"I'm Having a Bad Day – Am I Getting Worse Again?" What to Do When Your Mental Health Suddenly Dips

Recovery from a mental health difficulty is rarely a straight line.

Someone may have been feeling noticeably better for several weeks and then suddenly wake up one morning feeling anxious, flat, irritable or overwhelmed.

Understandably, this can be frightening.

The immediate thought is often:

"I'm going backwards."

Or:

"The treatment has stopped working."

Sometimes a deterioration does need attention, particularly when symptoms are persistent or becoming increasingly severe. But having a difficult day does not automatically mean that you are becoming unwell again.

Human beings have bad days.

The challenge is learning how to respond to them without accidentally making them even harder.

Don't Diagnose the Whole Week From One Morning

When we feel bad, our brains can be remarkably quick to predict the future.

You wake up feeling low and think:

"Here we go again."

An anxious morning becomes evidence that your anxiety disorder is returning. A poor night's sleep becomes the beginning of another period of insomnia.

Before long, you are not only dealing with today's difficulty. You are dealing with everything you are frightened today's difficulty might mean.

Try to keep the time frame smaller.

"Today is difficult."

That is all you necessarily know.

You don't yet know how tomorrow will feel.

Check the Basics Before You Analyse Everything

When our mental health suddenly dips, it is tempting to search immediately for a psychological explanation.

Sometimes there is one.

But sometimes you are exhausted.

Or hungry.

Or becoming physically unwell.

Perhaps you have been working excessively, sleeping badly or dealing with several stressful things at once.

Maybe you have spent the previous week looking after everyone except yourself.

Before asking:

"Why is my mental health getting worse?"

it can be useful to ask:

"What has the last week actually been like?"

Our emotional resilience is affected by what is happening to the rest of us.

Sometimes a bad day is your mind telling you something complicated.

Sometimes your body simply needs lunch and an early night.

Reduce the Size of the Day

On difficult days, ordinary tasks can suddenly feel enormous.

You think about everything that needs doing and immediately feel defeated.

Rather than trying to rescue the entire day, make it smaller.

What genuinely needs to happen in the next hour?

Perhaps you need to get dressed.

Attend one meeting.

Eat something.

Collect the children.

Reply to one important message.

Everything else can be reconsidered afterwards.

This is not giving up.

It is adjusting your expectations to the amount of capacity you actually have today.

We do this instinctively with physical health. If someone has a migraine, we don't expect them to perform exactly as they would on their best day.

Mental health deserves some of the same flexibility.

Keep Some Structure

Reducing expectations does not necessarily mean abandoning the day completely.

When people feel low or overwhelmed, the temptation can be to cancel everything, return to bed and withdraw from the world.

Occasionally, that may genuinely be what you need.

But sometimes it leaves you feeling worse.

Try to preserve a few basic anchors.

Get up.

Have a shower.

Eat something.

Go outside briefly.

Speak to another person.

Keep roughly to your usual sleep routine.

You don't need to have a productive day.

The aim is simply to prevent one difficult morning from completely dismantling the routines that usually support you.

Don't Make Important Decisions From Your Worst Moment

A difficult emotional state can make problems feel permanent.

You may suddenly feel certain that you need to resign from your job, end a relationship, abandon a course or make another major change.

Sometimes those decisions may eventually be right.

But they rarely need to be made at the exact moment when you are most overwhelmed.

Write the thought down.

Come back to it when things feel calmer.

If the problem is still there, you can consider it properly.

A useful rule can be:

Notice today. Decide later.

Strong emotions contain information, but they do not always require immediate action.

Use the Strategies You Already Know

People sometimes search for a completely new solution when their mental health dips.

Often, the more useful question is:

"What has helped me before?"

Perhaps exercise usually helps.

Perhaps you need some time alone.

Perhaps being alone is exactly what makes things worse and you need to see somebody.

Maybe you benefit from structure, writing things down, reducing social media, going outside or talking things through.

When we are struggling, we can temporarily lose access to things we already know about ourselves.

This is why it can be helpful to write down your useful strategies while you are well.

A difficult day is not always the best time to design the plan.

Be Careful About Numbing the Day

When people feel uncomfortable, it is natural to want the feeling to disappear.

That can lead to hours of scrolling, excessive gaming, overeating, alcohol or other ways of switching off.

There is nothing inherently wrong with watching television or distracting yourself for a while.

Sometimes distraction is exactly what is needed.

The question is how you feel afterwards.

There is a difference between something that helps you recover and something that simply makes several hours disappear.

A useful question is:

"Will this make the next hour easier, or tomorrow harder?"

The answer will not always be obvious, but it can help you choose more deliberately.

Talk to Someone Before Things Become Unmanageable

You don't have to wait until you are in crisis before telling somebody that you are struggling.

Sometimes saying:

"I'm having a difficult day today"

is enough.

You may not need advice.

You may simply need someone to know.

If you are receiving treatment, persistent deterioration is also worth discussing with the professionals involved in your care rather than waiting until symptoms become severe.

Early conversations are often easier than emergency ones.

Look for Patterns, Not Individual Days

One difficult day usually tells us relatively little.

Patterns are more informative.

Have you been feeling progressively worse for two weeks?

Are you withdrawing more?

Has your sleep changed significantly?

Have you stopped enjoying things again?

Are anxiety and avoidance gradually increasing?

Are you struggling to function in ways that you weren't a few weeks ago?

These changes deserve more attention than an isolated bad Tuesday.

If you keep a mood diary, try not to obsess over individual scores.

Look at the direction of travel.

Know When a Bad Day Is More Than a Bad Day

There are times when waiting and seeing is not appropriate.

If you are experiencing thoughts of harming yourself, feel unable to keep yourself safe, develop symptoms such as hallucinations or unusual beliefs, experience a marked change in behaviour or mental state, or people around you are seriously concerned about you, seek appropriate professional help.

Similarly, a sustained deterioration in your ability to function deserves assessment even if there is no immediate crisis.

Strategies are useful, but they are not a substitute for clinical support when somebody is becoming significantly unwell.

A Final Thought

A bad mental health day can feel particularly frightening when you have worked hard to get better.

It can seem as though all your progress has disappeared overnight.

Usually, progress doesn't work like that.

Recovery is not demonstrated by never feeling anxious again.

It is not never having a low day.

It is not waking up cheerful every morning or handling every stressful situation perfectly.

Sometimes progress is noticing a difficult day and responding differently to how you would have done before.

You reduce your expectations without abandoning everything.

You eat.

You go outside.

You tell someone.

You don't make the enormous decision.

You use the strategies you have learned.

And you give tomorrow the opportunity to be different.

A bad day is information.

It may tell you that you are tired, overwhelmed or need more support. If difficult days begin joining together, it may tell you that something needs reviewing.

But it is not automatically a verdict on your recovery.

Sometimes a bad day is simply a bad day.

And on those days, the goal doesn't have to be turning it into a good one.

Sometimes the goal is simply getting through it kindly enough that you don't make tomorrow harder.

Dr James Glass
MBChB MRCPsych
Medical Director, WMI Psychiatry