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All of a sudden your best friend stops calling. She no longer wants to join you for yoga on Saturday mornings. The last time you saw her she looked fragile and sad, like someone else was living in her body. Her husband doesn’t know what to do so he solicits your help in cheering her up.

Or maybe it’s your sister. She has been struggling with depression for a few months now. She’s been to a psychiatrist and is on an antidepressant, but she doesn’t seem to be making much progress.

What do you do?

I’ve been on the giving and the receiving end of kind-hearted attempts to liftdepression more times than I’d like to count. While every case of this maddening mood disorder is unique and responds to different treatments, there are a few universal things you can try to guide your depressed friend or family member down the path of healing and recovery.

1. Educate yourself.

Although people are better educated on depression and anxiety today than they were two decades ago, we still have a long ways to go on understanding how the brain operates: Why some people smile as they get run over by a truck, and others cry uncontrollably at the mere thought of that. It turns out that more is going on in our noggin than just a bunch of lazy neurotransmitters that can’t deliver messages to certain neurons. You don’t have to be a neuroscientist to help a friend or a family member with a mood disorder, but some basic knowledge on depression and anxiety is going to keep you from saying well-intentioned but hurtful things. It’s just hard to help someone if you don’t understand what the person is going through.

2. Ask lots of questions.

Whenever one of my kids gets sick or injured, I start in with a series of questions: Where does it hurt? How long have you felt bad? Does anything make it worse (besides school)? Does anything make it better (besides ice cream)? Just by asking a few basic questions, I can usually get enough information to determine a plan of action. With depression and anxiety, questions are crucial because the terrain is so vast and each person’s experience is so different. Your friend may be so desperate that she’s had a suicide plan in action for weeks, or she could just be under a lot of stress at work. She could be having a severe episode of major depression, or just need a little more vitamin D. You won’t know until you start asking some questions. Here are a few to consider:

• When did you first start to feel bad?
• Can you think of anything that may have triggered it?
• Do you have suicidal thoughts?
• Is there anything that makes you feel better?
• What makes you feel worse?
• Do you think you could be deficient in vitamin D?
• Have you made any changes lately to your diet?
• Are you under more pressure at work?
• Have you had your thyroid levels checked?

3. Help them learn what they need to know.

I used to rely on my doctors to tell me everything I needed to know about my health. I don’t do that anymore, because they don’t know me as well as my family and friends. Psychiatrists and psychologists have expertise in some areas, which can be critical feedback as a person begins to tackle the monster of depression; however, so much other valuable information is tucked away in memories with friends and families that could guide a person out of despair. For example, during this most recent relapse of mine, my older sister kept insisting that I probe into my hormonal imbalances. “You haven’t been well since you’ve had your kids,” she said. “Part of this depression has to be hormonal.” My mom reminded me that thyroid disease runs in our family and suggested I get my thyroid checked out. Initially I was annoyed by their opinions since it required more work on my part. When I couldn’t take the pain anymore, I sought after a holistic physician who could piece together my problems with my thyroid and pituitary glands and address the hormonal imbalances that contribute so heavily to my depression.

You know your sister, friend, brother, or father better than most mental health professionals, so help them solve the riddle of their symptoms. Together consider what could be at the root of their depression: physiologically, emotionally, or spiritually. Where is the disconnect?

4. Talk about stress.

You can be drinking kale and pineapple smoothies for breakfast, lunch, and dinner; meditating with Tibetan monks for eight hours a day; sleeping like a baby at night … and yet, if you are under stress, your veins are flooded with poison and your mind is under fire. About five pages into every psychology book there is a paragraph that says that stress causes depression. I think it should be on page one. There is just no way around it. Stress is bad, bad stuff, and as long as it’s pouring cortisol into your bloodstream, you aren’t going to get well. So one of the biggest jobs of a friend or relative of someone who is struggling with depression is to help the person construct strategies to reduce stress. They don’t need to quit their job. They can keep their kids. However, they may need to make some significant lifestyle changes and be sure to introduce self-care into every day. What is that? Five-minute breakshere and there to take some deep breaths, or an hour massage once in awhile, or maybe a day off here and there to sit by the water, golf, or go for a hike.

