Depression & Relapse: Learning from the Setbacks

Relapse is a reality. If depression returns, use it to learn management strategies.

You’ve pulled through an episode of depression. You feel “back to normal”—for weeks, months, maybe even years. Then the dreaded symptoms come creeping or slamming back and you’re once again in that dark place you thought you’d left behind.

When you’ve been able to maintain your mental health for a period of time, it’s scary and frustrating to deal with a setback. But life is unpredictable and full of challenges that threaten wellness, so accepting that relapses happen may be your first step in fighting despair. With hope and planning on your side, you’ll have what you need to carry you through this new episode.

Think of it this way: You’ve made progress before and you’ll make it again. And you may even come out the other side with deeper personal insight and better tools for averting depression in the future.

“I think you should view relapse as an opportunity for growth and introspection, which are very important tools for maintaining wellness,” says Peter Ashenden of Illinois, a former executive for the national Depression and Bipolar Support Alliance.

“It’s hard to take a candid look at yourself and see what you need to do to get back on track again, especially when you feel like you’ve lost the ball game. You think, ‘How am I back to this again?’ ”

Ashenden notes that even someone like himself, with a career in mental health training and peer support, can fall prey to the black dog’s return. Last winter—one of the coldest in decades—was especially hard. He started isolating himself. He let his healthy habits lapse, gaining 35 pounds.

“I had all these skills, yet wasn’t exercising them,” he says.

Statistics suggest that half of people who have recovered from an episode of depression will experience relapse. That figure climbs to 70 percent after two episodes, and close to 90 percent after three episodes, according to William R. Marchand, MD, a clinical associate professor of psychiatry at the University of Utah School of Medicine.

Assessing your individual risk is harder, because depression is actually an umbrella term describing symptoms that have varied causes and respond to different interventions. For some people whose depression is triggered by a life change (also known as situational depression or, more formally, as stress response syndrome), symptoms are unlikely to return once the episode is resolved. For others, depression will be a lifelong chronic disease that requires constant management, just as someone with diabetes needs to monitor insulin levels and maintain a suitable diet.

Riding the wave

The re-emergence of depression signals that your management strategies aren’t working and you need to make some changes. For example, it’s important to consult your prescribing doctor to see if your current medications need to be adjusted. Consider a refresher course of talk therapy, or a different psychotherapeutic approach than you’ve tried before. Review your sleep, diet and exercise habits.

What you absolutely don’t want to do is buy into the feeling that you’re flawed or somehow unsuccessful because you didn’t “beat” your depression.

“There is no such thing as failure, there is only feedback,” says Ivan Staroversky, a psychotherapist and wellness counselor in the Toronto area.

In the meantime, the tools that apply to an initial episode of depression make sense when it returns. Above all, remind yourself that “this too shall pass,” even if it feels like that can’t be true when you’re in the middle of a relapse.

Robin Harvell, a therapist in private practice in Indiana, uses waves as an analogy: Sometimes it feels as if they will sweep you away, but if you hold on to the things you know to be true—your coping skills, support from friends or relatives—the waves eventually retreat and the water becomes clear again.

“There is no such thing as failure, there is only feedback.”

“You just have to make it through,” she says. In the meantime, “definitely let yourself feel what you feel. Most of the time our feelings hurt us worse when we deny them or try to push them away. You can say, ‘This is real and it stinks.’ Just don’t get stuck there.”

Larry of Tennessee tries to maintain that kind of perspective when he’s overwhelmed by feelings of loss and separation associated with his wife’s complicated health issues.

“There’s incredible stress and incredible desperation and incredible depression,” says Larry, a retired mental health counselor. He might get pulled under several times in a year, but he reminds himself to gain some distance and hold onto the knowledge that he’ll get back on an even keel.

“Some of it is knowing not to be defined by the things that are hard for me,” he explains. “There’s a lot more to me than the things I struggle with. The things that are important, that I value, and the people I care about … none of that changes just because things are hard.”

Rolf Schrader, a psychotherapist in private practice in Vancouver, emphasizes the need to see yourself as separate from your symptoms.

“Once you externalize depression, it no longer becomes all-consuming,” he says. “You can see it’s just another experience in your life, a protective protocol, and in this way give yourself a space to heal. That doesn’t mean you won’t have another episode … but it becomes something you can actually address.”

Focus forward

Shrader encourages his clients to view depression as a teacher rather than an adversary. That perspective allows relapse to become an opportunity for self-exploration—using mindfulness practice, free-form writing exercises, creative dialogue with a therapist, or other techniques “to learn more about what is working for you or not”—rather than a blow to self-esteem.

“The first thing to do is honor the fact that the relapse is there, dust yourself off, and move forward,” he says. “It’s not a deficiency, it’s just a bounce in the road. The reality is if you don’t see it as a negative, it doesn’t have the same bite.”

In a similar vein, Staroversky says that relapse management begins by asking yourself several important questions after a setback: How can I make sense of this? What have I learned from it? Now that I know this, what would I do differently?

Understanding what tends to trigger your depressive symptoms and recognizing them on the horizon is key to preventing a full-blown episode. According to the U.S. National Mental Health Information Center, common triggers for depression include interpersonal friction, feeling overwhelmed, being judged or criticized, and ending a relationship. Work and personal stress, ill health, and major life changes—even joyful ones like the birth of a child—also rank high.

Leanne was diagnosed with depression four years ago. She also has a rare neurological disorder, and her recovery from depression gets derailed when she has trouble pushing her cart at the grocery store, for example, and when she can’t make it to the grocery store in the first place.

Frustration over her loss of independence is compounded by guilt from having to rely so heavily on her husband and relatives for support.

Her strategies for counteracting relapse include pursuing a longtime passion for making and editing videos. A former journalist who majored in television, Leanne grew up making movies with her cousin and now runs two YouTube channels with a childhood friend.

“It’s familiar, so it just calms me down,” she says. “It’s the only thing that makes sense to me when I’m in that state of mind.”

Leanne also has watch for cues that she’s losing her grounding. “I listen to my body more,” she says. “Everyone is different, but your body will tell you in many ways when you need to slow it down [and] rest the mind.”

Read more: 5 Strategies For When a Relapse in Depression Occurs

Printed as “Lesson Plan: Depression and Learning”, Winter 2015