Recovery and relapse prevention
From Depressive Illness: An Information Guide
Centre for Addiction and Mental Health
Dec 09, 2009
The Process of Recovery
People recovering from mild depressions usually resume their regular routines and responsibilities quite easily. Recovery from a more serious and lengthy depression can be a longer-term and slower process. A long period of illness can lower a person’s self-confidence, making him or her feel insecure and vulnerable in situations that used to be familiar and comfortable. Depression can cause people to become quite dependent on those around them. People are often surprised at how frightened they are at the prospect of being independent and resuming their responsibilities.
It is important to recognize that these reactions are a normal part of the recovery phase of depression. Give yourself permission to lower your expectations; you are recovering from a serious illness. Just as you would increase activities gradually if you were recovering from a broken leg, a gradual increase in activities following a depressive episode will allow you to slowly take on responsibilities and build your self-confidence. Some people rush into a full schedule of activities in order to prove to themselves and others that they are fully recovered. This “flight into health” leaves them feeling overwhelmed and exhausted. If you have high expectations of yourself, or you like things to be perfect, you are likely to feel dissatisfied at your rate of recovery and feel hopeless and demoralized that things are not working out exactly right.
Remember that recovery is a process, not a discrete event. At first, you should ease yourself into familiar activities and have modest expectations. Predict that when you return to activities such as socializing and going to school or work, you will probably feel anxious. Allow yourself to make mistakes. A social worker, occupational therapist or nurse can help you plan a strategy for recovery that might include volunteer activities, pursuing leisure interests, school courses and part-time or eventually full-time work.
Effective Relapse Prevention
Unfortunately, people who have suffered a major depressive episode are at risk of further episodes. It is important to use periods of wellness as an opportunity to actively prevent relapse. Depression, like disorders such as diabetes, requires you to “self-monitor,” or pay attention to how you are feeling, so you can catch early warnings of a possible relapse and possibly prevent a full depressive episode.
From Depressive Illness: An Information Guide
Centre for Addiction and Mental Health
Dec 09, 2009
The Process of Recovery
People recovering from mild depressions usually resume their regular routines and responsibilities quite easily. Recovery from a more serious and lengthy depression can be a longer-term and slower process. A long period of illness can lower a person’s self-confidence, making him or her feel insecure and vulnerable in situations that used to be familiar and comfortable. Depression can cause people to become quite dependent on those around them. People are often surprised at how frightened they are at the prospect of being independent and resuming their responsibilities.
It is important to recognize that these reactions are a normal part of the recovery phase of depression. Give yourself permission to lower your expectations; you are recovering from a serious illness. Just as you would increase activities gradually if you were recovering from a broken leg, a gradual increase in activities following a depressive episode will allow you to slowly take on responsibilities and build your self-confidence. Some people rush into a full schedule of activities in order to prove to themselves and others that they are fully recovered. This “flight into health” leaves them feeling overwhelmed and exhausted. If you have high expectations of yourself, or you like things to be perfect, you are likely to feel dissatisfied at your rate of recovery and feel hopeless and demoralized that things are not working out exactly right.
Remember that recovery is a process, not a discrete event. At first, you should ease yourself into familiar activities and have modest expectations. Predict that when you return to activities such as socializing and going to school or work, you will probably feel anxious. Allow yourself to make mistakes. A social worker, occupational therapist or nurse can help you plan a strategy for recovery that might include volunteer activities, pursuing leisure interests, school courses and part-time or eventually full-time work.
Effective Relapse Prevention
Unfortunately, people who have suffered a major depressive episode are at risk of further episodes. It is important to use periods of wellness as an opportunity to actively prevent relapse. Depression, like disorders such as diabetes, requires you to “self-monitor,” or pay attention to how you are feeling, so you can catch early warnings of a possible relapse and possibly prevent a full depressive episode.
- Become knowledgeable about the illness and treatment options. Read as much as you can about depression and its treatment; if there is something you do not understand, ask your mental health professionals.
- To help prevent a relapse, monitor changes in your mood, develop a list of personal warning signs, and pay attention to activities that have a positive impact on your moods. When feeling better, pay attention to the variations in your moods. Don’t ignore changes, such as sleep disturbances, or negative or hopeless thoughts, that may suggest a potential relapse. Pay attention to activities that help to stabilize or improve how you are feeling, and incorporate these into your everyday activities. For example, if walking your dog or visiting friends is helpful, make sure these are part of your structured routines.
