A Note On Medications
If you take medication, it’s important to follow your doctor’s recommendations even when you feel well. You may need to continue the medication for several months or longer, depending on your risk factors. Stopping medication too early is a major reason for relapse. It’s also important to talk to your doctor if you want to make any changes to your medication plan, such as reducing your dose or stopping your medication. For more on talking to doctors or other health care professionals, see the module Working With Your Doctor When you Have Depression at www.heretohelp.bc.ca.
Preventing Recurrent Depression: Long
Major depressive disorder is potentially a long-term or even lifelong illness for many patients, and maintenance therapy is designed to prevent relapse in patients with recurrent depression who have achieved remission. Patients who have residual symptoms, ongoing psychosocial stressors, or comorbid illnesses are among the suitable candidates for maintenance treatment. In the following discussion, experts in the treatment of depression address topics relevant to maintenance treatment: length of treatment, pharmacotherapy dosage, psychotherapy, and electro-convulsive therapy . Suggestions are also offered for improving subthreshold depressive symptoms and treatment adherence.
Dr. Dunner: We are going to discuss some issues that arise when treating MDD over the long term and attempting to prevent recurrent depression. Let us begin by talking about the difference between continuation therapy and maintenance therapy.
One: Identifying Early Warning Signs
An early warning sign is a sign that shows your health may be getting worse. These warning signs appear before major symptoms begin to affect your life in a big way. Identifying your unique warning signs can help you take action early.
Thinking about early warning signs can make some people nervous. After all, no one wants to remember difficult or unpleasant situations. It may be helpful to think of this exercise as an opportunity to take control of your health. When you identify your early warning signs, you give yourself the power to challenge depression.
To start identifying your warning signs, you’ll need to think back to times you were depressed. How did it start? How did it progress? What did you experience? What kind of thoughts did you have? Did your behaviour change? Did anything happen in a particular order? It may also be helpful to ask loved ones for their feedbackpeople close to us often notice changes before we see changes in ourselves.
Now that you’ve thought about what your warning signs look like, think about what was happening in your life when you started to notice these changes. This will help you see when and where your warning signs start to happen. For example, do warning signs seem to come up after working a lot of overtime or after a fight with loved ones? These situations are also called “triggers.” While everyone will have their own triggers, there are some common triggers. Here are some examples:
Here’s an example of a timeline:
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What Causes A Depression Relapse Or Recurrence
If you are someone who has suffered depression you are more likely to be triggered by a stressful life event than someone who has never experienced mental health issues. There are a range of other factors that can be triggers for depression including:
- Medical conditions such as obesity or diabetes
- Leaving treatment early
- Not receiving the right treatment for your initial episode of depression
- A major life event such as a death, family conflict or marriage breakdown
Will Depression Come Back
Some people have depression once in their life and it goes away and doesnt come back. One study found that 45% of people had depression once in their life, while 55% experienced depression multiple times. For people who experience depression multiple times , symptoms might get better at times and get worse at others, but it doesnt ever feel like depression is gone.
Your brain is a muscle so just like other muscles, getting better takes time, isnt a light switch, and how bad things were gives you information about how much effort and time it might take to recovery.
Here are some factors that can impact whether depression will come back .
1) If your first episode was really bad, it can be a sign of a chronic illness. How severe your symptoms are determines how much the depression has impacted your brains health and your quality of life. The more severe the depression is, the harder it is for your brain to recover. Severe depression isnt just feeling really sad for a while. Severe depression looks like feeling so sad you cant get out of bed, sleep is totally off, you miss school or work, and depression has gotten in the way of relationships.
2) If depression runs in your family, you might a genetic predisposition to clinical depression. If clinical depression runs in your family, it is an indicator that you may need medical intervention to feel relief. Its helpful to know what treatments did or didnt work for family members.
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From Recovery To Management
If were someone who lives with recurring depression to the point where its likely to continue recurring for an extended period, then we might choose to switch our focus from recovery to management.
This doesnt mean that weve given up, or that theres no hope.
What it means, is that we build things into our life to help us proactively manage our mental health.
This can mean things like sticking to a regular bedtime, having a healthy diet, ensuring we have a good balance between busy time and down time, making space to process how we feel, building in helpful habits such as journaling or meditation, and anything else that we find helpful.
