​Handling Relapse After Successful Treatment

By: Emily B

​When I tell people about my experiences with mental illness and my path to wellness, I like to use the term ‘relapsing-remitting chronic illness’ to describe what my illness is like to me. With something like bipolar disorder, relapse seems sometimes like this ever looming thing out on the horizon that may or may not come to shore now or later, or ever. With some mental illnesses, some like to paint this magical picture of one cure that will work forever for everyone, which isn’t always the case.

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When you go through the initial diagnosis and treatment phase, there’s a big focus on finding the thing that will get you well, giving the illness a name, and identifying things that make you feel worse. This can include a great combination of things like medications, therapy, diet, exercise, sleep hygiene, and building a support network. Each person’s illness is a unique course of illness and although we group like diagnoses with like, what works for one person won’t work in everyone. Once a point is reached where you feel like you have found a good combination that works for you, you might feel really great, satisfied, relieved, or determined.

But maybe one day you found you had a rather bad day, which happens, but the bad day turns into a bad week, or month, and you’re left wondering what happened, or frustrated that the "just right" combination isn’t working anymore. And you wonder to yourself, am I in a relapse? What’s not working anymore?

Some people won’t understand why you aren’t ‘all cured’ anymore. Others may go into therapist mode and try to rationalize your worries away because it will surely make you see things aren’t so bad. But when you get that nagging feeling that something is not working as it should, it’s okay to feel bad, and maybe disappointed.

An important first step of getting back on track is to tell someone you trust how you feel. Having a person who will be there to listen without rushing to problem solve is a valuable emotional support to have when changing things in your ongoing mental health strategy and can make you feel less isolated from others.

The second step is to evaluate your current strategy with your safe person and other helpful professionals you may see like a doctor or therapist to decide what changes might help you to feel better. Changing doses or medications is fairly common at this stage, and although it can sometimes feel like you’re back where you started, it can be a worthwhile change to make. A doctor may also order tests to check other things like iron and B vitamin levels that can contribute to low energy or feeling depressed or anxious.

You may also consider other things that support mental health like trying a course of therapy if you haven’t tried it before, attending a peer support group, and health promotion activities like exercise, sleep hygiene, or meditation. Everyone benefits differently from medications and supportive health activities and how much you benefit can change over time. Trying something new can be exhausting or daunting when your emotional and physical energy is being drained by mood problems or anxiety, but the benefit to feeling better can make it worthwhile.

For me my last issues with fatigue and mood imbalance were adjusted over several months. The current best combination for me is a dose increase, extended release tablets, more exercise, and treating an iron deficiency. I wouldn’t say I love cardio exercise and lifting weights, but I know it really helps me to feel less distress about the weight fluctuations that are a side effect of the medications, so I persist.
If I can impart one piece of wisdom I have learned about relapse over the years from my experiences with managing the ups and downs of bipolar depression, it’s that even when things changed or got harder I got better one step at a time until the good days began to outnumber the bad days again.

I wish you well.