By Melvin G. McInnis, MD

It’s so frustrating when you’ve been doing so well for so long, and then out of nowhere you experience a relapse. The disappointment is profound and the setback painful. A relapse of bipolar disorder should be approached with as much attention and urgency as the recurrence of any serious medical illness. If not treated appropriately, negative consequences—both medical and personal—may be imminent.

What is a relapse, and how do you know when it’s coming?

A relapse in bipolar disorder is when an episode of mania, hypomania, or depression occurs after a period of being in remission. To qualify as a relapse, generally the minimum time of doing well is around two months.

Sometimes it is possible to predict a relapse, often it is not. There may be subtle changes in behaviors, mannerisms, or speech patterns that may indicate to those who know us well that something is amiss. Often the sense of well-being and confidence of hypomania after a period of depression is so welcome that the individual and family or friends overlook this warning sign. The subtle beginnings of a depressive phase may be countered by an extra push to get things done, and this, again, may be overlooked.

For many, the onset of a relapse is sudden and seems to come “out of the blue”—this despite every effort to be sure that medications are taken, blood levels are checked regularly, a regular routine of sleep time is adhered to, and there is a strong and consistent presence of good social and personal support.

What do I do in a relapse?

The first and most important step is to see your health-care provider as soon as possible and get appropriate treatment.

In my experience, patients often inadvertently omit information about their condition or can be evasive on questions during the initial examination. Sometimes they don’t want the good feeling of the hypomania to end; other times they just can’t believe the depression is recurring. Take a close friend or family member with you to your appointment. Their perspective on the clinical background of onset and your current symptoms will help your provider develop an appropriate treatment plan.

How do I recover from relapse?

Working with health-care providers is essential to create a wellness management plan that addresses safety (how to deal with suicidal thoughts or other dangerous impulses), medications, and daily routines of sleep and activity. There may be personal, social, and vocational repercussions from the relapse that need to be addressed, and these can be painful. There may have been personal or social indiscretions, or difficulties in attending to daily obligations, that occurred in the context of an episode that compromised relationships. Your health-care team can help with strategies to talk to close friends and family about issues associated with relapse. It can be most helpful to engage a family therapist, marriage counselor, or personal therapist.

We tend to forget unpleasant experiences (thankfully!). Keeping a brief diary, or holding onto some small remembrance of the episode and its effects, can serve as a useful reminder of your strategy to stay well and as an impetus to sustain adherence to your wellness management plan.

Engaging loved ones in your treatment plan is a major strength and will increase the likelihood of living healthy with bipolar. Take someone with you to your appointments with your health-care provider, and share your wellness management plan with friends and family so they can support you and help you stick to the plan.

Finally, “why”-based questions abound—Why is this happening? Why me?—and there are few answers. All that really matters is that it happened, and now new plans can be made for a healthy and productive future.