For many mental illnesses relapse is part and parcel. Bipolar disorder is one of these. What’s especially unnerving for people is that relapse can seem random, as though you go to bed feeling one way and wake up another, feeling hints of mania or depression.
Why relapse occurs is largely unknown. But we do know certain facts based on research findings, according to Joseph R. Calabrese, M.D., director of the Mood Disorders Program at the Case Western Reserve University School of Medicine, in this excellent article in bp Magazine on relapse:
“Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I. Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania. Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.”
Even though relapse may be the rule, you do have some control in shrinking its severity and impact.
First and foremost, don’t ever stop taking your medication without talking it over with your doctor. According to Dr. Allan Young in the bp piece: “People who stop taking their meds have an 80 percent chance of relapsing within three months. Medication holds the illness in check; when you stop taking your medications, things go awry.”
However, as the article says, medication by itself isn’t enough to stave off a relapse. Also key are charting your moods and knowing your triggers. As Therese Borchard writes in her must-read book Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes:
“Aside from maybe the Bible, my mood/sleep journal that I mentioned in Step Five is the most important book in my house. Every morning I record the number of hours I slept that night and a number to rate my mood: one being practically normal, a stabilized person who doesn’t have to record every hiccup and sneeze in her day, and five being close to hospitalization—hysteria, shaking, behaving similar to the guy at the psych ward who drank the gallon of Tide.
Keeping a record of mood fluctuation allows me to discover important patterns in my temperament so that I can make the right adjustments before approaching the danger zone bordering the Black Hole. The journal does for me what a crew, or rail meat, does for a skipper trying to win the America’s Cup race: reads the wind and trims the sails in order to effectively manage the movement of a boat, or in my case, a brain.”
(In the same journal, Therese also records everything she’s grateful for, such as: “that I live in a free country, where I can make a career out of babbling online about my inner demons, and not in some war-torn corner of the world where women aren’t allowed to talk…that my coffee is strong, my bagel is fresh, and that the container of cream cheese wasn’t filled with sunscreen or another surprise.”)
Stress is a big trigger. When I wrote an article on living with bipolar disorder for Psych Central, clinical psychologist Elizabeth Brondolo, Ph.D, noted that even seemingly low-stress events can spark a relapse. Lack of sleep is another common trigger, particularly for mania. It’s vital to keep a strict sleep regimen.
Each person also has a unique set of triggers, she told me. The bp article underscored this as well: “For example, an increased need for sleep may signal a relapse into depression while irritability could be a sign of an oncoming manic or hypomanic episode.”
In my article on bipolar disorder, I listed several prevention strategies that I’d like to highlight:
- Even if you aren’t sure why a previously simple task is now a stressor, consider the reasons it was so tough or unnerving for you, Brondolo said.
- Try to maintain the same sleep schedule every night. Remember the importance of keeping a regular routine for all daily activities.
- “Don’t abruptly reduce your medication, unless you work out a safe way to do this with your doctor,” [clinical psychologist Monica Ramirez] Basco said.
- Learn how to problem solve, so when a stressor comes up, those skills are ready, Basco said. It’s also good to learn techniques to relieve tension and calm your thoughts and emotions.
- Know yourself well enough to identify the early signs and get help quickly; don’t try to tough it out, Basco said. Controlling mild symptoms increases the chance they won’t become major ones.
The bp article also emphasized the importance of familial support for reducing relapse. From the piece:
“According to a 2003 study in the Archives of General Psychiatry, 35 percent of those who participated in family therapy experienced relapse after two years, compared with relapse rates of 54 percent for those who received no family therapy. Moreover, a study in the British Journal of Psychiatry in 2010 found that family therapy reduced conflict, improved communication, increased empathy, leading to longer periods of wellness and less severe manic and depressive symptoms.”
Here are some ways loved ones can help (from my article):
- Keeping an open mind. Loved ones also can have difficulty accepting the diagnosis. However, keep in mind that an accurate diagnosis leads to effective treatment.
- Educating yourself. “Become knowledgeable about bipolar disorder so you can understand what the person is going through and how you can help,” Basco said. Even if the person isn’t ready to seek treatment, Basco still suggests learning about the disorder.
- Becoming an active ally. “Show support in an active way, go to support groups and meet with the therapist (with the patient’s permission),” Basco said. Establishing a relationship with the therapist is tremendously helpful for loved ones, who can ask the therapist what to do in specific situations, she said. You might ask, “When should I take suicidal thoughts seriously?” “Do I force my child out of bed when he’s depressed?”
A therapy called mindfulness-based cognitive therapy (MBCT) can be helpful in relapse prevention, too. Check out this blog post on Psych Central’s Bipolar Beat for more.
If you have bipolar disorder, what helps you in minimizing relapse?
Please share your prevention strategies below!