Often it's a combination, or I don't realize the sequence of events until much later when I can really reflect on things. Sometimes the trigger comes quite a bit earlier than when things get bad; in other words, if I don't handle the trigger well, down the road it spirals into an episode and I have trouble seeing the connection because it can sometimes be a month or so later that I pay the consequences.

After years of therapy and learning how to handle the things that do tend to trigger me, I find I have fewer episodes and those I do have are less intense. I am much more proactive about avoiding the triggers that set things off, about recognizing that pattern in my own decisions and behaviors that start me down that road. So, I know to keep a solid sleep schedule now; I know better than to allow myself to do things like get into a marathon grading session which can set of hypomania for me; I much sooner recognize situations that used to lead me into depression -- I have better ways to handle and respond to those situations so the depression stays situational and doesn't have the opportunity to feed on itself and turn into a full-blown episode, etc. I watch my health because I realized one trigger was physical illness for me. I consciously watch my activity level so I don't over-extend myself which inevitably turns into exhaustion and depression down the road, but often further down the road so I used to miss the connection. LOTS of self care and self awareness.