Summer Survival Tips for Bipolar I Disorder, With David Medina, M.D.

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As heat waves become more common, experts are warning that extreme temperatures may do more than make you sweat — they can destabilize mental health, especially for people living with bipolar I disorder. David Medina, M.D., medical director and principal investigator at Nova Psychiatry, explains how rising temperatures and poor sleep can trigger serious mood episodes like mania or depression. With summer now a high-risk time for mental health disruptions, Medina shares the signs to watch for, how to protect your emotional well-being and what to do if symptoms start to shift.

How does extreme heat affect people with bipolar disorder, particularly those with bipolar I?

David Medina, M.D.: Extreme heat can act as an environmental stressor, and for people living with bipolar I disorder that stress can bring about mood episodes. Even in the general population, heat can cause irritability, anger and fatigue. Those responses can be magnified in people living with bipolar disorder. What starts as physical discomfort or disrupted sleep can accelerate into a recurrence of mania or depression. These individuals may be more vulnerable to any kind of environmental change and heat waves are a prime example of something that can cause mood instability.

Are there specific warning signs patients or loved ones should watch for during heat waves?

DM: One of the earliest signs is a shift in mood, particularly increased irritability or anger. Sleep disruption is another big red flag. When it’s hot and you can’t sleep, that alone can be enough to activate a manic or depressive episode. It's important to pay attention to changes in mood or sleep patterns, as they can signal worsening mania, often marked by hyperactivity, euphoria or impulsivity, or a deepening depression. Staying in close touch with a health care team about medicines and care routine when things are feeling stressful can help keep more severe symptom recurrences in check. Some medications approved for bipolar I disorder, such as Lybalvi (olanzapine and samidorphan), have data supporting their use as a maintenance medication for use over time. It’s important to talk with a health care provider about which medication may best meet your needs.

What are some strategies to help manage mood symptoms that may intensify in hot weather?

DM: In extreme heat, I would advise anyone to stay hydrated, avoid alcohol and drugs, dress lightly and seek out shade or air-conditioned spaces. These simple self-care strategies are even more important for people living with serious mental illness. It’s essential to keep taking medication consistently and to reach out to a trusted health care provider if any mood symptoms begin to intensify. If a person is taking lithium, it’s a good idea to have blood levels checked more frequently during the summer months. And if sleep becomes a problem, that needs to be addressed immediately, as it’s one of the most important stabilizing factors for someone living with bipolar disorder.

How can people build support systems that protect their mental health?

DM: I often encourage people to spend time in libraries, which can be a cool, welcoming space in the summer and a great place to interact with others. Even just calling family or friends, planning a small get-together or going to community spaces where people come together can be supportive for someone who is beginning to feel their stability shift.

What kinds of community or national organizations can people turn to if they want to get involved or feel less alone?

DM: Libraries, religious institutions and community centers are great communities to get involved in. Many offer free classes, social groups and exercise activities. Nature is also a powerful tool for mental health. Whether it’s going for a walk or hike, spending time at the beach or just listening to birds in the yard, being outside can help people feel less alone. There are also national organizations, like the National Alliance on Mental Illness (NAMI), that have local and regional affiliates who offer support groups and volunteer opportunities for those living with mental health conditions, as well as for care partners.

Is there anything else you’d like our audience to know?

DM: One thing people often overlook is how seasonal temperature changes, whether it’s extreme heat or cold, can impact mood for people living with bipolar disorder. On top of that, the broader anxiety many people feel about climate change can also take a toll. So it’s important to be proactive. Get outside, get some sunlight and take steps to stay balanced both emotionally and physically.