For people with a history of depression or bipolar disorder, the risk of relapse looms like a cloud over their lives, threatening to separate them from their work, relationships, even their children. Stress, sleep deprivation, hormonal shifts, and stopping treatment are among the most common relapse triggers.
The National Mental Health Information Center at the U.S. Department of Health and Human Services lists numerous triggers. Here are five:
- Interpersonal friction
- Feeling overwhelmed or having too much to do
- Being judged or criticized
- Ending a relationship
- Physical illness
Sometimes the signs of dangerous stress are more subtle. Laura Gilmartin, 38, an office manager in Skokie, Ill., finds herself eating more junk food or smoking more than usual. "Or if I find myself coming home from work and falling into bed more than two days in a row, that gets me scared. The more time I want to spend in bed the more I know I need to get out of bed."
Delay decisions during relapse
The temptation to stop treatment on your own is another trigger, one that can lead to a downward spiral. Mary, 45, of Western Massachusetts, almost landed in the hospital during a suicidal depressive episode when she decided to go cold turkey. "What happens is I begin to feel great, and I rationalize that less is better when it comes to medication," she says.
If you are in the midst of a relapse, it's critical to realize that your outlook on everything is altered, and it's unlikely that you will be aware of your lack of perspective. "So to the extent possible, important decisions should be delayed," says Richard Raskin, PhD, a licensed psychologist in New York City.
Lisa, 42, a real estate broker in Huntington, N.Y., has been battling depression for years and can now steel herself against relapses. During the past year, she and her husband separated, and though she felt sad, she used the tools she learned in therapy to keep perspective. "I wasn't depressed. I think that's a testament of what talk therapy and medication can do. Ten years ago that would have put me in the grave."
Turning relapse into recovery
Here are some other strategies to try if you think that you are experiencing signs of a relapse.
- Talk to your relatives or friends who form your support network and tell them what's going on.
- Let your doctor know and ask for advice and direction, regarding taking medication, going to the hospital, or seeing a therapist/crisis counselor right away.
- Get someone to stay with you until you feel better, especially if you feel suicidal.
- Take some time off from work or your personal obligations so that you can attend to your health.
The worst thing you can do when you are depressed is to isolate yourself, though the temptation will be strong. "You need to stay connected to the world, and self discipline is a good way to achieve this," says Dr. Raskin. He recommends creating any type of routine, no matter how mundane, to keep you from ruminating into a worse psychological state. "The stay-in-the-house-in-your-pajamas syndrome makes things worse, and a routine demonstrates to you and to others that that if you are capable of getting through the day, you are capable of recovery." Gilmartin also urges treating yourself with as much gentleness as you can. "I treat myself like a doctor treats a patient," she says.