Is Relapse Guaranteed?
I've been relatively depression free for about three months. That's the longest that I can remember in my lifetime, but then my memory is shot (thank you ECT) so who knows? That's why I had to reference the posts in my blog to verify how long I've been doing well, I just can't remember things anymore. But I digress...
This morning when, once again, I had those wonderful thoughts that include "life is good," that old fear of relapse started creeping in.
In bipolar disorder, relapse is defined as the return of depression or a manic or hypomanic episode after a period of wellness. According to a 1999 study published in the American Journal of Psychiatry, 73 percent of those diagnosed with bipolar disorder experienced at least one relapse over a five-year period; of those who relapsed, two-thirds had multiple relapses.
“You can never say that someone with bipolar disorder has had their last episode; relapse is part of the illness,” explains Alan C. Swann, MD, professor and vice chair for research in the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston and director of research for the University of Texas Harris County Psychiatric Center. “Relapse is self-perpetuating; once it happens, the more likely it is to happen again.”
Great, thanks Dr. Swann for the encouraging news. I have all the tools, both holistic and medical. I see my therapist and my psychiatrist regularly, take my medication, and am trying to instill some holistic habits. But is it all for naught? Am I being negative or realistic?
It’s possible to do all of the right things— follow a proper medication regimen, eat well, exercise, minimize stress and get enough sleep—and still experience relapse. Unfortunately, there is no clear understanding of why this happens.
“There may be changes in the cellular level that cause cycling but their cause is unknown,” says Joseph R. Calabrese, MD, director of the Mood Disorders Program at the Case Western Reserve University School of Medicine in Cleveland, Ohio.
While the neurological causes of relapse are unknown, a few things are certain: Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I (this is good for me because I have bipolar 1). Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania (oops, not so good for me). Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.
In fact, Dr. Roger S. McIntyre, MD, associate professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, believes that even the mildest symptoms of depression and mania should be treated as potentially hazardous.
So what can I take away from this article? The Little Miss Pissy Pants part of me says "Oh shit, I'm screwed." Jill has been trying to teach me to turn around my negative thinking, but I'm having a tough time with this one. If relapse is part of the illness, and there may be changes in the cellular level that cause cycling, can you blame me for feeling this way? I base my thinking on logic, so empirical evidence is at play here.
It's definitely scary, but I'll try to stuff it back into the dark recesses of my mind. I have too much to do today to attend a pity party.