Patient information from BMJ

Bipolar disorder: how can I avoid a relapse?

Last published:Aug 05, 2021

Most of us have ups and downs in our moods. But if you have bipolar disorder, your mood swings are much more extreme. Bipolar disorder can make life hard. But with the right treatments, most people can control their very high and low moods.

How can I keep myself well?

If you have bipolar disorder, your mood swings much further than other people's. Sometimes, you might feel very high and have lots of energy. That is called mania. Other times, you might feel very low. That is called depression.

When you are well and your mood is stable, you'll want to stay that way as long as possible. If your symptoms of mania or depression come back, doctors say you have had a relapse.

The most common reason for a relapse is not taking your medicine. For example, you may have been feeling well and decided you didn’t want to take the medicine any more. Or you may be fed up with side effects. But if you stop suddenly, you are much more likely to have a relapse.

It’s best to discuss changing your medicine with your doctor before you stop taking it. Your doctor may be able to prescribe a lower dose, or switch you to another medicine with fewer side effects.

Relapses can also be triggered by things that happen in your life, such as:

• stressful situations like exams, and problems in relationships or at work

• sleeping too little or too much

• taking recreational drugs or drinking too much alcohol.

Some people just find it hard to remember to take their medication. Things like special pill boxes divided into sections for each day, and reminders on your calendars, can help. Different things work for different people. For example, it may be that a specific family member helps you to remember your medicine.

Having a talking treatment called cognitive therapy can help you make helpful changes to your life, such as learning to cope with stress. This can help you avoid a relapse and get on with your life in a more stable way.

A talking treatment called interpersonal social rhythm therapy can also help. It focuses on helping you:

• identify and keep up the regular routines of your everyday life (including your sleep), and

• solve issues and problems that happen when you interact with other people, which can affect these routines.

How can I learn to spot the signs of a relapse?

You can reduce your chance of relapses if you learn to spot the warning signs.

Early signs of a relapse can be different for everyone. For example, you might notice you need less sleep when you are getting a relapse of mania.

You can work out your own warning signs by having training with a psychologist. If you know the warning signs, you can take action to avoid a full-blown relapse. The psychologist can help you decide what to do when you feel a relapse coming on.

How can friends and family help?

Having a supportive family and friends can help a lot. But caring for someone with bipolar disorder isn't easy. This illness can put a strain on relationships, because it’s hard to see someone you care about when they're very depressed or when they're behaving in a way they will regret.

It might help your friends and family to find out more about bipolar disorder. Many people with bipolar disorder say they have trouble explaining how they feel, especially when they are depressed. This can make them feel very lonely. And the people who care for them often feel rejected, because it’s so hard to communicate.

Reading about bipolar disorder, or contacting a self-help group, can help your family understand your condition better. You might also ask your doctor about family therapy.

In family therapy, you and your family learn about bipolar disorder. You all get training on how to spot early signs of a relapse and what to do about it. And you may have training to help you all get better at communicating and solving problems together.

Planning ahead

If you do have a relapse of symptoms, you may not be able to think clearly about what sort of care you need.

While you are well, talk to your doctor about the sort of care you want if you have a relapse. This could include:

• which doctor or nurse you or your family can call, 24 hours a day, if you think you are having a relapse

• who should be told about your condition

• where you want to go for treatment, if you need care in a hospital or a clinic

• which medicines you want to be given.

You could also write down what you want done about important things you can’t manage yourself while you are unwell, like looking after your children, house, or pets.

This plan is sometimes called an advance directive. Your doctor can help you draw it up. It can be kept with your medical records. You might want to carry a copy with you, or share it with family or friends.

You’ll know what is going to happen if you get unwell. And your family may find it comforting to know what you want them to do.

Where to get more help

There are organisations and charities that provide advice and support to people with bipolar disorder, and their friends and family. You can ask your doctor or nurse for recommendations, or look online. For example, in the UK, one organisation is Bipolar UK (bipolaruk.org.uk).