5. Talk about support.

It doesn’t matter what the illness is — cardiovascular disease, colon cancer,fibromyalgia — a person needs support in her or his life to fully recover: People with whom they can vent and swap horror stories, folks that can remind them that they are not alone even though their symptoms make them feel that way. Research shows that support groups aid the recovery of a person struggling with depression and decrease chances of relapse. The New England Journal of Medicine published astudy in December of 2001 in which 158 women with metastatic breast cancer were assigned to a supportive-expressive therapy. These women showed greater improvement in psychological symptoms and reported less pain than the women with breast cancer who were assigned to the control group with no supportive therapy. Brainstorm with your friend on ways to get more support. Research and share with your friend various groups (online or in town) that might be of benefit.

6. Remind them of their strengths.

Just yesterday morning I was having suicidal thoughts during yoga. It was one of those painful hours when I couldn’t stop thinking about how soon I could die. Instead of being gentle with myself, I started comparing myself with a few incredibly accomplished people I swim with — the kind of people who swim across the English Channel for giggles — and tend to make the average person feel pathetic. Later in the day, I went for a walk with my husband, still fighting the death thoughts as we strolled along the rocks bordering the Severn River at the Naval Academy, our favorite route. We were talking about how jealous we were of couples who didn’t have kids (in some ways, not all), how damaged we feel after 13 years of parenting, but how much we’ve evolved as human beings because of all the struggles we’ve endured in that time.

“You’re strong,” he said.

I balked. “No, no I’m not,” I said. I was thinking strong meant swimming the English Channel, not fighting suicidal thoughts in yoga.

“Yes, you are,” he insisted. “You have a 200-pound gorilla on your back constantly. Most people would roll over and give up, coping with booze, pot, and sedatives. Not you. You get up and fight it each day.”

I needed to hear that. In my head, I categorize myself as weak because of the constant death thoughts, when, in reality, the fact that I can accomplish stuff in spite of them means I’m strong.

Remind your friend, sister, brother, or dad of their strengths. Bolster their confidence by recalling specific accomplishments they’ve made and victories they’ve won.

7. Make them laugh.

As I mentioned in my post, “10 Things I Do Every Day to Beat Depression,” research says that laughing is one of the best things we can do for our health. Humor can help us heal from a number of illnesses. When I was hospitalized for severe depression in 2005, one of the psychiatric nurses on duty decided that one session of group therapy would consist of watching a comedian (on tape) poke fun at depression. For an hour, we all exchanged glances like “Is it okay to laugh? I sort of want to die, but this woman is kind of funny.” The effect was surprisingly powerful. Whenever the “black dog” (as Winston Churchill called depression) has gotten a hold of a friend, I try to make her laugh, because in laughing, some of her fear and panicdisappear.

8. Pass on some hope.

If I had to name one thing a person (or persons) said to me when I was severely depressed that made me feel better, it would be this: “You won’t always feel this way.” It is a simple statement of truth that holds the most powerful healing element of all: hope. As a friend or family member, your hardest job is to get your friend or brother or dad or sister to have hope again: to believe that they will get better. Once their heart is there, their mind and body will follow shortly.

9. Listen.

You could disregard everything I’ve written and just do this: listen. Suspend all judgments, save all interjections … do nothing more than make excellent eye contact and open your ears. In her bestselling book, “Kitchen Table Wisdom,” Rachel Naomi Remen writes:

I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it’s given from the heart. When people are talking, there’s no need to do anything but receive them. Just take them in. Listen to what they’re saying. Care about it. Most times caring about it is even more important than understanding it.

Last summer I met a friend for coffee. I cried through most of our hour together, as I was in the midst of a severe depression episode.

At one point, she folded her hands on the table, looked intently into my eyes, and said, “It’s a hard time of year.”

I started laughing … because we say that about every season. Autumn seems to bring anxiety with all of its change. Winter’s short days are difficult for those of us who need lots of sunlight. And Spring actually has the highest suicide rates of any other season.

But, yes, summer is a hard time of year, especially if you need structured days, or like the house to yourself, or can’t stand the heat. In fact, 10 percent of those diagnosed with Seasonal Affective Disorder (SAD) suffer symptoms at the brightest time of the year. Because my two biggest breakdowns have happened in the summer, I know that I have to be proactive about having sanity boosters in place, ideally before school lets out. Here are a few of them.

1. Force Some Structure

The two summers I had minimal depressive symptoms were those in which I was working an 8-to-5 job. I had a structure already in place, and my days were not so different to those in other seasons. Working from home is really bloody difficult in the summer if you have energetic bodies in the house that summon your help every five to ten minutes. They do go to camps, but different ones each week, so the schedule changes every five days.

