Mental Health Relapse Warning Signs: Early Clues and Prevention Strategies
A mental health relapse occurs when the symptoms of depression, anxiety, schizophrenia, bipolar disorder, or any condition you were previously treated for return.
Relapse is, in no way, a weakness. It’s rather a statistically expected feature of most major mental health conditions. For example, 50% of people who have experienced one depressive episode and recovered are likely to experience one or more additional episodes during their lifetime.[1] In research studies, the relapse rates for schizophrenia are between 52 to 92%, and that of bipolar disorder are 65 to 73%.[2]
That said, relapse is largely preventable if you catch its signs very early before it progresses to clinical deterioration.
This page explains the signs of relapse in its different stages and for different mental health conditions, as well as what you can do to prevent it in the first place. It covers:
- The stages and early signs of mental health relapse.
- The differences between relapse and setback.
- Factors that increase the risk of relapse.
- Relapse prevention strategies.
- What to do if you notice signs of relapse.
Stages of Relapse
In 1986, the author Terence Gorski described relapse as a step in the process of change in behaviors that occurs in three stages. These stages are:[3]
- Emotional relapse.
- Mental relapse.
- Physical relapse.
Each of these stages is defined by thoughts and actions that lead a person to return to their previous behavior. Below, we provide an outline of each stage.
1. Emotional Relapse
The first stage of relapse, emotional, occurs when you aren’t even consciously thinking about giving up on your recovery. However, you experience negative emotions that you can’t explain the reasons for, such as anger, frustration, anxiety, or sadness for no apparent reason.
The warning signs of emotional relapse are:
- Withdrawing from your close friends and family.
- Neglecting basic self-care like your sleep, nutrition, and exercise.
- Bottling up your feelings instead of talking them out with someone you trust.
- Changes in mood that you can’t explain.
- Skipping therapy appointments just because you don’t feel like going.
2. Mental Relapse
If emotional relapse goes unaddressed, you may start having active thoughts of returning to harmful patterns of behavior. It is also the time of an internal battle during which a part of you realizes that something is wrong while the other part rationalizes your thoughts of relapse.
During a mental relapse, the following symptoms are noticed:
- A persistent sense of hopelessness about your future.
- Feeling like the old patterns of avoidance and unhelpful thinking were logical.
- Non-specific physical symptoms like fatigue, mild and crampy abdominal pain, muscle tightness, and so on..
3. Physical Relapse
The physical stage of relapse is called the “full return of psychiatric conditions’ core symptoms”, for example:
- Low mood, anhedonia, impaired concentration, and all the other clinical features of major depression.
- A manic or a depressive episode of bipolar illness.
- Psychotic symptoms (delusions, hallucinations, or disorganized speech).
- Reactivation of the anxiety cycle in its full clinical intensity.
At this stage, professional intervention through a psychiatrist is typically medically necessary.
That said, reaching the physical stage of relapse does not mean your recovery is over. It’s just that your treatment plan needs to be readjusted so that you can stay in control of your life.
Early Signs of Mental Health Relapse
Besides the signs of relapse discussed in its different stages, different mental health conditions show early signs of relapse in distinct ways.
Depression Relapse Warning Signs
Depression is one of the most common mental health conditions in the world. It is also one of the most likely to recur. After treatment of the first episode of depression, about half of all people will relapse, the risk of which increases with each subsequent episode.[1]
The early signs of depression relapse are:
- Cognitive impairment.
- Decreased pleasure response to activities you used to like (anhedonia).
- Changes in sleep, such as difficulty falling asleep, waking during the night, sleeping far more than usual, waking in the early hours, and so on.
- Difficulty concentrating.
- Feeling like you are in a cycle of negative thoughts.
- Pulling back from your loved ones.
- Irritability.
Anxiety Relapse Symptoms in Adults
Research says that on average, 23.8% of people treated with cognitive behavioral therapy for anxiety-related disorders experience relapse after completing their treatment.[4]
The re-emergence of relapse symptoms creates a secondary layer of anxiety about the anxiety, also known as “anticipatory anxiety.” In other words, dreading the return of anxiety can itself trigger it.
Other signs of anxiety relapse are:
- Fear and avoidance in relatively safe situations.
- Returning physical symptoms like muscle tension, headaches, gastrointestinal discomfort, restlessness, heart palpitations, or shortness of breath.
- Being hypervigilant of your surrounding environment.
- Sleep disruption and restlessness.
- Habitual worst-case-scenario thinking.
Bipolar Relapse Early Symptoms
The recurrence rates of bipolar disorder are also very high. A review of 22 studies found that before the recurrence of a manic or hypomanic episode, people can experience a relapse prodrome (an early set of signs).[5]
Its symptoms include:
- Being more talkative than usual.
- Having higher energy.
- More goal-directed behavior.
- Racing thoughts.
- Increased self-esteem.
- Increased interest in sex.
- Increased activity.
- Impulsive spending.
The median prevalence of sleep disturbance is also about 77% in multiple studies.[6]
A cross-sectional study reported the first recognized symptom of recurrence in mania to be a change in energy level (21%), sleep (17%), and social functioning (16%).[7]
The symptoms of depressive episodes were a change in thought patterns (15%), mood stability (12%), energy level (12%), social functioning (11%), and sleep (10%).[7]
Relapse vs. Setback in Mental Health
During your treatment, you will likely encounter situations in which you transiently face a challenge that makes your progress difficult. Such challenges are known as “setbacks,” and they do not necessarily mean a full return to your pre-treatment behaviors.
