Onika L. Dainty

Relapse looks different for everyone who experiences it. It may last days, weeks or months depending on the severity of the Bipolar episode. Similarly, recovery, remission or long-term stability has its own set of challenges that one must face on their wellness journey. In this article I will discuss how to plan for long-term stability after Bipolar relapse, how to overcome shame and rebuild confidence, the importance of a support system during challenging times and key ways of moving forward to create a life beyond Bipolar relapse.   

Building a Stronger Long-Term Stability Plan After Relapse

Building Your Crisis Plan

A mental health crisis plan is a proactive strategy developed before a crisis occurs which outlines the steps to take in a mental health emergency. Crisis plans include identification of early warning signs, a person’s coping mechanisms, emergency contacts, medical information including preferred hospitals or psychiatrists and resources for support. 

The goal of a crisis plan is to empower individuals when experiencing wellness to state how they would like to be treated in the future if a crisis occurs allowing them to maintain autonomy and dignity in navigating their own mental health crisis effectively and potentially minimizing harm to themselves or others.Unlike reactive measures that are often taken in a mental health crisis creating a plan allows an individual dealing with mental illness to have proactive involvement in how a crisis is handled as well as treatment outcomes where applicable. 

A typical crisis plan includes: 

• Early Warning Signs: a list of the early signs of potential crisis or distress symptoms that can help individuals identify if emergency services are needed.

• Coping Strategies: a list of specific techniques, like breathing or tapping, that help manage the overwhelming distress symptoms or reduce anxiety that can be invaluable to de-escalating a crisis. 

• Support Network: a list of trusted individuals who can be contacted to offer support during a mental health crisis. This list can be done in order of importance or trust. 

• Emergency Contacts: a list of contact information for crisis lines, preferred hospitals, wellness lines, mental health professionals or emergency services which ensure quick access.

• Medication List: a list of up-to-date medications and dosages an individual experiencing a crisis is taking. This can be useful for emergency service attendants if a crisis escalates and hospitalization is necessary. 

• Actions to Be Taken: an outline of the preferred steps to be taken in a crisis situation such as who to call first, if mental health professionals should be contacted, if a wellness check is necessary or which hospital an individual in crisis prefers. These action steps will be considered but not necessarily followed depending on the seriousness of the crisis.   

There are courses available through outpatient services such as Durham Mental Health Services (DMHS) or The Mood Disorder Association of Ontario (MDAO) which offer support in crisis planning. Wellness Recovery Action Plan (WRAP) is a personalized tool for managing mental health and well-being, developed through a structured process to help individuals identify triggers, wellness tools, and create plans for maintaining and enhancing their wellness, including crisis and post-crisis strategies. 

Medication Management 

After a Bipolar relapse a part of your rebuilding strategy may be revisiting your medication regime and the therapy you choose to participate in. When it comes to medication management it's important to note that the meds that were effective prior to your relapse may not have the same stabilizing result post-relapse. It has been my experience that an increase in dosage or a change to a different but recommended medication has been necessary for me to regain baseline mental health after an episode. This process of medication exploration by psychiatrists can take weeks before the correct cocktail is found and there is always the possibility of side effects occurring which can lead to further relapse. These are the risks that go hand-in-hand with medication management and adherence.

Therapeutic Strategies

Psychotherapy, counselling and group therapy after Bipolar relapse can be beneficial tools to maintaining remission or long-term stability. With the support of professionals it is possible to discover the root cause of the relapse especially if causes are related to life stress, specific triggers, loss of loved one or employment, adjustment to newness or change, anxiety, depression or substance use. Speak with your mental health network in your local community to find out how you can get connected to services that will lead to positive outcomes in your journey to long-term stability. Joining a peer support group can give you access to peers who have experienced relapse and can share tools and practices used to assist them on getting back on track. Online communities are a great and accessible resource for finding support after Bipolar relapse. It’s important to do your research in all cases to ensure you find professionals, groups and communities that fit your needs.      

Structure, Routine and Habit

Creating structure, routines and good habits after a Bipolar relapse goes a long way in finding balance in your daily life. Making small lifestyle changes like setting an alarm for waking you up or going to bed at the same time nightly will establish consistency and promote better sleep hygiene. Incorporating practices like daily exercise such as cardio or taking a walk are healthy habits that will have a positive effect on focus and stability. Tracking your mood in a journal or writing your thoughts down can help you manage your emotions and reflect on your feelings with the goal of long-term stability in mind. Staying connected with your support system of friends, family and mental health professionals is key during this time of transition. Knowing when to ask for help can be the difference between stability and further relapse. Through incorporating structure, routine and habit you can gain perspective into the practices that have a positive effect on your mental health, gain self-awareness and build a stronger long-term stability plan after relapse.   