In order to force some structure into my day, I decided I would get up and swim early, like I usually do, and then work at a coffee shop for a few hours in the morning, to make sure I get at least some writing done. So right now I’m writing from a back room of a coffee shop that is under construction and am thinking those energetic bodies at home might be less of a distraction than the pounding. Ah, well. Summer.

2. Hydrate With Water, not Diet Soda

I brought up this point in my post, “6 Conditions That Feel Like Clinical Depression but Aren’t.” Dehydration is one of those conditions. It sneaks up on you, because by the time you feel thirsty, you are already dehydrated. According to two studiesconducted at the University of Connecticut’s Human Performance Laboratory, even mild dehydration can alter a person’s mood.

You might be tempted to grab a Diet Coke at a family picnic, but it’s best if you stay away from all diet sodas. A recent study by the National Institute of Health showed that people who drink four cans or more of diet soda daily are about 30 percent more likely to be diagnosed with depression than people who don’t drink soda. Coffee drinkers are about 10 percent less likely to develop depression than people who don’t drink coffee. People with mood disorders are especially sensitive to the superficial sweeter aspartame in most diet sodas. In fact, a 1993 study conducted byRalph Walton, M.D., of Northeastern Ohio Universities College of Medicine found that there was a significant difference between aspartame and placebo in both number and severity of symptoms for people with a history of depression, but not so for persons with no history of a mood disorder.

3. Remember Good Summers Past

Rick Hanson, Ph.D., and Richard Mendius, M.D., explain in their book, “Buddha’s Brain,” that the brain has a negativity bias. They describe it as Velcro for negative experiences and Teflon for positive ones. Moreover, pain today can breed pain tomorrow because negative experiences and memories can reshape the circuits of our brain to think more negatively in the future. However, positive experiences also shape the brain. By intentionally activating positive memories, we can shift the emotional backdrop of our minds. So when I think about “summer,” my mind usually goes to those painful summer memories when I was on so many different drugs I fell into my cereal bowl and couldn’t stop bawling. Naturally, I panic. Summer! However, by consciously changing my memory to be of those summers when I was younger, when I started the day with swim practice at 8 a.m. and stayed at the pool until dinner, soaking in the sun and playing all kinds of imaginative games with my friends in the water, I am actually rebuilding my neural structure to recall positive memories the next time someone mentions “summer” in the general sense, or when I start to become anxious and think I’m relapsing like I did last summer. The memory doesn’t have to be of summer, of course, but by activating some positive memory and savoring that experience, you help your brain run like an optimist … one that’s not annoying.

4. Find Support

This summer I’m equipped with an important tool that I didn’t have last year: a kick-butt online support group that I started a few weeks ago on Facebook. Some of the members have the same summer fears as I do, which helps me to put mine into perspective. Others simply remind me to try to enjoy what I love about summer — lots of open-water swimming, paddle boarding, kayaking — and be sure to do those things that protect me from self-sabotage: meditation, exercise, a diet rich in leafy greens and omega-3 fats, laughing, and time to myself. They encourage me to stay in the moment as much as is humanly possible, because peace exists in the present moment.

Learn about mood and mental health issues that may accompany pain and other symptoms of rheumatoid arthritis.

People who live with chronic diseases such as rheumatoid arthritis may experience more than physical pain and disability. Their illness could also affect their mental health. While sometimes the illness causes mental health issues, more often than not it’s because of the changes brought about by chronic illnesses.

Managing Chronic Disease May Take A Toll On Mental Health

If you are used to being active and challenging life head-on, it will be difficult to accept that you may not be able to accomplish what you have before. Work may become too difficult; even doing the small pleasurable things, such as hobbies, may become impossible. As the disease progresses, you may end up isolating yourself from others.

“One thing we usually see in anyone with RA is an existing pain syndrome, which then brings on depression, feelings of helplessness, poor self-esteem, irritability, and problems with social interactions,” says Patricia A. Farrell, PhD, a psychologist in Englewood, N.J.

“Pain, caused by the physical damage from RA, is also intensified by anxiety, so as anxiety goes up, the ability to tolerate pain goes down,” Dr. Farrell adds. “We need to address these psychological and physical elements, and work with the patients’ other treatment providers.”

Another issue that may cause stress for individuals with chronic illnesses is the fear of the unknown, or of what will happen in the future. With diseases such as rheumatoid arthritis, people know that their pain probably will get worse, that they’ll become more disabled — but they don’t know when or how disabled they may get.

When Mood Disorders Start To Take Hold

It’s important to act quickly to intervene when mental health is an issue. The earlier treatment or management begins, the less likely it is to spiral out of control. It’s important for people with rheumatoid arthritis to understand that it’s all right to ask for and accept help.

