Mental illnesses, especially bipolar disorder, schizophrenia and clinical depression, are usually episodic. Symptoms vary over time. When your loved one experiences another episode, it’s called a relapse.

You can help minimize the results when you recognize the early warning signs. Many people have a specific set of signs called a relapse signature. Knowing that in advance can help you prepare. You also can learn to tell the difference between a bad day and a relapse.

First, it’s important to know the difference between a relapse and treatment-resistant symptoms. People who experience persistent symptoms even when the illness is stabilized have treatment-resistant symptoms. When a person’s symptoms get worse, that’s a relapse.

Before a relapse, people often experience changes in feelings, thoughts and behaviors. Those changes are early warning signs. Studies indicate between 50% and 70% of people experience early warning signs over a period of one to four weeks before a relapse.

Looking for early warning signs allows you to start working with your loved one and his treatment providers to minimize the setback. When you are the most frequent contact with your loved one, you are the person who sees these warning signs. The ill person will not be able to see them.

While many warning signs are common, individuals may have their own specific signs or “relapse signatures.”

Common Warning Signs of Relapse

• Feelings of tension, anxiousness or worry
• More irritability
• Increased sleep disturbance (either reported or when you hear them in the night more often)
• Depression
• Social withdrawal (more extreme than usual, such as not leaving their rooms to eat)
• Concentration problems (taking longer to do tasks, having trouble finishing tasks, having trouble following a conversation or TV show)
• Decreasing or stopping medication or treatment (refusing to go to the doctor or case manager, skipping the vocational program)
• Eating less or more
• Excessively high or low energy
• Loss of interest in doing things
• Lost interest in the way they look or poor hygiene
• Being afraid of “going crazy”
• Becoming excessive in religious practices
• Feeling bothered by thoughts that will not go away
• Feeling overwhelmed by demands
• Expressing worries about physical problems

The most common relapse indicators for schizophrenia are:

• Restless or unsettled sleep
• Nervousness or tension
• Having a hard time concentrating
• Isolation
• Feeling irritable
• Having trouble taking care of routine things
• Lack of energy
• Feeling sad or depressed
• Feeling confused
• Change in appetite

The most common relapse indicators for bipolar disorder are:

• Disturbed sleep or insomnia resulting in no sleep
• Talking quickly and more often than usual
• Acting reckless
• Feeling very tired
• Feeling very depressed

An Off Day or the Start of Relapse?

Everyone can have an off day. You can feel down in the dumps with no energy. Or you can seem a little manic. If a person has had mental health problems, it’s important to consider whether this is an off day or the start of a relapse. The indicators that it is the start of a relapse are:

• A cluster of changes
• Happening together
• Lasting over a period of time
• Gradually getting worse
• Following the same pattern as in previous relapses

Your Loved One’s Relapse Signature

If you are reading this, you are probably the best person to decide what the relapse signature is. Think about the last time your loved one got worse. If you keep a journal, go look at what you wrote. Things to consider include:

• What was the time of year?
• Did your loved one say how they were feeling physically?
• How was your loved one’s mood? Ability to concentrate?
• Did any unusual changes in behavior take place in the weeks before the last relapse?
• Did your loved one do things that seemed “out of character” before the last relapse?
• Have the same behaviors preceded other relapses?

Thinking about what was happening in the person’s life when you start to notice these changes can help, too. Many relapses in major mental illness do involve the person stopping medication, experiencing stress or abusing alcohol or drugs.

Here’s 10 things to do when you see the warning signs.