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First published in Bipolar Life on 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 the 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:
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 episode .
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 depression .
Below you will find some general examples. Try to be as specific as you can.
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.
1. 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.
2. 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.
3. 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.
Dr Alice Lam
I'm a doctor who is passionate about writing quality health content.