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Mental Health

Preventing Relapse of Depression

 

Author: Canadian Mental Health Association, BC Division

 

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When you feel well, the last thing you want to think about is a relapse of depression. But you can do a lot to lower the risk of relapse if you plan ahead. Try thinking of it this way: if you injure yourself, you would likely do things to prevent the injury from happening again. If you injured your knee running, for example, you might prevent another injury by seeing a physiotherapist or doing strengthening exercises regularly. Preventing a relapse of depression isn’t that different. In this sheet, you will learn a systematic way to monitor your well-being and take action when you need it.

Symptoms of a mental illness may come back or worsen at times. People use terms like "relapse," "dips," and "blips" to describe this experience. While you can't guarantee that you'll never feel unwell again, you can take a lot of steps to help prevent or reduce the impact of a relapse or worsening symptoms. You can look for early warning signs, create a plan to help with difficult situations, and take care of yourself. These steps may help you take action before symptoms become a major problem and help lessen the effect they have on your day-to-day life. This is based on the principles of "self-management," which means you take charge of your health. It may sound daunting, but self-management is really about building small, practical strategies into your day.

When it comes to preventing relapse, there are three big parts to self-management: identifying your warning signs, taking action, and seeking outside help when it's needed. The best time to do self-management planning is when you're well.

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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.

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Part 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 feedback—people 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:

  • Poor sleep or not getting enough sleep

  • Loss or grief

  • Conflict with loved ones

  • An unpleasant event such as a perceived failure, disappointment, or criticism

  • Other stressful events

  • Alcohol and other drug use

  • Certain times (a change in the season or your reproductive cycle)

  • Not following through on your treatment plan (such as not completing psychotherapy homework or taking prescribed medications)

  • Other health problems or concerns

Now that you have your early warning signs and your triggers, it's time to put everything together. Think back to your last episode of depression. Can you tie your warning signs to a particular trigger? If you can, try to map out a timeline that shows your triggers and warning signs in order.

Here's an example of a timeline:

Working late every night > not getting enough sleep > a small drop in mood > feeling very negative > having a hard time concentrating at work > spending a lot of time analyzing why you feel this way > avoiding friends, not going out > even lower mood > episode of depression

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Part Two: Taking action

Now that you've figured out what warning signs and triggers to watch for, it's time to decide how you'll take action when they come up.

This part is made up of smaller parts, but they all work together. Taking action includes:

  • Building healthy coping skills

  • Identifying stressful situations

  • Managing stressful situations

Building healthy coping skills

A big part of coping skills is a healthy lifestyle. Healthy activities like eating well, exercising regularly, getting enough sleep and practicing relaxation exercises can have a significant impact on your mood and your ability to tackle challenges.

Eating well—Researchers increasingly see links between mood and good eating habits. However, many people with depression find it challenging to manage meals due to poor appetite, low energy, or access to healthy and affordable options. Consider talking to a dietitian to help you find solutions. BC residents can call 811 to talk to a dietitian for free—visit www.healthlinkbc.ca for more information.

Exercising regularly—Exercise has many positive benefits for mental health. Find an activity you enjoy. The goal is to exercise for at least short period of time on a regular basis. Start with manageable, realistic goals and gradually increase your goals as you gain confidence. Local community centres can be a great place to start, and some offer lower rates if costs are a barrier.

Getting enough sleep—Sleep plays a big part in depression. Depression may cause sleep problems, and sleep problems may cause or add to depression. Medications can also affect sleep for some. See Wellness Module 6: Getting a Good Night's Sleep at www.heretohelp.bc.ca/wellness-modules for more on healthy sleep habits. Talk to your doctor if you frequently experience sleep problems.

Relaxation skills—Relaxation skills help calm you down and release tense muscles. You can learn specific skills like meditation, mindfulness, deep breathing exercises, progressive muscle relaxation, guided imagery or yoga. But relaxation doesn’t have to be formal: listening to your favourite music, gardening, writing, or other activities that work for you are also good options.

