Recovering from depression is a long and difficult journey.
Unfortunately,
50% of people who have one major episode of depression will relapse,
and the likelihood goes up if you’ve had more than one episode, says Eve
A. Wood, MD, medical director of the Eating Disorder Center of Denver
and author of
10 Steps to Take Charge of Your Emotional Life.
Your relapse risk can vary, depending on the severity of your symptoms and family history.
The good news is that there are some steps that may help you avoid depression relapse.
Don’t take on too much
While staying busy isn’t a problem, doing too much, too soon could be.
Feeling overwhelmed creates stress, and stress is a risk factor for depression, says Nancy Irwin, PsyD, author of
You-Turn: Changing Direction in Midlife. What’s more, stressful experiences can make the symptoms of anxiety and depression additionally severe.
“Thwart
stress by creating balance and knowing your limits,” Irwin says. “If
you are prone to depression, this is your responsibility—just like
brushing your teeth or obeying the speed limits.”
Exercise regularly
One of the best ways to prevent depression? Exercise.
“Exercise
appears to be an antidepressant in its own right and may act like an
antidote to stress,” says Gerard Sanacora, MD, PhD, professor of
psychiatry at Yale University and director of the Yale Depression
Research Program, in New Haven, Conn.
A 2009 analysis found that exercise lightens depression as well as cognitive behavioral therapy (CBT) or antidepressants.
A
resistance and aerobic combo seems better than aerobic exercise alone.
Workouts with a meditative focus, such as tai chi and yoga, also help,
according to a 2008 study.
Work on a positive attitude
Is your glass half empty? It can help to try to have a more positive attitude.
In
fact, certain depression treatments, such as CBT, can help you develop a
more upbeat outlook—although this treatment doesn’t work for everyone.
“Not
all respond to CBT interventions,” says Dr. Wood. “The underlying
philosophy of CBT is that the thoughts are what cause the distress and
if you change the thoughts you can change the depression, but that’s
true for only a subset of people.”
Take care of your health
Now is the time to focus on both your mental
and physical health, because the mind-body connection plays a role in depression and relapse.
“The
more we take care of ourselves, the less vulnerable we might become to
depression, as well as to a recurrence,” says Dr. Wood.
Depression is associated with a greater risk of heart disease and diabetes.
“There’s
very good evidence that people with depression have higher rates of
medical illnesses than people without depression, and the more medical
illnesses you have, the more likely you are to have depression and to
relapse,” explains Dr. Sanacora.
Put off big decisions
You may feel like a new person, but it's not the time to make major changes—even ones that you think will make you happier.
“Both
good and bad ‘big decisions’ are stressful," says Susan L. Marusak, MD,
research physician and clinical faculty at the Mood Disorder Research
Program at UCLA Medical Center and a private practitioner, in Santa
Monica, Calif. "I often advise patients to wait, if they can, until they
are feeling stable and euthymic before making a major life-changing decision.”
Irwin
recommends putting off big decisions until you're at least a six on a
happiness scale of one to ten (where zero is misery and ten is elation).
Stop blaming yourself
If you’re prone to depression, you may mentally berate yourself for missteps, either real or imagined.
But
a constant barrage of “I should have done this differently” or “If only
I would have done that” is counterproductive, and could send you
spiraling downward into depression.
You need to learn to accept
what you can’t change and focus on changing what you can, says Dr.
Sanacora, who recommends seeing a therapist with expertise in techniques
like cognitive behavioral therapy to help change your thought patterns.
Watch your diet
Diet and exercise go hand in hand when it comes to maintaining mental and physical well-being.
“A
low-fat diet, rich in fish, especially omega-3s, and folic acid can be
helpful for mood. And avoiding alcohol and minimizing caffeine use is
also helpful,” says Dr. Marusak.
A Mediterranean-style diet, rich
in veggies, fruits, nuts, whole grains, and fish, is linked to a lower
risk of developing depression, according to a 2009 study in the
Archives of General Psychiatry.
