Can You Relapse on Bipolar Medication? Yes, Here’s Why it Happens
Many people assume that when you are on medications for bipolar disorder, you won’t have relapses. I know that I did. However, out of the blue, after having a powerful steroid shot for shoulder pain, manic symptoms returned with a vengeance.
👉I shared my story in the Daily Mail to help others understand this lesser-known risk.
In this blog post, we’ll explore why relapses happen and what you can do.
TL;DR
You can take medications faithfully and still have a bipolar relapse. Meds help prevent relapses, but they can’t eliminate the possibility that you will have another episode. Things like stress, forgotten doses, hormonal changes, sleep disruption, and certain medications (like steroids and antidepressants) can trigger an episode.
If you notice early warning signs, don’t take a wait-and-see approach: reach out to your psychiatrist or medication prescriber right away. Review triggers, and follow your crisis plan if symptoms are severe.
Long-term stability with bipolar disorder rarely occurs from medications alone. It comes from a multi-layered approach— medications, therapy, and lifestyle changes.
Yes — Relapses Can Happen Even While Medicated
Bipolar disorder is a chronic condition. Medication is a treatment — not a cure. It is possible to experience a bipolar relapse despite medications. Here are some common bipolar relapse signs:
Manic symptoms, which may include racing thoughts, pressured speech, risky behaviors, and concentration problems.
Depressive symptoms, such as fatigue, hopelessness, low mood, irritability, and changes in appetite or sleeping.
Mixed features like feeling energized and also sad or tearful at the same time.
Why Do Bipolar Relapses Happen While on Medication?
There are several reasons why bipolar relapses can occur despite being on medications, including:
Subtherapeutic medication levels: This means that your medication is not at a therapeutic dose. It can be due to missing doses of your medications. It can also happen because of absorption issues. Some people’s bodies do not absorb certain medicaiton correctly.
Physiological triggers: This happened for me when steroids triggered a manic episode that was so severe it left me hospitalized for three weeks. Some medications interfere with the brain’s neurotransmitters, which can trigger an episode.
Seasonal changes: Seasonal changes can disrupt your circadian rhythm, which can trigger symptoms.
Severe stress: Stress is a well-known trigger for bipolar episodes.
Insomnia and sleep deprivation: This is another well-known trigger, especially for manic episodes.
Hormonal changes: Perimenopause is associated with a significant increase in the risk for mania. Other hormonal changes, such as those that occur during the perinatal period, can trigger episodes, as well.
Bipolar Symptom Breakthroughs: What to Do
1. Look For Early Warning Signs
Learn to pay attention to subtle shifts in your mood. Notice changes like racing thoughts, sleep shifts, and impulsive behavior. When you notice these changes, you can quickly take action.
Tip: Use a mood tracker app like eMoods or Daylio. These apps make tracking simple.
2. Review Hidden Triggers
When you notice an increase in bipolar symptoms, think about things in your daily life that could be causing increased symptoms. Are you getting enough sleep at night? Is your daily routine consistent?
Are you under a lot of stress? Have you traveled recently? Jet lag can severely destabilize your mood. Review all new medications you are on, especially ones that are notorious for triggering episodes, like steroids and antidepressants.
3. Contact Your Mental Health Team
Don’t “wait and see” if symptoms get worse. When you notice changes in your mood, contact your psychiatrist, therapist, or mental health team right away. They may adjust your medication dosage or be able to provide other supports.
5. Use Your Bipolar Safety Net: Your Crisis Plan
If symptoms are severe, and you have thoughts of harming yourself, follow your safety plan. It can be helpful to reach out to a trusted family member or friend for help. Also, contact your psychiatrist or mental health provider. You can also:
Call a crisis hotline (such as 988 Suicide & Crisis Lifeline in the United States).
Call 911 or emergency services in your location.
Go to the emergency room or hospital.
Finally, advocate for yourself with other medical providers. Always inform your other doctors about your bipolar diagnosis before they prescribe medications, especially ones that can interfere with mood stabilizers. This simple step is vital for preventing a medication-induced relapse.
FAQs
Can bipolar relapse while on medication?
Yes, absolutely! Taking medication does not completely cure bipolar disorder. Meds help manage symptoms, but bipolar disorder is a chronic condition. There is always the potential for release.
What can trigger a bipolar relapse?
Many things can trigger a bipolar episode relapse, including medications (antidepressants, steroids), jet lag, severe stress, or loss. Problems in interpersonal relationships could also trigger episode relapses. Stopping bipolar medication abruptly can also cause a relapse. Many have to be tapered.
What are the warning signs of a bipolar relapse?
Warning signs of a bipolar relapse include a notable decrease in the need for sleep. You may feel rested after sleeping for just a couple of hours or feel like you can’t sleep. Another sign is feeling irritable, happy, or elevated. With depression, the changes may include feeling sad or hopeless, sleeping too much, and having low motivation. You may start to struggle with basic everyday tasks.
Managing Bipolar Disorder: Beyond Medication
Yes, relapses can happen even while medicated—but knowing why and having a plan makes all the difference. Bipolar disorder management consists of multiple things — medications, a daily routine, and therapy (particularly Interpersonal and Social Rhythm Therapy).
If a relapse occurs, it’s not a failure; it simply comes with managing a chronic condition. To prevent relapses, talk openly with your medical team about potential triggers and be an active partner in your care, always.
References:
Nasereddin, L., Alnajjar, O., Bashar, H., Abuarab, S. F., Al-Adwan, R., Chellappan, D. K., & Barakat, M. (2024). Corticosteroid-Induced Psychiatric Disorders: Mechanisms, Outcomes, and Clinical Implications. Diseases, 12(12), 300. https://doi.org/10.3390/diseases12120300