Healthy thinking skills—Depression can really affect the way you think about yourself, others and the world around you. Healthy thinking skills help you challenge distorted or unhelpful thinking traps and look at situations realistically. See Wellness Module 8: Healthy Thinking at www.heretohelp.bc.ca/wellness-modules for more. Healthy thinking skills are a major part of cognitive-behavioural therapy, or CBT.

Identifying stressful situations

Managing stress is a big part of wellness. You can control some things that cause stress—for example, you can try to get enough sleep and use alcohol and other drugs wisely. But it's unlikely that you can eliminate all stress from your life. These skills help you identify stress and take action by solving problems proactively so you can manage stress before it affects your well-being.

The first step is learning to identify when you're experiencing stress. You may notice stress in four general areas:

  • Physical signs in your body, like tense muscles or an upset stomach

  • Emotional signs, like feeling overwhelmed or feeling upset

  • Cognitive or thought signs, like thinking that everything is hopeless or thinking that you aren't appreciated

  • Behavioural signs, like getting into arguments or acting aggressively

These signs of stress may look just like some of your early warning signs, and in fact, that's what they may be for you.

Next, you can plan ahead if you know a particular event or situation is coming up. Identifying situations that cause you stress and taking action before you feel overwhelmed is a big part of maintaining wellness. Problems with your job, money, or relationships may come to mind easily. However, a situation doesn't have to be "bad" for it to cause stress. Stressful situations or events might include:

  • Starting a new job or school course or taking on new responsibilities

  • A major holiday or anniversary

  • A new relationship or commitment

  • Pregnancy

  • Moving or other changes in your home

  • Other health problems

Managing stressful situations

Now that you've identified your signs of stress and situations that may cause problems, it's time to decide how you manage them. Healthy coping skills, including your toolbox of supports, are a good place to start. There are also practical steps you can take as you approach upcoming situations or events. Here are some tips to consider:

  • Start slowly. If possible, add in new stresses gradually, rather than all at once. For example, if you want to go back to school, it may be possible to start taking courses part-time.

  • Make sure your own expectations are realistic. It's okay to cut back on other responsibilities or activities if you need to take care of a stressful situation.

  • Ask for help. Family members or friends can be a great support with daily tasks or other needs.

  • Take care of yourself. Self-care is important when you're dealing with a stressful situation.

Problem-solving skills are also useful when you're facing a challenging situation. This is a structured approach to help you think through problems and solutions in a logical way. For more on problem-solving skills, see Wellness Module 4: Problem-Solving at www.heretohelp.bc.ca/wellness-modules.

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Activity: A toolbox of support

Taking time to do things you enjoy is important for everyone, but it's easy to cut back on these activities. Write down a list of things that help you when you start to feel overwhelmed or notice warning signs.

Some examples include:

  • Setting aside time for extra sleep

  • Talking with a friend or loved one

  • Talking with your health care professional

  • Attending a peer support group

  • Spending time in nature, like going to a park

  • Writing in a journal

  • Spending time on a hobby

  • Volunteering for your favourite organization or helping someone else

  • Watching a funny movie

  • Cutting back on a few non-essential responsibilities

Other healthy actions:

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You can also list things that don't help you feel well or manage stressful situation well. For example:

  • Staying out late

  • Taking on extra projects or responsibilities

  • Spending time with people who aren't supportive

  • Overanalyzing why I feel bad

  • Drinking more

Other unhealthy actions:

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Keep this list in a place you'll see it often. Regularly pick a helpful activity from your list and set aside time to do it.

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Part three: Seeking outside help when needed

At times, you may need extra outside help. Warning signs may come up very suddenly or you may feel that your self-management strategy isn’t enough. Seeking outside help doesn't mean that you've done anything wrong and it isn’t a sign of weakness. In fact, asking for help when you need it is a sign that you understand how depression affects you and want to take action.