Overcoming Shame and Rebuilding Confidence

It has been my experience that societal expectations as well as the expectations of those closest to you can add to the emotional burden of Bipolar relapse. It’s like looking into a mirror full of shattered glass, each piece representing the shame you feel inside, the broken trust of those around you and the assumption of a future full of relapse that society places on you. How do you overcome these burdens of belief and find a way to rebuild when all you see in front of you is a distorted view of who you used to be? How do you overcome all the challenges that Bipolar relapse brings and find the confidence you need to start again? It starts with self-forgiveness and challenging negative self-talk. 

To practice self-forgiveness, acknowledge your mistakes, accept responsibility, treat yourself with kindness, learn from the experience and move forward. This can be challenging especially when you have gone through a Bipolar relapse where the circumstances are a direct result of your illness rather than a particular action you took. The key to self-forgiveness with this type of relapse is acknowledging and accepting responsibility for the negative experiences that may have occurred as a result of the episode, practice self-kindness for the elements of your relapse that were out of your control, learn from your relapse and move forward armed with new found knowledge and understanding that will give you the confidence to rebuild a plan focused on long-term stability. When challenging the negative self-talk that may plague your mind after aBipolar relapse, start with questioning the thought’s validity, practice self-compassion, replace negative thoughts with positive affirmations while seeking the support of others in your care circle while also setting realistic goals for your future mental health outcomes. 

Final Thoughts

Bipolar relapse is not failure and it is not for others to judge as a failure. Picking up the pieces from that shattered mirror is a daily choice. Looking into your reflection and seeing someone worth fighting for rather than someone who feels shame or self-loathing is a step toward reframing your goals and rebuilding your future. Relapse is a setback and a stepping stone toward the actualization of who you can become regardless of your mental illness. Rebuilding stability can also mean reclaiming your joy, the hobbies or passions that previously brought happiness to your day or creating a self-care routine that helps you find your balance. Relapse is lessons learned from self-reflection leading you to the self-awareness that will determine your future long-term stability. 

Remember, every day is a new opportunity to do something you’ve never done before, so choose to move forward with confidence rather than shame looking beyond Bipolar relapse to a future filled with possibilities and long-term stability.

You don’t have any understanding that Bipolar relapse is a natural part of the recovery cycle because you don’t quite have a grasp of your own cycle until months or even years after your Bipolar disorder diagnosis. Women facing Bipolar disorder often encounter unique challenges from societal stigma to personal guilt and shame. It’s important to remember relapse isn’t the opposite of recovery–its a step within it. This article shares powerful stories of how to rebuild your life after relapse, along with expert advice on recovery, resilience and self-compassion.  

Bipolar Relapse: Why It Happens and How to Respond

Bipolar disorder is a mental health condition that involves shifts in mood, energy and activity levels. The three main types of bipolar disorder are Bipolar I, Bipolar II, and Cyclothymic disorder. Bipolar I disorder involves longer periods of Mania that last at least a week to eight weeks with depressive episodes that last two weeks. Bipolar II disorder is characterized by cycles of hypomanic episodes that can last for up to four days and depressive episodes that may be shorter and less severe. Cyclothymic disorder involves frequent mood swings of hypomania and depression that are not severe enough to be considered episodes of hypomania or depression.

Understanding and avoiding triggers can help people with Bipolar disorder minimize symptoms and limit the number of cycles they experience. Below are some common relapse triggers to consider when managing your Bipolar disorder cycle.  

Relapse Triggers That Effect Bipolar Cycle

• Stress: Stressful life events such as loss of a loved one or loss of job. Stressful events often trigger a mood episode.

• Sleep: Changes in sleep patterns, such as insufficiencies or severe insomnia can trigger a mood episode.

• Medications: Certain antidepressants and other medications can trigger a mood episode.

• Substance Use: Drugs and alcohol use can trigger a mood episode.

• Hormones: Menstruation, pregnancy and other hormonal shifts can trigger a mood episode.  

• Other Factors: Grief, change in season or events like travel can trigger a mood episode.

The above list seems to incorporate everything one may go through on a daily basis. That’s the challenging part of managing Bipolar disorder, there are every few life events that can’t lead to cycle changes and ultimately relapse. Stress, for example, is a natural occurrence in our life cycle but for women with Bipolar disorder how we manage stressful events can mean the difference between experiencing severe mood changes that lead to a hypomanic, manic or depressive episode. Another common life event in people with Bipolar disorder is medication changes. It is important to stay mindful when going through changes such as this one by staying in touch with your medical team and taking time to rest though this process of transition to ensure your body and mind stay balanced. 

Remember, Bipolar relapse should never be considered a failure, rather it is an opportunity for healing and a deeper understanding of an illness that is by its nature full of ups and downs. The emotional toll that relapse can have on an individual can range from guilt and shame to fear of further setbacks, all realistic emotions however can be misplaced. Consider the following: if you are always in a state of wellness on your journey, how can you identify when you are unwell unless you experience low and high periods that characterize Bipolar disorder? A part of maintaining good health is recognizing the experiences that challenge your mental health. Feelings of guilt, shame and fear are normal but are also indications of feeling failure and Bipolar relapse should never be considered a failure rather a learning lesson on your journey to overall wellness.    

