Ask Betsy: How do I keep my depression from recurring

The greatest fear for most people who have suffered through and survived a long depressive illness is that it will recur.

And recurrences are common, especially if you have had 3 or more episodes.The reason is simple. Depressive symptoms are never completely forgotten. And because depression tends to last for weeks, months, or years, the symptoms of the illness become deeply-grooved and easily triggered ways of being.

Think about anything you do over and over. The more you repeat anything, the better you get at doing it. And whatever we get good at becomes easier to do the next time. And in the case of depression, once your brain has “practiced” being depressed for long enough, it takes less and less to trigger another depressive episode.

For example, my first episode of depression began with a series of migraines that made it impossible for me to sleep, feel emotionally-fragile and exhausted, and caused a dark mood that worsened as evening approached in anticipation of yet another sleepless night. The longer these symptoms lasted—which began in the winter, and during perimenopause (a hormonally-difficult time for many women)—the worse I felt. Within weeks, I was sure i had at least a brain tumor, and might also be suffering from some extreme gastrointestinal condition.

As far as I knew at the time, I wasn’t depressed. I was physically ill. I felt—and still feel when I get a rash of migraines—like I had a full-body flu. But after getting checked up one side and down the other, I got a diagnosis of clinical depression, which turned out to be exactly what was causing my symptoms. My first episode was brought on by a perfect storm: perimenopause (with its attendant hormonal instability), migraines (with all of its dirty rotten symptoms), and an exhausting period of care taking for a dying grandmother (which took a terrible toll on me emotionally and physically).

I eventually dug my way out of this episode, but it took two years of medication trials, steadfast support from friends and family, and a lot of physical and mental health therapy. Because I wasn’t just depressed, but had almost crippling anxiety, I was exhausted, but also wired. This meant that I was compelled to keep moving, to do everything I could to get better. I did yoga and tai chi. I walked twice a day. I forced myself to drink protein shakes so I wouldn’t lose more and more weight (which happened anyway), and I worked with my medical team to find a medication regimen I could tolerate.

My advice to you now—while you’re well—is to develop a plan to increase your mental and physical resilience, and weaken the neurological bonds that have been created to make depression easier to fall into. There are two programs designed to help you do this. One is called MBCT, which stands for Mindfulness-based Cognitive Therapy, which is an 8-week program that consists of 8, 2 hr. classes in yoga, meditation, and cognitive therapy designed to prevent depression relapse. The other is almost the same. It’s called MBSR—which stands for Mindfulness-based Stress Reduction—and it is virtually identical to the MBCT program, only without the cognitive therapy aspect. The link to this second program (actually created by Jon Kabat-Zinn as the first program like this) offers you a chance to take MBSR for free.

As one therapist who was diagnosed with a brain tumor once wrote: “Do it now! You don’t learn to meditate after you’re diagnosed with a brain turmor.”

The MBCT program has been scientifically-proven to reduce depression relapse by 50% in people who have suffered 3 or more episodes of clinical depression. No other treatment I know of (and I’m a highly-motivated therapist and fellow sufferer) gets the kind of results this program gets. It doesn’t require that you stop taking your meds—which I do NOT recommend you do either—but it does require daily practices that strengthen your mind and body’s abilities to maintain stability under fire. This means that even though your body will remember traumatic events, people, situations, seasons that have triggered dark episodes, you will be in a stronger place mentally and physically to challenge and replace depressive habits of thinking and reacting so that slight triggers do not cause you to slide back into the dark rabbit hole of depression.

I will warn you, though, the tools you learn in the 8-week course require daily practice, and that practice needs to continue between episodes, otherwise, you won’t be able to call on them when you need them. What you’re trying to do is weaken your tendency to slide into despair with the least provocation/memory of a depressive episode, and strengthen your ability to quickly catch a slip before it gathers steam and turns into a slide.

I also strongly recommend; that you NOT play games with medications that are working. I have on countless occasions decided that I no longer need the medications I’ve been on. This is especially true when I’ve been depression-free for years. And each time I have done this, I have eventually crashed. Don’t do it. The medications that work for you are helping. In fact, both cardiologists and neuroscientists will tell you that the worse thing for the heart and brain is untreated depression. There is evidence that the SSRIs (the most commonly-prescribed antidepressants) have been found to promote the growth of new neurons in the brain (neurogenesis), which is a great thing, especially since untreated depression can cause neurons in the brain to die, causing a shrinking of structures in the brain that regulate emotions and deal with stress.

I have just created a Facebook page called @counselorsgetit. It’s about supporting other therapists and professionals to remove the stigma surrounding mental illness by sharing out own experiences with it. This blog is my attempt to be a part of the solution. If you need help, ask for it. If you’ve made it through another nasty episode, now is the time to develop these skills.