Your Depression Has Returned... Now What?

Whilst this piece is accredited to me in name, the author is actually a good friend of mine, who wishes to remain anonymous at this moment in time. In the interest of respecting their privacy and appreciating just how much of a big conversation this can be, I fully support their decision.

J x

WARNING: This post addresses: low mood, self-harm and suicide. Naturally, the content may be shocking, triggering and/or distressing to some readers.

Depression can present itself in many ways with multiple underlying causes. For some people, depression may be a one-off event. However, for others, depression can rear its head repeatedly, akin to lightning striking the same place. Others may live under a dark cloud for a long time. The return of your symptoms can be distressing, frustrating and disruptive – especially when you thought you had recovered.

Some variants of depression, such as Seasonal Affective Disorder (S.A.D.) are characterised by their recurrent nature. People who suffer from S.A.D. are at risk of experiencing further episodes of depression as the seasons change each year. While this is distressing for sufferers, it can be predicted and prepared for to some degree. Preventative measures for winter S.A.D. may, for example, include: walking in natural light, buying a therapeutic light box, taking vitamin D supplements (following the direction of your doctor) and being able to attribute your symptoms to the dark nights, so you can visualise an end to your symptoms when the days begin to get longer and brighter.

The recurrence of symptoms can happen at a less predictable frequency. They may be attributable to a change of circumstances or single event, or in some cases, not attributable to an identifiable cause at all. There are significant stressors, which include: bereavement/loss of a loved one, breakdown of relationships, loss of employment, and poor physical health.

This post comes from a first-hand perspective of depression. There are other mental health conditions, which have recurrent periods of low mood regularly as a core symptom. For example, bipolar disorder can present as recurring periods of low mood with ‘high’ or ‘mixed’ states. I cannot speak as to how to cope with recurrent low mood due to other mental health conditions, but, hopefully some of the tips I have can be of universal application.

Personally, I have experienced multiple recurrences of my depressive symptoms with at least one discrete period of extended low mood per year for the last decade. Each relapse has been different in duration and intensity. Each had a different underlying cause, or no recognisable cause at all. For me, my low mood manifests as: feeling blue, lacking in energy and feeling a loss of purpose. I struggle to concentrate, my short-term memory deteriorates, and my anxiety and insomnia both intensify. I can binge eat and drink more alcohol; consequently, gaining weight. At my worst, I experience frequent suicidal ideation and urges to self-harm.

Between and through the lows I have found a way (most of the time) to live rather than exist. Here are some things that have worked out along the way or have helped me.

Don’t panic – you are not broken!

The first thing to hang on to is this: recurrence of your symptoms is normal. You are not a broken human being and you will not feel this way forever. You have not failed to get better.

I found this picture (or a variation of it) online years ago; I think it really captures how ‘progress’ actually looks. Recovery from mental illness is not linear; a return of your symptoms is a bump in the road, and focusing on one day at a time is the best tactic.

I can easily lose perspective of where I have come from. Five years ago, I had an episode of depression where: I didn't leave the house, I didn't eat and I couldn’t go into spaces where there were lots of people (including supermarkets). My life shrunk around me. This year I have experienced a flare up of my low mood, but my life has not shrunk in the same way. While I can get so angry with myself for how I feel, I must give credit for the ways in which I have tried to live the fullest version of my life possible.

Matt Haig sums this up so well in "Reasons to Stay Alive":

My depression returning repeatedly has only added into my bank. It is filled with dark moments but each of those has prepared me better for the next time it happens. To use a gaming analogy: when you first encounter a boss to defeat, it can be difficult to defeat them on your first attempt. If you have already encountered the boss, even if you attempted to beat it and lost, you have the memory and experience to better equip you next time round.

Get help

This is super important. Make sure you reach out to your GP or mental health team and let them know how you feel. There are lots of things they can do for you, including: trying medication, increasing doses to optimise therapeutic effects, and referring you on for additional support from psychiatrists. They can suggest where you are able to access suitable therapy. Of course, medication is not for everyone. If you wish to try it, it can take quite a while to find the right medication for you and sort out the appropriate dosage. Many anti-depressants take approximately 2 - 4 weeks to fully start having an effect, so you won't feel the impact immediately. Hang on in there, it can be totally worth it once it finally clicks into place.

Reaching out and sharing what you are going through is also helpful. It can reduce the burden on you. Remember, a problem shared is a problem halved. Whether this is with your GP, family or friends, the act of talking moves your thoughts from inside your head and into the world. Here, light can shine on them and you can see them for what they really are. Here is a blog talking about how to get around starting a conversation about your mental health.