Embracing Strength: Stories of Finding Hope After Relapse

Embracing My Bipolar I Disorder

Early on in my mental health journey I didn’t have the knowledge and understanding of my Bipolar I disorder cycle. Mania and depression were my state existence and constant self-blame and self-loathing were my mental baseline. I blamed myself for my mental illness, I blamed myself for the recurring symptoms of Bipolar I disorder and the co-occurring substance use disorder I was experiencing not knowing how to manage either. It took many years to first accept that my Bipolar disorder was not going anywhere, that it was a permanent part of my psychological make-up but that didn’t mean that it had to live in the passenger seat of my life or dictate my future. Secondly, I had to show myself compassion regarding my substance use, finally coming to the realization that the substance use was a symptom of the larger issue of unmanaged mental illness. 

Once I accepted these two truths about how I was handling my illness, once I recognized that my struggle was not unique and could be overcome, I started doing the work. I made a declaration about my life. If I was going to live my life as a woman with Bipolar I disorder, I was going to make it the best life it could be despite my mental illness. I decided to embrace my Bipolar disorder through psychoeducation, counselling services, medication management, self-care, creating structured routine and good habits, sharing my lived experience and advocacy work. I stopped blaming myself for a condition I was born with, I stopped running from a disorder I had to stand and face and I started fighting for my future knowing that Bipolar relapse is always around the corner but arming myself with the tools to face any challenge.    

Embracing Grama Judie, My Mental Health Mentor

It starts with one person. One person in your life to reach out to you and say, “I’m here for you, I want to help you and you are not alone.” It may not be a member of your family, your mom or your dad who are struggling with the reality of their daughter having a severe and lifelong mental illness. It may not be your little sister who is too young to understand the consequences that mental illness brings. It may not be your circle of extended family and friends who are focused on having you be who you were to them before the chaos came. Instead it could be a stranger you meet along your journey who sees you hurting and reaches out to help. For me that was an 80-year-old woman I met while in the hospital 17 years ago. Her name is Judie, fondly known as Grama Judie, my best friend and who I’ve often referenced in my articles as my Mental Health Mentor. 

Seventeen years ago she saw a lost young woman sitting at a table reading a book and she approached me. “Whatcha reading?” she said. “A Historical Romance,” I replied. She sat down and thus began a relationship that has almost spanned two decades. She has been my friend, my  mental health advocate, my substitute decision maker, my community connector, she has taken care of my home when I’m hospitalized, visited me in and out of psychosis, been there for wellness checks, though the good, bad and challenging times are always ready to support me. Her confidence in my ability to rebuild and reinvent myself after every episode has been unwavering. I cannot negate the others who have joined my support network over the years of dealing with my mental illness but I am most grateful to my Grama Judie because her belief in my strength and resilience is what has given me the fortitude to continue rebuilding after every major episode.    

Embracing My Setbacks

On the road to wellness there have been more setbacks than I care to admit or recount. However, what I can say is that every setback has been a learning experience. In few years ago I experienced a year-long Bipolar relapse which included several suicide attempts,  homelessness and nine hospitalizations. The constant chaos and instability led me to a place of dejection and hopelessness. I was sick and tired of being sick and tired. I had to take stock of my life and the decisions I had been making or rather not making concerning my mental illness. I call this year in my life “The Great Rebellion,” as I had rebelled against the mental health care system, against my psychiatrist, against my medication, against those who loved me and to what ends? I was the one who was suffering for not doing the work I knew I needed to do to live a full and healthy life. 

The structure, routine and habits that I was able to maintain during my four month stay in Ontario Shores Centre for Mental Health Sciences gave me the clarity I needed to forge ahead in a positive direction where relapse was still possible but manageable when making good decisions around my mental health. I was also able to maintain my sobriety with the help of counsellors and therapists that gave me a better understanding of how substances interacted with the chemical imbalance that defined my illness. For the first time I was listening and learning about myself in a way I had never done before. I was once again in a space where self-awareness and self-compassion took the lead on my journey of resilience and recovery. Although there are many reasons for setbacks in my life, the biggest challenge has always been getting out of my own way and allowing myself to heal and be whole, seeing relapse as an opportunity to learn lessons about myself that I have yet to learn.    

Final Thoughts

Bipolar relapse exists within mental health recovery, it is not the end of the road but a part of the journey. It acts as a barometer which allows you to reflect on both the changes made and the changes you may need to make on the journey to your final destination of mental wellness. Every woman’s recovery journey is unique and full of challenging experiences but the common theme is always resilience, your ability to keep moving forward towards your goals regardless of the challenges. When managing a severe mental illness like Bipolar disorder it’s important to remember relapse is almost always inevitable but knowing this can mitigate the severity and make the road to recovery more accessible. 

Seeking support from your mental health network during challenging times can go a long way in your journey to recovery. Sharing your lived experience story can inspire and help others in their own recovery journey. Finally, continue moving forward because your journey is not defined by your setbacks but by your resilience. Remember, there is light at the end of every dark tunnel and there is always sunshine after the rain.