The best therapy programs include these four common features.

* Providing a solid structure for each day
* Avoiding overstimulation and getting enough sleep
* Resolving any family conflicts that contribute to symptoms
* Learning to recognize the warning signs of manic and depressive episodes

Until quite recently talk therapy had a minor role to play in the treatment of bipolar disorder. Many patients describe hospitalizations combined with high doses of mood-flattening drugs, but little effort to understand the sometimes irrational thoughts of people with the disorder.

For people with a history of depression or bipolar disorder, the risk of relapse looms like a cloud over their lives, threatening to separate them from their work, relationships, even their children. Stress, sleep deprivation, hormonal shifts, and stopping treatment are among the most common relapse triggers.

Signs – Symptoms of Depression:

* Depressed people usually possess the following characteristics.

* Persistent sad mood
* Difficulty in concentration and unusual forgetfulness
* Slowness in actions and thinking
* Extreme pessimism and feeling of worthlessness
* Suicidal thoughts
* Feeling of not being loved by anybody and life has no meaning
* Low drive or motivation
* Unexplained feeling of fatigue
* Rapid gain or loss of body weight and inability to experience appetite
* Sleep disturbances mainly during early morning hours
* Palpitation
* Disturbances in the stomach
* Intolerance to sound
* Increased sensitivity and unexplained feelings of guilt.

The National Mental Health Information Center at the U.S. Department of Health and Human Services lists numerous triggers. Here are five:
• Interpersonal friction
• Feeling overwhelmed or having too much to do
• Being judged or criticized
• Ending a relationship
• Physical illness

Sometimes the signs of dangerous stress are more subtle. Laura Gilmartin, 38, an office manager in Skokie, Ill., finds herself eating more junk food or smoking more than usual. “Or if I find myself coming home from work and falling into bed more than two days in a row, that gets me scared. The more time I want to spend in bed the more I know I need to get out of bed.”

Delay decisions during relapse

The temptation to stop treatment on your own is another trigger, one that can lead to a downward spiral. Mary, 45, of Western Massachusetts, almost landed in the hospital during a suicidal depressive episode when she decided to go cold turkey. “What happens is I begin to feel great, and I rationalize that less is better when it comes to medication,” she says.

If you are in the midst of a relapse, it’s critical to realize that your outlook on everything is altered, and it’s unlikely that you will be aware of your lack of perspective. “So to the extent possible, important decisions should be delayed,” says Richard Raskin, PhD, a licensed psychologist in New York City.

Lisa, 42, a real estate broker in Huntington, N.Y., has been battling depression for years and can now steel herself against relapses. During the past year, she and her husband separated, and though she felt sad, she used the tools she learned in therapy to keep perspective. “I wasn’t depressed. I think that’s a testament of what talk therapy and medication can do. Ten years ago that would have put me in the grave.”

Guide for this: Health