How Likely is a Bipolar Relapse? Avoiding Bipolar Relapse
Recently, I was asked about planning for the future with bipolar disorder considering the threat of immanent relapse. This individual was in the last year of medical school and wanted to know how to plan the rest of his life, knowing that, at any moment, he might have a bipolar relapse. He was on meds, and they kept him functional, most of the time, but the bipolar medication didn’t prevent two major relapses in the past.
So the questions in this scenario are: How likely is a bipolar relapse? How can I avoid a bipolar relapse? How can I plan a life with such uncertainty?
How Likely Is a Bipolar Relapse?
It is fair to say that most people with bipolar disorder – on medication or not – will relapse at some point in the future. No, not everyone, but most will. In a 2014 naturalistic study of 300 patients with bipolar I and bipolar II, over the course of four years, 68% relapsed and most relapsed to the polarity of their initial episode (in other words, if you initially got sick with a manic episode, you’re more likely to relapse into mania rather than depression). Average time to relapse was 208 days. Lithium appeared to reduce the risk of relapse and switching medications or stopping medications increased the risk of relapse. People with no bipolar symptoms during remission also fair better than those with lingering, untreated symptoms.
So bipolar relapse is a reality we must face, and yes, probably even plan on.
Avoiding Bipolar Relapse
Even with the best coping skills in the world, you may not be able to avoid a bipolar relapse, and you shouldn’t feel bad if you fall into this category. However, given this, my advice on fighting bipolar relapse is this:
- Keep up with your treatment – that means medication and psychotherapy for most
- Take bipolar seriously and remember if you don’t actively fight it, it will likely come back with a vengeance
- Change your lifestyle to create a more stable environment that is less likely to lead to relapse (this means make sleep a priority and create a bipolar routine, among other things)
- Reduce your stress
- Learn about the prodromal (early) symptoms of a bipolar episode to nip any relapse in the bud
- Track your mood and watch for subtle changes
- Learn bipolar coping skills like those taught in cognitive behavioral therapy
- Don’t take you wellness for granted – work at keeping it every day
Of course, all of this doesn’t handle the question of planning for such an uncertain future. Next time, I will get to that question.