Symptom recurrence is common in bipolar disorder. Managing your stress and following your treatment plan may help.

Were you recently diagnosed with bipolar disorder? Or have you been feeling symptom-free for some time but now feel like your symptoms are returning?

No matter what type of bipolar disorder you have, symptoms are likely to recur at some point. Even if you’ve been following all your prescribed treatments, you may still experience a return of symptoms.

A recurrence of symptoms in bipolar disorder isn’t uncommon, but there are ways to prevent it and manage it when it happens.

The natural course of bipolar disorder includes periods of wellness followed by periods when symptoms return or recur.

A recurrence occurs when symptoms such as depression, hypomania, or mania return after a symptom-free period.

Instead of “relapse,” using the words “recur” or “return” is a more accurate way of framing the overall nature of bipolar disorder. It also eliminates the negative associations with the word relapse, such as feelings of failure or shame.

So, just how common is a symptom recurrence in bipolar disorder?

The rate of symptom recurrence can vary depending on the following factors, according to a 2016 study:

  • the type of treatment you receive
  • your overall adherence to the treatment plan
  • whether you have a family history of mood disorder

With medication treatment alone, research from 2015 found that recurrence rates were be anywhere between 40% and 60% over 2 years.

According to research from 2019, psychotherapy in combination with medication delays the overall symptom recurrence rate. Indeed, those who pursue psychotherapy may find that symptom recurrence is less common.

The duration of each recurring episode can vary depending on which type of bipolar disorder you’re living with and the type of symptoms you’re experiencing.

According to a 2017 study, depressive episodes generally tend to last longer than manic or hypomanic episodes. Researchers found that depressive episodes lasted about 5 months, whereas manic and hypomanic episodes lasted about 3.5 months.

In the same study, depressive episodes were also found to last longer in those with bipolar II disorder than bipolar I disorder.

Two of the most well-known triggers that can result in a recurrence of bipolar disorder symptoms are stressful life events and non-adherence to medication.

Karen Bridbord, PhD, of Karen Bridbord & Associates in Brooklyn, emphasized the effect of stressful life events and self-care on symptom recurrence in bipolar disorder.

“If you aren’t sleeping, eating nutritious foods, or are under significant grief, it can easily push you into symptom recurrence,” Bridbord says. “The fundamentals of health are profoundly important in bipolar disorder.”

Stressful life events

Stressful life events can assume many different forms, but each can impact the stability of your mood. Additionally, the particular event can determine whether you experience a manic or depressive episode.

According to a 2019 study, recurrences of manic symptoms were associated with social life stressors, whereas depressive recurrences were associated with personal life stressors.

Examples of common life stressors can include:

  • marital or family conflicts
  • sleep disturbances
  • financial loss, difficulty, or unemployment
  • moving
  • death of a friend or family member
  • troubles with a neighbor
  • traveling

Bridbord states that stressors can be positive events too such as getting promoted or having a baby.

Discontinuing medication

Taking prescribed medications regularly is important in bipolar disorder because they can help stabilize your mood. While taking them helps to prevent symptom recurrence, skipping them hastens recurrence.

Lithium helps to reduce symptom recurrence in about half of people who take it, according to research from 2022.

A 2021 review found that other common medications for bipolar disorder — such as aripiprazole, lamotrigine, and quetiapine — may also delay recurrence rates.

The symptoms of bipolar disorder typically include episodes of depression, hypomania, or mania.

Since bipolar disorder is further classified into bipolar I disorder, bipolar II disorder, and cyclothymic disorder, the specific symptoms you experience during a recurrence will first depend on the type you’ve been diagnosed with.

Additionally, symptoms might differ from those you’ve experienced at an earlier date. Keeping track of your symptoms can be a helpful way to identify symptom patterns that are unique to you.

If you’re living with bipolar I disorder, you may experience a return of either manic symptoms, hypomanic symptoms, or depressive symptoms.

If you’re living with bipolar II disorder, you may experience a return of hypomanic or depressive symptoms.

In cyclothymia, you may experience a return of hypomanic symptoms or depressive symptoms.

Manic episode

  • increased or faster speech (being very talkative)
  • sense of extreme happiness or very high self-esteem
  • extreme irritation
  • racing or uncontrollable thoughts
  • quickly changing ideas or topics when speaking
  • easily distracted
  • restlessness, increased activity
  • risky behavior such as reckless driving, quitting your job, spending lots of money, etc.
  • needing fewer hours of sleep

Hypomanic episode

The symptoms of hypomania are essentially the same as manic symptoms. But hypomania, which literally means “below mania,” isn’t as severe and doesn’t last as long. These symptoms also:

  • don’t interfere as much with your life
  • don’t result in the need to visit a hospital
  • are present for at least 4 consecutive days

Depressive episode

  • overall depressed, hopeless, or helpless mood
  • lack of pleasure or loss of interest in the things you usually enjoy
  • feeling tired or lethargic
  • feelings of worthlessness or excessive guilt
  • trouble thinking, focusing, or concentrating
  • increased or decreased appetite
  • changes in weight
  • suicidal thoughts or actions

An effective way to prevent bipolar disorder recurrence can be to ask a healthcare or mental health professional about adding another type of therapy to your treatment plan or additional therapy sessions.

There are various psychotherapies that have been shown to reduce the overall rate of symptom recurrence in bipolar disorder. According to research from 2019, these include:

Aside from these, it’s also crucial to:

  • take any prescribed medications regularly
  • seek treatment for other mental health conditions that you may be living with
  • visit a mental health professional if you’re experiencing or anticipate a stressful life event

A recurrence of bipolar disorder symptoms can be frustrating and disheartening. If you’re currently experiencing symptoms, remember that it’s not your fault.

Before and during a recurrence, it’s crucial to manage your life stress and continue taking prescribed medications. Both these factors are proven to help manage symptoms.

When medication and stress management isn’t enough, another type of psychotherapy or additional sessions may offer additional benefit. Consider talking with a mental health professional about which therapy might be right for you.