My biggest triggers are hormones and stress. Hormonal changes, such as PMS, are hard for me, and coming off the birth control pill triggered a severe hypomania, maybe mania, I'm not sure which. I also don't do well with stress. Some of my worst episodes were while recovering from a car accident, while buying a condo, going to grad school, and going through divorce. I'm OK for awhile, but stress eventually makes me come unglued. I told my pdoc that I thought I could come off meds because my episodes are stress related. She said there will always be unpredictable stresses in life, and my reactions to those stressors are extreme and not normal. So as much as I want to blame stress, I think it is only a trigger for the underlying problem of bipolar disorder. I'm under a lot of stress right now for job related stuff which happened suddenly yesterday, and my mood crashed from stable into highly anxious immediately, and it feels like a depression is coming on. I am just hoping things get better quickly, and I'm hoping I can bounce back from this without going into a major episode. Hopefully all these meds will do the trick at preventing disaster.