- If medication has been prescribed, continue to take it until your doctor advises you otherwise. Often, patients begin to feel better and stop taking their medication. Relapse is more likely if medication is discontinued too soon. Doctors usually recommend that medication be taken for six months to a year following a depressive episode. For some conditions, antidepressants may be recommended for several years. If you are experiencing side-effects, you may be tempted to stop taking your medication. Rather than making decisions on your own, work with your doctor around a treatment plan you can live with.
- A healthy lifestyle is important: proper nutrition, exercise and good sleep habits. It makes sense to pay special attention to these areas if you are struggling with depression. Fatigue is worsened if you eat very little, or eat an unhealthy diet. Research has demonstrated that regular exercise can have a positive effect on mood. If you are struggling with falling asleep, staying asleep or waking up early in the morning and being unable to get back to sleep, it is important for you to develop good sleep routines. Repeating these routines each night can help restore better sleep patterns. Try to go to bed at the same time each night. Avoid stimulating activities close to bedtime; plan on paying bills, completing work or having important discussions earlier in the day or evening.Many people find that relaxation exercises, easy reading or a warm, non caffeinated beverage just before retiring are ways to promote a relaxed state of mind. Expect that it will take you some time to fall asleep and try not to anticipate sleep problems, as this will only add to your anxiety. For some people, a sleep medication provides relief and allows them the much-needed rest they have been deprived of due to depression.
- Think about whether any features of your personality may lead to depressive thinking. If you tend to view circumstances and events around you in an overly negative way, if you worry a lot, if you have trouble expressing your feelings, or if you tend to be inflexible or perfectionistic, you might benefit from psychotherapy. Through psychotherapy you can learn to address these issues, and build on your strengths.
- You cannot avoid stress, but you may learn to cope better by adopting new strategies. Many people with depression tend to use only one coping strategy. For example, they hide their worries and avoid dealing with problems. This may work in some cases, but not in others. Where possible, try different strategies. Deal with some problems as they happen. Avoiding them allows stress to build up. Be realistic about your stress-breaking point. Work toward recognizing what aspects of relationships in your life might be unhealthy and, if possible, try to avoid situations that may trigger relapse.
- Remember that meaningful relationships and social support are important for your sense of self-worth and happiness. Spending too much time alone can contribute to depression and relapse, yet the feelings of depression often make people want to isolate themselves. Strong social networks and social support can serve as a buffer against depression. Try to avoid spending too much time alone and work toward maintaining contact with your social network.
Who you tell about your depression is a very personal choice. While the stigma of mental illness is certainly much less than it once was, it remains a concern for many people. As a buffer against relapse, however, it is important to have at least one person you can rely on and in whom you can confide. Along with family and professional support, many people struggling with depression find that self-help and support groups are a valuable part of their social network.
- Try to develop a well-balanced life with enough time for work, family and friends, and leisure activities. It might seem easy at first to escape from your depression by focusing entirely on one area, such as work, or a hobby. Eventually however, this coping strategy may not work, and you will need to develop other aspects of your life. It is important to keep in contact with all the facets of our lives, such as school, work or volunteer activities, family and friends, and hobbies. As you recover, investing energy into several areas will help you develop a more balanced and satisfying lifestyle, which will help you to avoid relapse.
- Get follow-up treatment. It is important to have both a family doctor and, if necessary, a psychiatrist who can follow you regularly. Depending on your needs, you may also benefit from individual, group or family therapy, or a support group to help you deal with the impact depression has had on your life. If you start to feel depressed again, contact your doctor immediately.Help may come in the form of a visiting nurse, occupational therapist, or social worker who can provide extra support when necessary. Early intervention may help to prevent or minimize the severity of another depressive episode.
- Finally, be aware that it is common for patients, once recovered, to silently worry about relapse. Think about establishing an emergency plan with your family, partner or a friend just in case you begin to feel unwell again. This plan will include knowing who will notify your doctor and take you to appointments, who will notify your school or work, or look after your children, and who will ensure your rent and bills are paid should you need to be hospitalized. You may feel less anxious about the future if you know that a back-up plan exists.
