You made it to remission. Treatment worked and you've been symptom-free for two months or longer.
Remission is a big milestone; however, depression can come back. Around 60% of people relapse after their first depression episode. The more bouts of depression you have, the more likely you are to relapse.
Your depression might not come back, but you want to be ready if it does. Don't wait for symptoms to appear. "When you're feeling depressed, it's really hard to think clearly," says Pallavi Visvanathan, PhD, a licensed clinical psychologist in private practice in New York City.
You'll have more control if you plan now, while your mind is clear. Then, if symptoms do come back, you'll already have a toolkit to guide you through relapse.
Build Your Scaffold
When you have depression, scaffolding includes gathering or setting up all the tools and systems now that will support you through any depression episodes ahead.
Remember what helped. Keep a list of medicines or therapies that helped you feel better in the past. Refer to that list if you relapse.
Gather a support team. The size of that team doesn't matter. What matters is that they understand and value you. Choose people who've helped you in the past and who'll be your support system when you need them.
See your therapist. You might have stopped your sessions once you went into remission. But therapy can also give you skills and prevention strategies to prepare you for a relapse.
Learn self-compassion. "People with depression are prone to guilt and self-criticism," says Jeffrey B. Rubin, PhD, a psychoanalyst and psychologist in private practice in New York and author of The Art of Flourishing. Don't give in to those negative feelings. "Cherish yourself, appreciate yourself, and cut yourself a little slack."
Define your minimum viable day. There will be days when you can't get much done. Plan for the least amount you can accomplish and still feel ok. Then, everything above that minimum will be a win.
Reframe your thoughts. Depression can fill your mind with negative thoughts. Shift your thinking. Turn negatives into positives. Therapy and mindfulness techniques can teach you how to see your thoughts differently and not react as strongly to them.
Track your wins. When you do something good, no matter how small, write it in a success journal. Maybe you ran a mile or cooked a delicious dinner. Use these wins to remind you of your value.
Practice. It might be hard to call up the skills you need when you're in the grip of a relapse. Find techniques now that work for you, and practice them while you're still in remission. "Then, if the going gets bad, the tool is right there. You know how to do it," Rubin says.
Research helpful apps. Technology is your ally in managing depression. Apps such as Calm, Headspace, and Insight Timer teach mindfulness techniques. Bearable and eMoods track your symptoms. And Happify helps you gain more control over negative thoughts.
Learn Early Warning Signs
Write past depression symptoms in your toolkit. They'll help you spot early warning signs in the future.
You could be headed for a relapse if you:
- Suddenly feel irritable, restless, or frustrated
- Are sad much of the time
- Have brain fog — you can't concentrate, remember, or make decisions
- Don't want to do activities you used to enjoy
- Eat more or less than usual
- Sleep too little or too much
- Have aches and pains that aren't from another cause
- Are very critical of yourself or feel guilty or worthless
- Have thoughts about suicide or hurting yourself
Don't be afraid to call your doctor or therapist about these signs. They can help you manage symptoms before they get severe. Noticing depression symptoms is a skill, not a sign of failure. "You're not born being able to control depression," Visvanathan says. "It's something that you figure out with time and experience."
Keep a Contact List
On a bad day, you might not remember which people to call. Have a list of contacts ready. Include a mix of professionals, friends, and family:
- A psychologist, psychiatrist, therapist, or social worker
- A friend or family member who understands what you're going through
- A depression hotline or warmline
Nourish Your Body and Mind
Food does more than fuel your body. It also affects your mental health. Comfort foods such as pizza and cookies increase depression symptoms. They also cause blood sugar spikes and drops, which could make you even more irritable and anxious.
But even if you want to eat a nutritious diet, cooking can feel impossible when you're down. Fill a notebook with simple meal ideas. Include foods that are nutrient-dense, easy to make, and also enjoyable. "What are the simplest meals you can make when you're feeling depressed that still feel nutritious, still feel satisfying, and still feel pleasurable?" Visvanathan says.
Focus on Ways to Stay in Remission
Put together a relapse prevention plan. "Think about what worked for you when you were at your best. What was your routine? What were your relationships like?" Rubin says. "Visualize a really good time in your life when you were fine. And write down the ingredients."
These are some of the ingredients to include on your list.
Treatment. You might be tempted to stop antidepressants once you're in remission. But you'll be less likely to relapse if you stay on your medicine and talk therapy long-term. See your mental health provider at regular intervals to keep yourself on track.
Sound sleep. Insomnia often goes hand in hand with depression. People who don't sleep well are more likely to relapse. If sleep loss is a constant problem, cognitive behavioral therapy for insomnia (CBT-I) can help. CBT-I teaches you techniques to sleep longer and more restfully.
Nutritious diet. What you eat affects how you feel emotionally. Healthy eating plans such as the Mediterranean diet are good for your mood. Foods such as whole grains, fruit, vegetables, beans, nuts, fish, and chicken give you all the nutrients you need, and they keep your blood sugar level steady.
Structure. Routines give you a feeling of control over your life. People who structure their day have fewer depression symptoms and a greater sense of well-being. Try to wake up, eat, exercise, sleep, and do other activities on a set schedule.
Exercise. Physical activity acts like an antidepressant. When you exercise, your body releases endorphins, hormones that boost your mood and make you feel good.
Stress reduction. Find the relaxation methods that work best for you, such as deep breathing, muscle relaxation, yoga, tai chi, or prayer. Mindfulness focuses your thoughts on the present moment without judgment. "There is really good evidence that mindfulness practice is as good as antidepressant medication in terms of preventing relapse," Visvanathan says. "It is something that anyone can do."
Prep for Work and Family Life
Think ahead about what you'll do if depression appears again. What strategies could you put in place now to help you manage work and family life during a relapse?
If you work, look into unpaid leave under the Family and Medical Leave Act (FMLA). Ask your company if you can switch to a more flexible schedule or a lighter workload. See if you can work from home or move to a more private work space in the office.
Have a talk with family members and close friends. Your mental health affects them, too. Let them help you plan for a possible relapse. Ask who can step in and help with daily responsibilities. Find out who is most likely to answer when you call for help.