Talking with your health care professional is a good first step. You may schedule more frequent visits, and your health care professional may adjust your treatment, such as adding or changing medication, or adding psychotherapy. Loved ones and members of your support network can also help, even if you just need to talk to someone.

Planning for relapse

You can plan ahead for times you need extra help. Planning ahead may help ease worries of what might happen if you experience a relapse because you know there is a plan if you need it. Your plan may be a formal agreement with your health care professional, or it may be an informal plan among loved ones or other members of your support network. Whatever you choose, your plan will outline what will happen if you or others notice warning signs and what each person should do. It might include:

  • Signs that show you aren't feeling well

  • At what point you want outside help: As soon as you notice warning signs? When you can no longer manage symptoms on your own?

  • Where to go for help or who to contact in an emergency situation

  • What treatments you'd prefer

  • A list of your current medications and any other treatments (including alternative treatments)

  • Contact information for your health professionals the loved ones you want notified

Your action plan may also include practical steps that your loved ones agree to take. For example, a loved one may contact your employer and keep everything in order (like rent or bill payments) if you need to spend time in the hospital.

If your plan or agreement involves the care of your children, access to your financial information or other important matters, it's best to talk with a lawyer about your options. There are a number of different legal tools to help you plan for your care, but there are important differences between these tools. A legal professional can help you make the best choice for your unique situation.

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Activity: My relapse prevention plan

Write down your own relapse prevention plan using the prompts below. Be as specific as possible! It's a good idea to work with the people you identify as important contacts when you write your relapse prevention plan so everyone understands what they need to do. When you're finished, give everyone who will help a copy. Periodically review your plan and share any changes with your contacts.

Events or situations that triggered relapses in the past:

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Early warning signs that I experienced in the past:

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Things that help me when I experience an early warning sign:

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People who help me and what I would like them to do:

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People I'd like to contact in case of an emergency:

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(Source: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services)

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Where do I go from here?

In addition to your family doctor, check out the following resources for managing depression:

BC Partners for Mental Health and Substance Use Information

Visit www.heretohelp.bc.ca for info sheets on depression, self-care and recovery, such as Coping With Mental Health Crises and Emergencies and Finding Help for Mental Illnesses. You can also find personal stories from people who are working through recovery, our Wellness Modules, and self-tests.

Self-management workbooks

Visit www.sfu.ca/carmha.html for free self-management tools like the Antidepressant Skills Workbook, Antidepressants Skills at Work, and Dealing With Depression: Antidepressant Skills for Teens.

Bounce Back

Visit www.cmha.bc.ca to learn more about Bounce Back, a free program for adults and youth experiencing mild to moderate depression or anxiety. You'll learn skills and strategies to help you manage symptoms and improve your mental health. Bounce Back is available online or over the phone with telephone coaches who speak English, French, Cantonese, or Punjabi. You need a referral to access the program, so talk to your doctor if you're interested in participating. BC residents can take an online self-guided version for free and without a doctor's referral at www.bouncebackonline.ca.

Living Life to the Full

Living Life to the Full is an eight-week skills-based course that gives people different tools to manage low mood, stress, anxiety, and depression. Living Life to the Full is meant for anyone who’d like to take control of their well-being. It's not specifically a treatment program on its own, but it can enhance your treatment plan and provide a safe place to connect with others and practice your self-management skills. Living Life to the Full is offered by the Canadian Mental Health Association. Visit www.livinglifetothefull.ca to learn more and find courses.

WRAP: Wellness Recovery Action Plan

WRAP is a recovery and prevention tool for mental illnesses. Visit www.mentalhealthrecovery.com to learn more about the program, try practice exercises, or purchase WRAP materials. You can also talk to your care team to find WRAP courses in your area.

 

Learn more

This the third module in a three-part series. The other two modules are When You're Diagnosed with Depression and Working with your Doctor When You Have Depression.

 
About the author

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The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

 

 

A PDF version of this info sheet will be available in Spring 2021. Please contact us if you have any questions.

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