Dr Alice Lam – 21 March 2021
Wouldn’t it be great if you could stop a depressive or manic episode in its tracks?
Is there any proof that anything can be done to keep yourself from having a relapse of illness?
Fortunately, for many people with bipolar disorder, they are able to sense a relapse.
What we are talking about here is the prodrome, a set of early signs of relapse or recurrence of illness. (Although the term “prodrome” can be used for symptoms evolving before a person’s first episode, this article is for people who already have been diagnosed with bipolar disorder.)
For those with bipolar disorder, and people in their support network, not knowing how to recognise the prodrome could be a significant contributing factor to the stress of the condition. Self-monitoring is therefore an important part of bipolar management.
What do studies show?
A 2003 review of 17 studies, looking at over 1,000 people with bipolar disorder was undertaken by researchers. They looked at the prodromal symptoms and duration before a depressive or manic relapse. These were their main findings:
- Sleep disturbance was one of the key indicators of an impending manic episode
- The length of the prodrome could be variable: a mean duration of 11-19 days for depressive episodes, and 1-120 days for manic episodes1
In 2016, another review of 11 studies was undertaken, again covering over 1,000 people. The researchers concluded that prodromes before recurrent episodes were much shorter than before first episodes, lasting about one to two months. The symptoms in the prodrome period were similar to those in the impending recurrent episode2.
What does this mean for me?
It is helpful to know that if you are able to pick up on any early warning signs, it could mean you prevent a relapse altogether; or at least that the episode will be milder and more manageable.
If you are well enough to think back on your previous episode(s), why not make some notes on what your early signs were.
Although there isn’t a definitive test or list of symptoms that applies to everyone, the good news is, there is some evidence that your warning signs are a useful marker for you. About half of people with bipolar disorder are able to identify at least three features that indicate impending mania or depression3.
Below you will find some general examples. Try to be as specific as you can.
- Mood: Low / irritable / elevated. “I felt so happy and confident, like I could do anything. I was invincible.” “I would cry at the drop of a hat…even seeing a sad TV ad and I’d break down.”
- Sleep: Broken / need for less or more sleep. “I remember being up till 4 a.m. and waking at 7 a.m. for work, feeling totally refreshed.”
- Activity: Pacing or fidgeting (can’t sit still) / sluggish / hypersexual. “I was speeding up and down the corridors at work but there was no need to hurry.” “I lay in bed most of the time, no energy to do anything but cry.”
- Appetite: Reduced / increased. “I knew I should be eating but I kept skipping meals, I was so busy with my vlogging.”
- Interest / ideas: Loss of interest in usual activities / thoughts racing / obsessive interest in new projects / unhealthy risk taking. “I totally neglected my work as I had to attend to my spreadsheet of twenty different projects which were going to make me super-rich.” “I got into online poker and nearly lost my home.” “I was totally wrapped up in my depression. I thought there was no point in anything, no joy in the world, no way out…everything and everyone was fake.”
- Speech: Speech is fast, hard to follow/interrupt. “I kept getting annoyed with my friends because they wouldn’t let me finish what I had to say. When I recovered, they all told me I never drew breath and I was rambling.”
- Appearance: People around you may notice you are dressing with less attention to your appearance or in a completely different style. “I spent thousands of dollars online for a brand-new wardrobe. The clothes were totally not my style, looking back, and sometimes really inappropriate.”
Okay, I think I might be heading towards a relapse; now what?
Get help from your doctor, whether that is your GP or psychiatrist. They might need to review your medications. It could be that your sleep cycle is out of balance, or perhaps there are stressors that need to be managed. If you are getting worse, such as feeling you feel you can’t cope on your own, or you might harm yourself or someone else, go to your nearest Emergency Department or call the ambulance service.
And finally, get support from your partner, family and/or friends.
Dr Alice Lam has worked as a GP both in the UK and Australia and has advocated for countless patients. To find out more about her health writing service, please go to www.dralicelam.com/health-writer-service.html.
- Geddes, J. “Prodromal Symptoms May Be Identified by People with Bipolar or Unipolar Depression.” Evidence-Based Mental Health, vol. 6, no. 4, 2003, pp. 105–105, ebmh.bmj.com/content/6/4/105, 10.1136/ebmh.6.4.105. Accessed 21 Mar. 2021.
- Meter, Anna R. Van, and et al. “The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence prior to Initial or Recurrent Mood Episodes.” Journal of the American Academy of Child & Adolescent Psychiatry, vol. 55, no. 7, 2016, pp. 543–555, jaacap.org/article/S0890-8567(16)30171-X/fulltext, 10.1016/j.jaac.2016.04.017. Accessed 21 Mar. 2021.
- Geoffroy, Pierre Alexis, and Jan Scott. “Prodrome or Risk Syndrome: What’s in a Name?” International Journal of Bipolar Disorders, vol. 5, no. 7, 2017, journalbipolardisorders.springeropen.com/articles/10.1186/s40345-017-0077-5#Abs1, 10.1186/s40345-017-0077-5. Accessed 21 Mar. 2021.