How to manage a depression relapse

Depression is not so much something that can be cured; more something for which we have a variety of treatment options. It operates in cycles and phases, which are often unpredictable. It could be likened to a potential shadow, lurking ominously in the background, ready at any moment to descend.

What is a relapse?

We have all experienced periods of low mood or depression, which no matter their duration, can be difficult to manage, and bring forth painful and upsetting feelings and experiences. These episodes can leave us with an uncomfortable sense of unease, and the fear that the feelings may return. This says much about the link between relapse and anxiety.

Triggers

In its most basic form, a relapse can be understood as a deterioration after a period of increased improvement. This often results in an increase of unhelpful thinking patterns or behaviours and difficulty in managing and taking on day to day activities. In moments of relapse, there are often triggers - a date such as an anniversary, a change of job, or ending of relationship for example. All these can provide uncertainty, and lead to an increased sense of fragility in one’s own mental states. These triggers can also be difficult to identify and occur outside of our conscious awareness. By increasing your own understanding of the things that can be detrimental to you during a period of depression, you may limit the risk of a relapse occurring.

Lost progress

A depression relapse can be incredibly damaging and difficult to tolerate, and can lead us to feel as if the progress or changes we made prior to a relapse have been swept away. Regaining our momentum or equilibrium can feel very difficult, and it can be challenging to hold onto any sense of historic achievement.

In other words, there can be a removal of the past and the future, and the sense that only the present remains. Without a sense of knowing or feeling what may happen beyond the current difficult and painful feelings can be a worrying and difficult experience. This experience speaks to the power of depression, and the hold it can have on us.

Attacks on the self

Being kinder to ourselves is never the easiest of tasks, and this challenge becomes more difficult during times of depression relapse. The internal persecutory voices we experience can become louder, more frequent, and more damaging. These can be thought of as internal attacks on the self, and can be likened to a weakened immune system, more exposed and vulnerable to attack from infection. In our vulnerable moments, we can be more susceptible to latching onto this internal script and becoming entwined within it.

How to identify a relapse

A depression relapse will be different for us all and impact us in various ways depending on our personal experiences. However, there are some commonalities to look out for in identifying a relapse. The list below is not exhaustive and is intended to give an outline only.

• altered patterns of sleep - having less sleep, waking up in the night or difficulties getting up in the morning, or a lack of sleep entirely
• an increase in stress
• finding yourself feeling more on edge, anxious or worried than before
• an increased persecutory internal voice
• a lessening of personal care - not showering, eating, or looking after yourself
• a removal from social activities and a sense of needing to hide away
• noticeable changes in your usual behaviour - a lack of libido, an increase of insecurity or self-doubt
• problems with concentration, keeping focused or being active

How to manage a relapse

One of the key aspects to managing a relapse is acknowledging and accepting that it is happening. Being honest with yourself and allowing yourself the chance to name your experiences is of real importance. Whilst it can be painful to accept you might not be doing as well as you would like, or feel disappointed or even ashamed you have found yourself once again in a similar position, acceptance offers the chance to begin the process of recovery. This is important because it allows us to offer ourselves kindness during a time when we can be most punishing towards ourselves.

As with identifying a relapse, managing one will also differ depending on our personal experiences. The list below offers some ideas on how we might manage a depression relapse and navigate the difficult feelings you may experience. Again, this list is not exhaustive.

• Find some time for yourself to do something you enjoy.
• Reach out to a friend, colleague or family member in whatever way is most comfortable for you - depression thrives on silence, but can lessen when spoken about openly.
• Ask for someone to check in on you, to send you a text or give you a quick call - you don’t need someone monitoring your every move, but just having someone ask how you are can be very meaningful.
• Find some inspiration or creativity - re-establish connections to those parts of yourself which bring forth ideas and generate movement of creative thought.
• Try to exercise or get outside into nature - even a simple walk around a local park can be helpful.
• Work hard to re-establish your routine, but don’t beat yourself up if you can’t do everything as well as you could before.
• Take care of your body in the way which is most manageable for you - drinking less alcohol or eating more healthily can be helpful practices to keep in mind.

How psychotherapy can help

Psychotherapy offers a space to explore your thoughts, feelings, and experiences, and to examine why or how a period of relapse may have occurred. It allows you the chance to verbalise what might be happening internally, and to have your experiences, no matter how small they may feel, to be heard. Most importantly, a relapse does not equate to failure, nor does it mean it is indefinite. As with all things, there is change and fluidity available, and nothing is set in stone.