Research shows that when people have a chronic illness, the highest risk of developing a problem such as depression is within two years of being diagnosed. This is why it’s important for mental health practitioners to work with the patients’ other treatment providers, Farrell says. Working together, they can address both the psychological and physical elements of rheumatoid arthritis.

“We begin by helping them understand that they do have power in this situation and a variety of self-help techniques will help them,” Farrell says, noting that the team and patient have to work together. “It’s a multidimensional approach to the disorder that works best.”

Maintaining Mental Health

For treatment to be most effective, you need a thorough evaluation by both a psychiatrist and a cognitive therapist (a therapist who helps you recognize and change negative thinking patterns) who are used to working with the chronically ill, Farrell says.

Self-help is also a central part of easing the pain and disability of depression and anxiety. “We teach people how to use relaxation breathing, imagery, and how to manage stressful lives,” Farrell, says. Medication, a necessary treatment tool for some people, is not the answer for all: “The decision to use medication or not is an individual one after careful consideration of the patient’s symptoms and needs.”

Knowing that help is available is a key component to mental health management.

There are four distinct types of people when it comes to weather and mood, according to a study published in Emotion in 2011.

• Summer Lovers (better mood with warmer and sunnier weather)
• Unaffected (weak associations between weather and mood)
• Summer Haters (worse mood with warmer and sunnier weather)
• Rain Haters (particularly bad mood on rainy days)

Although my mood seems to be better with more sun, I understand why a substantial number of folks get more depressed in the summer. Extreme heat is hard to tolerate. In fact, in a study published in Science in 2013, researchers reported that as temperatures rose, the frequency of interpersonal violence increased by 4 percent, and intergroup conflicts by 14 percent.

Ten percent of those diagnosed with seasonal affective disorder suffer symptoms at the brightest time of the year. The summer’s brutal heat, bright light, and long days can affect a person’s circadian rhythm and contribute to depression for the opposite reasons that winter conditions do.

If you’re a Summer Hater, or just notice that your mood is affected negatively by the heat, here are some summer depression busters that may help you better tolerate these months — maybe even enjoy them.

1. Plan Something Fun

You don’t need to plan some elaborate cross-country trip that’s going to deplete your savings. Just taking off an afternoon to have lunch with a friend or go kayaking by yourself can be a pleasant break and something to look forward to. When I was working through a severe depression, someone told me to plan something enjoyable every few weeks to keep me motivated to keep going. Scheduling fun activities sporadically throughout the summer might help carry you through some hot afternoons.

2. Be Around People

It can be as tempting to isolate yourself during the summer months as during the winter months, especially if you have body image issues and don’t like showing your legs and arms. But isolation breeds depression, especially if you’re a ruminator like I am. You don’t need to hang out poolside with a crowd of people in order to connect with friends. Sometimes just picking up the phone is enough to fend off depression and anxiety.

3. Add Some Structure

Summer is typically more relaxed, which is why some people look forward to the season all year. It’s nice not having to get the kids out of the door at 7:30 a.m., lunches packed. But those of us who are prone to depression do better when we have some structure to our day. If you don’t work outside the house, you may have to design this structure during the summer months and dig deep for the discipline to stick with it.

4. Stay on Your Sleep Schedule

Related to the last point, it’s easy to get off a regular sleep schedule in the summer if you don’t have anywhere you have to be at 7:30 in the morning. A few days of sleeping in feel great, but an aberrant sleep schedule is a slippery slope to depression for many of us. Even if the day’s events are changing from week to week, make sure to keep your sleep schedule the same: Go to bed at the same time every night, wake up at the same time every morning. Try not to sleep much less than seven hours and no more than nine hours a night.

5. Hydrate

Dehydration is one of the conditions I mentioned in my post, 6 Conditions That Feel Like Clinical Depression but Aren’t. It sneaks up on you, because by the time you feel thirsty, you’re already dehydrated. According to two studies conducted at the University of Connecticut’s Human Performance Laboratory, even mild dehydration can alter a person’s mood.

Dehydration causes a shortage of tryptophan, an important amino acid that is converted to serotonin in the brain. Our bodies can’t detoxify when there is a shortage of water, so tryptophan isn’t distributed to the necessary parts of the brain. Low levels of amino acids in the body can contribute to depression, anxiety, and irritability. A good way to make sure you’re drinking enough is to calculate how much water you should be drinking based on your weight, height, and age, and then fill up two or three containers equaling that amount of water and stick it in the fridge each night before you go to bed. Each day, try to drink enough to empty the containers.

