Bipolar disorder: how can I avoid a relapse?

How can I keep myself well?

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 bipolar depression come back, doctors say you have had a relapse.

The most common reason to get a relapse is not taking your medicine. You might have been feeling well, and decided you didn’t want the medicine any more. Or you might 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 first. Your doctor may be able to prescribe a lower dose, or switch you to another medicine with less side effects.

Relapses can be triggered by things that happen in your life. For example:

• Stressful situations like exams, problems in relationships or difficulties at work
• Sleeping too little or too much
• Taking illegal drugs or drinking too much alcohol.

Having a talking treatment called cognitive therapy may help you make changes to your life, like learning to cope with stress. This may help you avoid a relapse and help you to get on with your life better.

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

You can help to avoid 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. Research shows that if you have training to spot the signs of a relapse, you may be less likely to get a full-blown relapse of mania. But it doesn’t seem to help you avoid a relapse of depression.

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. It’s hard to see someone you care about very depressed or to see them behave 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, may help your family understand your condition better. Ask your doctor about family therapy, a type of talking treatment. It’s designed to help you and your family cope with your bipolar disorder. Research shows family therapy can help you avoid a relapse.

In family therapy, you and your family learn about bipolar disorder. You’ll 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, like looking after your children, house, or pets, while you are unwell.

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

The Bipolar Organisation is a UK charity that provides advice and support to people with bipolar disorder, and their friends and family. The organisation runs a network of self-help groups. You can see their website on http://www.mdf.org.uk or call 08456 340 540.