (IPSRT). A type of psychotherapy that aims to improve emotional stability through sticking to regular daily routines and building up relationships.

IPSRT may help by:

Improving understanding of bipolar disorder through psychoeducation (learning about the condition, symptoms, triggers, and treatment).
Developing better awareness of early warning signs of mood changes.
Improving medication adherence (taking prescribed medicines regularly and as advised).
Reducing the risk of relapse or breakthrough episodes (episodes that occur despite ongoing treatment).
Maintaining a consistent sleep-wake schedule and daily routine.
Identifying and avoiding personal triggers, including stress and substance use.
Improving communication and relationships with family, friends, and colleagues.

Please share your current treatment plan, including your medication doses, how long you have been taking Lithium and Quetiapine, any recent lithium blood levels if available, and how often these mood episodes occur. This information will help in understanding your situation better and discussing possible treatment adjustments with your healthcare provider.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.