If we lived with a physical condition, such as asthma, then there might be certain things we have to do to manage it like taking medication, avoiding pets or grassy fields, remember an inhaler when we go on a jog, keeping our stress levels low, and having a yearly check-up with our asthma nurse.
Managing our mental health is no different. Its not admitting defeat or giving up. Its just thinking about things we can build into our lives to reduce the risk of a depression recurrence.
Adhere To Therapy Recommendations
If you were already in therapy for depression, it’s likely that you received some homework and/or recommendations on how to move forward after the last session. Reflect back on your time in therapy and what you learned.
Are there strategies you could start using again? Are there workbooks or tracking logs that your therapist gave to you? Anything that was helpful to you in the past will likely be helpful to you again as you face a depression relapse.
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How To Prevent A Depression Relapse
Commit to treatment If you have been prescribed antidepressants it is vital that you take the full course of your medication and follow your doctors advice. It can be tempting, when you start to feel better, to stop taking your meds but that increases your risk of relapse. If your treatment involves counselling and therapy sessions make sure you keep going to them until your psychologist advises that you are okay to stop.
Meditation Studies have shown that mindfulness meditation, practiced a few times each week, can reduce your chance of relapse by up to 50 percent within a year. You dont have to spend hours crossed-legged on the floor to achieve this. It is all about taking a moment to be completely present each day rather than allowing your mind to dwell in the past or future.
Accept help Friends and family can provide support when it comes to noticing the warning signs of depression. If you open yourself to their help, you can reduce your chances of falling back into depression.
Have a plan Always discuss with your therapist the best plan of action when it comes to acting on the warning signs of depression. Consider writing out a plan so that you feel empowered to deal with symptoms if they return.
What Causes Depression Relapses
Depression relapses can happen at any time, even if youre already receiving treatment or are on medication for depression. Its like any other condition if you have it once, you may be predisposed to it and are more likely to experience it again.
Sometimes people will experience relapses caused by specific triggers, even when the treatment would have otherwise worked. Possible triggers include:
- the death of a loved one
- ruminating on negative experiences, mistakes, and painful memories
- stressful life events, like a medical exam coming up or knowing that your company is laying off a large number of employees
- changes to the family structure, like divorce or having a child move away to college
- hormonal changes, like going through puberty, pregnancy, or menopause
The most common cause of relapses, however, is not maintaining treatment after a depressive episode. Most people benefit from sticking to their treatment plan, even if theyre not currently experiencing depressive symptoms. This includes coping mechanisms learned in therapy to combat the depression.
If youre experiencing symptoms of depression relapse, get treatment as soon as possible.
Treatment can include a combination of different types of therapies and medications. This includes:
Cognitive behavioral therapy : CBT can help you identify all the thoughts, beliefs, and behaviors you have that contribute to your depression. Your therapist can help you develop strategies to manage these behaviors.
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My Depression Has Come Back What Should I Do
Dont blame yourself. Whether its your family or work circumstances, a physical or chemical reason, or you have no idea why you feel down, its not your fault.
Relapsing doesnt mean youre back to square one. This time you have the advantage of knowing whats going on. Think: what helped last time? What didnt? Use your knowledge to your advantage.
Go to your GP and tell them how youre feeling. Talk to them about what helped before. Was it a talking treatment? Or medication?
Go through the steps above are you following them? Are you using your coping strategies? Are you confiding in your friends and family? Doing these things wont make you feel better immediately, but they will help you begin to recover.
We know you wish you didnt feel like this again, depression is horrible. But this wont last forever. After all, you got better last time, didnt you?
Explore Lifestyle Changes That Might Make All The Difference
Natural treatments for depression seem to go in and out of fashion with the seasons. By themselves, these practices may not be especially effective against a full-blown disorder, but they can do wonders in combination with other treatment options. Some lifestyle changes have been scientifically proven to increase your chances of achieving remissionthese are the ones youll want to focus on.
The first: getting good sleep. Most likely, you simply are not giving your body enough mental and physical rest. Your body heals best when asleep, so give yourself the best chance possible. Treat any sources of insomnia with your doctor as well as you can, and make sleep a priority.
This next strategy might make you roll your eyes, but its definitely worth your attention if you havent experimented with it already. Exercise. A steady, vigorous form of daily exercise has been proven to have incredible mental health benefits. Some psychiatry clinics today even proclaim to prescribe exercise as the number one medication to all of their depression patients. Clearly, somethings working there. Give it a tryif nothing else, the daily endorphin boost may give you a much-needed pick-me-up in the moment.
