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Recently, I was asked about planning for the future with bipolar disorder considering the threat of imminent 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?
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). The 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.
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:
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.
Natasha Tracy is an award-winning writer, speaker, advocate, and consultant from the Pacific Northwest. She has been living with bipolar disorder for 26 years and has written more than 2000 articles on the subject.
Find more of Natasha’s work in her acclaimed book: "Lost Marbles: Insights into My Life with Depression & Bipolar" on Amazon.
Connect with Natasha at the social media links below.
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How likely is the sun to come up? Pretty likely… Might be a good idea for someone to have a plan as what to do if they have a relapse. That’s something actually productive to think about rather than just building anxiety worrying. In my own life I’ve found dealing with it is the only real long term solution.
Hi Natasha,
I think your advice can be applied to so many people beyond those with bipolar disorder – of course the advice would need to be tweaked for the persons’ scenario. But so many folks have so many things going on where they never know what may happen moving forward. In my family there are several of us with the dx of bipolar (though the dx changes, depending on the practitioner). And we have other hard illnesses and other things going on that make you realize you just don’t know what will be from one day to the next. And I have met many more of them through different support groups whether for Lyme, cancer, MS, mental illness, etc. that face issues like they have a full time job for 30 years and now realize they may never work again. . I think we need to look at our special circumstances – that would be our illness and how it affects our day to day, or how it may later affect us. And we should look at other details tied to our personal scenarios from how it affects our job/financial stability, parenting/family/friendship issues; where else we might try and get support, etc. And like you say, come up with a plan and realize we have some control, but not all the control on the world.