Bipolar disorder tends to look different in different people. For instance, one person experiences a depressive episode as angry and irritable, said Sheri Van Dijk, MSW, RSW, a psychotherapist in Sharon, Ontario, Canada. Another person is unable to get out of bed or take care of themselves, she said. They barely eat and spend all day sleeping. A third person experiences a “mixed” episode with symptoms of depression and mania at the same time. “They have a lot of energy, but their mood feels low.”
During a hypomanic episode, one person has an elevated mood and high energy and breezes through their to-do list. On the other hand, someone else gets really anxious and agitated.
So it’s not surprising that relapse looks different, too. People get triggered by different things and experience different signs that an episode is occurring. That’s why it’s so important to understand your own experience of bipolar disorder—and not to compare your treatment or relapse, if it happens, to anyone else’s, said Deborah Serani, PsyD, a clinical psychologist who specializes in mood disorders. In fact, bipolar disorder can look different in the same person from one episode to the next, added Van Dijk, who’s written several books on bipolar disorder.
Elaina J. Martin, who pens the popular blog Being Beautifully Bipolar, has a severe case of bipolar disorder. Which means that she often experiences relapse. For her irritability is the first sign of a depressive episode. “I get annoyed by simple things—the dogs barking or rain when I have to go outside. Mundane and silly things to get riled up about.” A manic episode is typically precipitated by what she calls a “buzz” in her head. “I start talking really fast. That is a tell-tale sign, and my support system knows it.” Because everyone’s signs are different, Serani educates her patients to focus on these three things to identify a possible relapse (and intervene):
- Physical changes: Pay attention to your body. For instance, are you getting headaches, stomach pains or back pains? Are you eating more or less? Are you sleeping more or less? Might an illness be responsible for your symptoms? Is this a normal reaction to a stressful week? Or maybe your physical changes are the signs of a relapse.
- Behavioral changes: Are you restless? Are you up all night performing different tasks? Are you snapping at others? Are you talking fast? Are you taking impulsive action? Are you drinking too much caffeine?
- Identifying traits: “Once you’ve taken notice of the physical and behavioral changes, ask yourself why these traits are occurring.” For instance, is there a problem at work? Did you get into an argument with a loved one?
Again, like warning signs, triggers also are unique to each person. For Martin stress and sleep are big triggers. “If I stay up all night, I am almost guaranteed to have a manic episode. I don’t handle stress—not well or hardly. I just can’t handle it at all.”
But there may be commonalities. According to Serani, other major triggers include: insomnia; workplace stress; unresolved family issues; financial troubles; separation or divorce; loss; the passing of a loved one; and sudden issues, such as an accident or illness.
“Living with any chronic illness requires you to become well-versed in your day-to-day experiences,” Serani said. “So think of managing your bipolar disorder as way of taking a daily mind, body and soul inventory check.” For instance, keeping a mood chart, journaling or using a mood app helps you keep track of your emotional states, she said.
She also suggested using a calendar to mark any trigger dates in advance. This might be the death of a loved one or an anniversary of a traumatic event. This gives “you a heads-up to take extra good care of yourself before a tough day.”
Depending on the severity of your disorder and other factors, you might or might not be able to stave off a relapse. According to Serani, individuals who follow their treatment plan, take medication as prescribed, work their therapy skills and understand the uniqueness of their illness experience less relapse than others.
However, sometimes medication can lose its effects, as our bodies are constantly changing, Van Dijk said. She and Serani stressed the importance of taking care of yourself in other ways, as well, including: staying away from drugs and alcohol; getting enough sleep; eating nutrient-rich foods; exercising; and engaging in enjoyable and fulfilling activities, such as spending time with loved ones.
Whether you can stave off an episode or not, you might be able to minimize its intensity. That’s where the other activities are vital. When you feel a relapse coming on, schedule an appointment with your therapist and/or psychiatrist and gather your support system, Martin said. She wants readers to know that experiencing a relapse is not some sign of weakness. “This is an everyday-till-the-day-you-die illness. Some days are simply better than others. Sometimes you need med adjustments. Sometimes you need more sleep. Sometimes you need less caffeine.”
Sometimes you can do everything and still have a relapse—which is incredibly frustrating and disappointing, no doubt. Unfortunately, that’s the nature of bipolar disorder for many people. It is a complex and chronic illness. So please know a relapse isn’t your fault. But you can absolutely get better. Again, take compassionate care of yourself and reach out for help.