6. Eat Mood-Boosting Foods

It’s not uncommon to eat more sweets and drink fancy, fruity drinks during the summer. But sugar is poison to depression. For one, it causes spikes and drops in glucose, and your brain does much better when it has an even supply of blood sugar. Processed foods — those that come in pretty packages listing a bunch of ingredients you can’t pronounce — aren’t going to help your depression either. During these hot months, stick with foods that can boost your mood, like turkey, pumpkin seeds, fatty fish, walnuts, turmeric, dark leafy greens, avocados, berries, and dark chocolate. I try my best to be sure and pack some nuts and seeds if I’m going to a picnic because the average American picnic is not supplied with brain food. And even one day of eating processed junk, and especially sugar, will do a number on my mood.

7. Get to the Water

Hanging out near water is one strategy for calming down your nervous system that Elaine Aron offers in her book The Highly Sensitive Person. She writes, “Water helps in many ways … Walk beside some water, look at it, listen to it. Get into some if you can, for a bath or swim.”

I find this to be especially true during the summer. I love to run by the Severn River, or walk to Back Creek at the end of my street, or have my lunch on the dock by Spa Creek. I find that being close to the water does calm me down and reminds me what I like most about summer.

8. Avoid Diet Soda

It’s easy to grab a Diet Coke when you feel hot and thirsty, but a study by theNational Institutes of Health (presented at the 2013 American Academy of Neurology meeting) showed that people who drink four or more cans of diet soda daily are about 30 percent more likely to be diagnosed with depression than people who don’t drink soda.

People with mood disorders are especially sensitive to the superficial sweeter aspartame in most diet sodas. In fact, a 1993 study conducted by Ralph Walton, MD, of Northeastern Ohio Universities College of Medicine found that there was a significant difference between aspartame and placebo in both number and severity of symptoms for people with a history of depression, but not so for persons with no history of a mood disorder.

9. Replace Your Depression Triggers

In their book Extinguishing Anxiety, authors Catherine Pittman and Elizabeth Karle explain that in order to retrain the brain from associating a negative event to a trigger that creates anxiety, we must generate new connections by exposure.

So, for me, I need to replace memories of depression relapses in the summer (which trigger anxiety for me during the summer) with positive summer events. One way I’m doing this is by getting involved in the kids’ golfing events. It gives me joy to see them learn a new activity and it generates happy memories of my dad taking my three sisters and me for a ride on the golf cart when we were young.

10. Try Something New

Summer is a great time to try a new activity. Ten years ago, when I was emerging from a severe depressive episode, I took a tennis class with about 20 other women. It was one of the best things I ever did to move past the depression. I still remember the evening that I thought to myself, in the midst of executing a volley, “I am going to beat this thing” (the depression, not the ball).

For the last few summers, I’ve tried new things: kayaking, paddle boarding, and open-water swimming. Each activity has helped my mood because it not only distracts me from ruminations, but the process of learning a sport gives me confidence. Neurologists have found that trying something new essentially rewires our brain. In the process of learning, our neurons become wired together.

From fatty snacks to morning cups of joe, these foods may trigger mood swings in people with bipolar disorder.

Your morning coffee and doughnut could trigger a manic episode.

People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium.

Thursday, May 12, 2016

Lithium outperforms newer mood stabilizers in the treatment of bipolar disorder, a new study has found.

Patients taking lithium had lower rates of self-harm and unintentional injury compared to those taking other bipolar drugs, such as valproate (Depacon, Depakote), olanzapine (Zyprexa) or quetiapine (Seroquel), said lead researcher Joseph Hayes. He is a fellow of psychiatry at University College London.

“This is important because people with bipolar disorder are 15 times more likely to die by suicide and six times more likely to die by accidental injury than the general population,” Hayes explained.

People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium, Hayes and his colleagues found.

And people on valproate or quetiapine were 32 percent to 34 percent more likely to fall victim to unintentional injury, most likely while experiencing a manic episode, the researchers said.

“Lithium still is the gold standard for the treatment of bipolar. We really haven’t had a medication that surpasses lithium, as far as we know,” said Dr. Raphael Braga. He is physician-in-charge of the Center for Treatment and Research of Bipolar Disorder at Zucker Hillside Hospital in Glen Oaks, N.Y., and was not involved with the study.

RELATED: Why Bipolar Disorder Is Often Misdiagnosed

Hayes noted that lithium has been used for more than half a century to treat bipolar disorder, but it’s still not clear how the drug stabilizes a person’s mood.