Don’t stop treatment
Doctors recommend taking medication for six to nine months after symptoms lift and you start to feel stable, says Dr. Marusak.
The
decision to end therapy or medication should be made with your doctor's
help. “Some drugs, if you go off them, may not work for you again when
you go back on them—(there’s no) guarantee that if it worked once, it
will work next time,” says Dr. Sanacora.
For some people, the best way to prevent a relapse is to continue treatment.
Volunteer
Reaching out to others may help you too.
One 2005 study in the
Journal of Health and Social Behavior
found that volunteering had a beneficial effect on depression among
older adults, and preliminary findings conducted at the Institute of
Psychiatry at King’s College, London, suggest a “strong link” between
volunteering and recovery from mental health problems, with about 85% of
participants reporting positive outcomes after volunteering.
“Usually when we can get out of ourselves in some way, we can feel a lot better,” says Dr. Wood.
Avoid alcohol and drugs
Steer clear of alcohol and especially illegal drugs, which can
interfere with depression medications and alter your mood—and not in a
good way.
“Alcohol is a depressant, and many street drugs deplete
serotonin and dopamine, which are important neurotransmitters in
relation to mood,” says Dr. Marusak. “We usually recommend patients
abstain from alcohol, even socially.”
Irwin says that you can be
setting yourself up for a relapse if you take unprescribed drugs.
“Alcohol gives depressives ‘permission’ to slip into that abyss, because
it underscores or verifies your negative mood state,” she says.
Manage stress
Chronic stress can actually cause physical changes in the brain, which can affect moods and emotions.
In
fact, a number of studies have led researchers to suspect that stress
produces changes in the brain similar to those caused by depression.
“Stress
might have a large effect on some of the brain regions that control
emotion and memory,” says Dr. Sanacora. "If it is chronic and
uncontrollable, stress might actually cause physical damage to the
brain."
Develop stress-busting strategies, such as exercise,
yoga, pilates, meditation, acupuncture, hypnosis, talk therapy, or
turning to friends and family for support.
Have an attitude of gratitude
Although it sounds simplistic, research suggests that for many, gratitude is a road to greater happiness.
In fact, a 2005 study published in the journal
American Psychologist
found that people who performed daily gratitude exercises, such as
making a list of three good things in their life, had lower levels of
depression.
Join a support group
“Support groups are particularly helpful, because there will be
people there who have learned how to manage their depression and can
provide excellent advice,” says Anne Sheffield, author of
Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond.
To find one near you, check out the National Alliance on Mental Illness or the Depression and Bipolar Support Alliance.
“Being
with people who share your problem forces you to realize that you’re
not alone and that others have battled the same problems and can help
you find solutions,” says Sheffield.
Reconnect
Depression can make you feel alone, so it’s important to reconnect with friends and family.
“We know that for all aspects of wellness, community has a healing and protective effect,” says Dr. Wood.
In fact, a 2009 study published in
The American Journal of Psychiatry
found that people 65 and older with a history of depression were at
greatest risk of developing major depression if they believed they had
poor social support.
Talk to people you trust
Many people don’t want to talk about depression because they think
they should be able to handle it on their own, or don’t want to burden
others.
But confiding in close friends, a spouse, or family
member can give you the social support you need to stay on the path to
recovery.
“Health, purpose, and love are your weapons against
depression,” says Irwin. Just remember, your friends or spouse aren’t
licensed therapists and may not know how to help you, warns Sheffield.
So if you start having depression symptoms again, you should reach out
to your doctor or therapist as well.
Get your rest
It's important to get sufficient rest as you
recover, since sleep helps regulate moods and is necessary for both
mental and physical health.
Insomniacs are almost 10 times as
likely to have depression compared to their well-rested counterparts,
according to a 2005 study in the journal Sleep.
“Sleep is
a cornerstone of health, like food,” says Irwin. “If it goes
unattended, the body and mind cannot function properly. Regulating sleep
can really help prevent depression and relapse.”
Source: http://www.health.com/health/gallery/0,,20431660,00.html