A relapse has a specific clinical definition. It is the return of your symptoms during the remission period.
For example, if a person managing generalized anxiety disorder well for several months faces a new financial stressor that makes them feel more anxious than usual, that is a setback. During this time, they will still be able to use their coping skills and will be back on stable ground in a few weeks.
The setback was triggered by a specific, identifiable event and was time-limited.
If, however, the same person does not use their coping skills at all and avoids talking about their issues until their anxiety intensifies to a level that it disturbs their work, relationships, and daily functioning, that would be a relapse.
Factors That Increase the Risk of Relapse
The following are some research-supported factors that increase the likelihood of mental health relapse:
- The strongest single predictor of future relapse is past relapse that happened due to residual symptoms at the end of treatment. Each episode, if not fully treated, can make subsequent episodes easier to trigger.[8]
- Stopping treatment before you have been completely symptom-free for at least a few months can also make you prone to relapse.
- Non-adherence to medications increases the risk of relapse. And unfortunately, as many as 65% of patients with severe mental illness do not take their medication as recommended.[9]
- Stressful life events at school, work, home, and social environment are usual setbacks that can lead to a full-blown relapse if your support system is weak.
People with a history of trauma, such as childhood maltreatment or abuse, are at risk of relapse.
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
Relapse Prevention Strategies for Adults
Here are some steps you could take to prevent a mental health relapse.
Identify Your Triggers
Every mental health condition has a signature set of triggers, which can be:
Internal triggers: The emotional states a person feels that can make you prone to falling back into unhealthy behaviors. These include things like:
- Shame.
- Loneliness.
- Hopelessness.
- Anger.
- Boredom.
- Physical exhaustion.
External triggers: These happen outside of the active control of your mind and include things like:
- The environment of your surroundings.
- Social situations.
- Certain times of year.
- Relationship issues.
- Disruptions to your routine.
You need to build a written map of your own triggers by evaluating what usually happens within you and in your external environment during the periods when your symptoms worsen.
Develop a Written Wellness Recovery Action Plan
A Wellness Recovery Action Plan (WRAP) is a personalized document that prepares you to maintain your mental health.
A clinical experiment found that people with severe and persistent mental illness who had a WRAP in place reported better symptom reduction over time.[10] They also had a better quality of life.
The WRAP document should include:
- A personalized list of activities that you know keep you stable, like the creative outlets you like, your exercise habits, your ideal sleep routine, and your preferred spiritual practices.
- Descriptions of what you feel like when you are doing well.
- A list of daily tasks you need to do to maintain an internally satisfied state.
- A list of your identified triggers.
- Specified actions you need to take for each trigger.
- A set of instructions to follow for the times when your condition deteriorates to a crisis level, including the names and contacts of people who will support you, your doctor’s details, your preferences for care, and so on.
Establish a Structured Daily Routine
An unstructured life creates chronic unpredictability in which managing a stressor becomes very difficult without falling into relapse. You can maintain a stable lifestyle by following a consistent daily schedule – it could also reinforce a sense of control in you.
Your daily routine should consist of:
- Consistent sleep and wake times.
- Regular physical activity.
- Healthy eating habits.
- Taking your psychiatric medication at the same time every day.
- Scheduled therapy or psychiatric appointments.
- Any purposeful activity through work, volunteering, learning, creative pursuits, etc.
Build a Support Network
Research shows there is a positive influence of supportive social networks on recovery for people with a diagnosis of severe mental illnesses.[11]
However, people with mental health problems tend to have poor social support. You should, therefore, put active effort into building a support network.
Your support network could include a mental health professional and trusted people in your personal life who understand your condition and won’t judge you. It could also involve peer support from people who have lived experience of similar mental health challenges.
Ideally, your family should be involved in the therapeutic process through psychoeducation, so they can provide you with a comfortable recovery environment at home.
What to Do if You Notice Signs of Relapse
If you recognize any of the signs of relapse discussed so far in your current behavioral patterns, you should consider meeting with your therapist immediately. Early intervention can prevent a severe relapse episode that may require a subsequent inpatient admission.
When you reach out to your mental health provider, explain your emotional, mental, and physical symptoms.
Your provider will assess where exactly you are in the relapse spectrum and determine the appropriate clinical response, which can include:
- Resuming your treatment if you have stepped back from it.
- Reviewing your current medications and possibly adjusting their dosages or adding an adjunctive medication.
- Stepping up to a higher level of care, such as an intensive outpatient program, day hospital program, or inpatient care.
Find Support for Relapse Prevention and Mental Wellness
Mission Connection provides compassionate, evidence-based outpatient care for those living with mental health conditions and at risk of relapse or actively experiencing one. We understand that the journey of treatment is not linear, and we will never treat it as though it should be.
Our care is delivered by a multidisciplinary clinical team working under board-certified psychiatrists. We build individualized care plans taking into account the latest psychiatric research and design them around who you are.
We offer a variety of flexible treatment models, including:
- In-person outpatient programs at our locations in California, Virginia, and Washington.
- Telehealth treatment.
- Hybrid programs that combine in-person and virtual care.
Additionally, Mission Connection is Joint Commission-accredited, the gold standard of quality and safety in healthcare. We accept insurance and are in-network with most major insurance plans.
If you believe you are in need of help with regard to mental health relapse, call us at 866-833-1822 or get started online.