Bipolar disorder, which used to be called manic depression, is characterized by extreme mood swings ranging from emotional highs to depressive lows.

The researchers undertook their study following evidence reviews and studies that suggested lithium might be better than newer medications at preventing suicide and self-harm.

These studies have contended that lithium achieves these results by reducing symptoms such as depression, aggression, risk-taking and impulsive behavior, according to background notes in the study.

Lithium can be hard on the body, the study authors said, increasing a person’s risk of kidney and thyroid disease, but even that may have a positive side in bipolar patients. Because patients must be closely monitored for side effects, they are in more frequent contact with doctors who can pick up on emotional problems that lead to suicide, the researchers contend.

To compare lithium against newer medications, Hayes and his colleagues collected medical data on nearly 6,700 people diagnosed as bipolar and prescribed only one of the drugs — lithium, valproate, olanzapine or quetiapine.

The investigators found that people on lithium were less likely to harm themselves, either intentionally or by accident.

The suicide rate was lower in the lithium group, but too few suicides occurred to allow accurate risk estimates, the study authors said.

The findings were published online May 11 in the journal JAMA Psychiatry.

Lithium can cause kidney disease and hypothyroidism (underactive thyroid gland), Braga and Hayes said.

Doctors need to carefully weigh benefits versus harm when prescribing lithium to people with kidney or thyroid problems, and “if these are severe, it should be avoided,” Hayes said. “Lithium [also] needs to be reviewed on an individual patient basis before pregnancy.”

Braga said psychiatrists often require patients taking lithium to undergo lab tests every three to six months, to make sure their kidney function hasn’t been compromised.

Even with this, lithium is much cheaper than the other medications in the study, Braga said. Hayes noted a 2008 study that found lithium was nearly $500 cheaper per month compared with olanzapine.

“Lithium is a great drug,” Braga said. “It’s definitely a drug every clinician should think about when prescribing for bipolar disorder.”

For most people with bipolar disorder, strict adherence to medications is necessary to help keep episodes to a minimum.

If you have bipolar disorder, you may be wondering what the future will bring. Will your bipolar symptoms get worse or can this disorder go away? What happens if you stop taking your medications or seeing your psychiatrist?

Bipolar Disorder: Treatment Over Time

“Having bipolar disorder is very different than having a blood pressure problem ordiabetes,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says that unlike other illnesses, in which patients accept the fact that they need to take medicine to control their disease, people with bipolar disorder often refuse to take their medications — an issue called treatment compliance. These patients often have trouble perceiving that they have a problem, even during a bipolar episode (a condition known as anosognosia, and therefore don’t believe they need treatment.

Avoiding treatment, however, is the worst thing you can do with bipolar disorder. Why? Because bipolar disorder tends to get worse if it’s not treated. So to improve your prognosis — your future with this condition — you need to follow your doctor’s prescribed treatments.

Bipolar Disorder: The Timeline

Bipolar symptoms usually appear during the late adolescent years, but they can emerge at any time from early childhood to your 50s. For a very few people diagnosed with bipolar disorder, symptoms will improve with medication to the point that medications will no longer be necessary.

But most people won’t be that lucky, since it is typical for manic and depressive episodes to recur later on.

“If you have a single episode of mania, the chances that you are going to have another one over your lifetime is virtually 100 percent,” says Sachs.

And there is a good chance that your manic and depressive episodes will become more frequent and severe over time. According to Sachs, most people can also expect more depressive episodes and fewer manic ones. “You will have fewer highs and more depression,” he says. Your illness may even progress to what is called rapid-cycling bipolar disorder, which is when you have four or more episodes a year.

And, Sach adds, “If you’ve had several [bipolar] episodes, there is probably a 60 to 80 percent chance that you will have one episode every year if untreated.” But with treatment, you can probably cut your risk of having an episode by half.

Bipolar Disorder: Remission

Most people who have bipolar disorder will have normal moods in between their manic and depressive episodes. However, in almost every case, bipolar disorder is a lifelong illness requiring treatment.

While there is no cure for bipolar disorder, there is every reason to believe that with proper treatment, you will get better. Proper treatment means taking all your medications and attending therapy sessions as recommended by your doctor. It is important to take the bipolar medications even between episodes of depression or mania. Consistency in taking the medications can stabilize your mood swings.

By learning to recognize the early signs of a manic or depressive episode, you will be empowered to take control of your bipolar disorder and deal with your symptoms before they become a full-blown episode.