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Can’t Enjoy Sex Fun Or Friends
This is a biggie. Activities you used to enjoy may now feel like a burden. If you’ve been depressed in the past and notice that you’ve lost feelings for your spouse or children, aren’t interested in work, hobbies, or other favorite activities for more than 2 weeks, you might be relapsing. It’s more likely if your symptoms come back within 6 months of an episode. Ask your doctor for help.
How Is Seasonal Affective Disorder Treated
Your provider will talk to you about treatment options. You may need a combination of treatments, including:
- Light therapy: Bright light therapy, using a special lamp, can help treat SAD.
- Cognitive behavioral therapy :CBT is a type of talk therapy. Research has shown it effectively treats SAD, producing the longest-lasting effects of any treatment approach.
- Antidepressant medication: Sometimes, providers recommend medication for depression, either alone or with light therapy.
- Spending time outdoors: Getting more sunlight can help improve your symptoms. Try to get out during the day. Also, increase the amount of sunlight that enters your home or office.
- Vitamin D: A vitamin D supplement may help improve your symptoms.
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Is Light Therapy Safe
Light therapy is typically safe and well-tolerated. But you may need to avoid light therapy if you:
- Have diabetes or retinopathies: If you have diabetes or a retina condition, theres a potential risk of damaging the retina, the back of your eye.
- Take some medications: Certain antibiotics and anti-inflammatories can make you more sensitive to sunlight. Light therapy can then cause harm.
- Have bipolar disorder: Bright light therapy and antidepressants can trigger hypomania or mania, uncontrolled boosts in mood and energy level. If you have bipolar disorder, let your provider know. This will play a role in your treatment plan.
Looking After Someone With Depression
It’s not just the person with depression who’s affected by their illness. The people close to them are also affected.
If you’re caring for someone with depression, your relationship with them and family life in general can become strained. You may feel at a loss as to what to do. Finding a support group and talking to others in a similar situation might help.
If you’re having relationship or marriage difficulties, it might help to contact a relationship counsellor who can talk things through with you and your partner.
Men are less likely to ask for help than women and are also more likely to turn to alcohol or drugs when depressed.
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What You Can Do
No two people with depression feel the same. If you have any of these warning signs or symptoms that concern you, talk to your regular doctor or a psychiatrist. They may suggest therapy or more medication to prevent a relapse. Cut your stress and do something every day that makes you feel good. You might need long-term treatment if you’ve had three or more depression episodes.
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Why Does My Depression Keep Returning
You battled depression before. You felt fatigued and had no energy to do anything, your thoughts became increasingly negative, and you struggled just to get out of bed in the morning. It was awful. Luckily, you were able to find a doctor to help you. With the help of both medical treatment and therapy, you were a whole new person again. You could feel more, do more, and sleep a normal amount. Everything seemed great until all of a sudden, you noticed the depression was back. If you are getting medical care and therapy, then why does your depression keep returning?
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What Are The Types Of Major Depression
There are several types of depressive disorders:
Life After Depression: How To Thrive What Helps What Gets In The Way
Depression keeps itself alive with an intense, overwhelming sense of hopelessness. This hopelessness kills the motivation to reach into the world for support, something that is already fragile because of the stigma that is so often attached to mental illness.
New research, published in the journal Psychiatry Research, offers a reason for hope. There is life after depression a strong, healthy, happy life and the research has found the factors that will help to make this possible and those that will get in the way.
In a study involving more than 2,500 people who had experienced a major depressive disorder at some time in their lives, researchers found that about two in five people were able to fully recover and experience full mental health. The researchers defined full mental health as:
- experiencing happiness or life satisfaction almost every day for the last month
- a full year without depression, anxiety, suicidal thoughts or substance abuse and
- positive social and psychological well-being.
The research revealed important findings about what helped, what hindered and what had no bearing at all on the likelihood of thriving after depression.
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Tips For Living Well With Major Depressive Disorder
Living with major depression can feel lonely. People may be fearful or ashamed of being labeled with a serious mental illness, causing them to suffer in silence, rather than get help. In fact, most people with major depression never seek the right treatment. But those struggling with this illness are not alone. Its one of the most common and most treatable mental health disorders. With early, continuous treatment, people can gain control of their symptoms, feel better, and get back to enjoying their lives.