If you feel you have no one to talk to, the Samaritans help line is free, confidential and available 24 hours a day. Please reach out if you need help.

I understand that it is difficult to get the right support, either finding the right medication or therapy (and then having to wait for it for long periods of time) but keep persisting. Hannah Jane Parkinson’s brilliant article details the struggles she has had finding help but also the difficulties of living with long-term mental ill health illustrating my point. It's a longer read but worth the effort.

Personally, I have tried: 9 different medications, 4 types of therapy and numerous therapists (over the space of a decade). My current medication is the best one I have tried so far and the last therapist I had was life changing. Waiting is terrible when you feel low, but know that there is always hope that what you are waiting for will be just what you need.

Be kind to yourself

Try not to beat yourself up. You’re going through a rough patch and a little kindness goes a long way.

I appreciate that being kind can be the most difficult task, but it is worth the effort. Think of it as something to practise rather than a task to be achieved. We can always practise more even if something seems to come naturally to us. Practise when you are feeling well, as this also has an impact. To take a practical example, in martial arts, people undertake thousands of repetitive movements in training so that when they need to call on their skills, in unscripted fights or self-defence, their muscle memory kicks in and they don’t need to think as hard about what they are doing. Your brain is also a muscle and practising self-kindness daily will allow you to call on it when you are struggling.

I am still practising self-kindness, and I am better at it than I was. In my most self-critical moments I aim for neutrality because the absence of anything negative can be positive enough. For example, instead of thinking ‘I am depressed again and it’s my fault’, I would aim to say ‘I am depressed again’ therefore removing the judgement from the statement. Neutrality doesn’t feel as much of a burden when my energy stores are depleted.

For me, a good way to visualise what kindness or neutrality looks like is this: asking yourself whether you would tell your friend what you are saying to yourself in your head? I certainly would not be as negative to a friend as I do to myself.

Focus on your mental wellness. Some small actions of self-kindness which can help are as follows:

• Try to brush your teeth and hair;

• Step outside – or open your windows so you feel more connected to the world;

• Open your curtains;

• Have a shower, don’t wash your hair if you don’t have the energy;

• Try to eat instead of snacking;

• Exercise if you can – walking is good exercise;

• Avoid alcohol;

• Get dressed – try to get out of your pyjamas and into clothes (even if they are super casual); and

• Do something you enjoy – read a book (or a chapter). Watch your favourite tv show. Do a facemask – whatever you like…

Although these things alone don’t make me better, not doing at least some of them is guaranteed to make me feel worse. But, don’t beat yourself up if you don't manage all of these things!

Adjust your expectations – if this will help you

When I was first diagnosed with depression at 15, I was determined that I would ‘get better.’ Admittedly, my understanding of depression was crude: ‘It’s just an illness. Follow the treatment plan and then you will be cured.’ I said to myself. What I soon realised is that depression is not that simple. For me, the most freeing thing was to change my idea from total recovery to management of my mental ill health. Obviously, recovery is totally possible for many people and I not saying this will help everyone. However, it has radically changed how I treat myself and my outlook on life. I haven’t given up on living a life without the weight of ill mental ill health, but I feel relieved of the pressure I was putting on myself to be in a different mental place to where I am currently.

I can still create a rich and interesting life in spite of my mental illness, and it is evident that many others do, too. For example (and a fun fact for literature fans): J.K. Rowling reportedly wrote Harry Potter and the Philosophers Stone while severely depressed, later personifying her depression by creating dementors.

Prepare for the future

Once I realised that my depression would probably always come back, I started thinking about ways to make my life easier when it does come back. Some of these do require a certain amount of disposable income and privilege – but others can save money in the long run.

Routine

This is a big one for me personally; I try to get into a good routine when I am not struggling from low mood. Things such as: pencilling in gym sessions, meeting up with friends regularly, video chats with family abroad and ‘self-care’. Routine is another thing that works best when you practise it. When you have a good routine sorted, it is easier to continue things when your mood deteriorates. If you are struggling now, even starting with the basics such as: setting a regular bed-time and alarm may help you feel better. Another part of routine could be visiting familiar places regularly. My familiar place that I visit is an independent coffee shop. I know the staff and lots of the customers. I can sit and work with my headphones on and still feel like I’m socialising, or I can walk for 5 minutes and grab a takeaway coffee just to have a five-minute chat with people in the shop. Importantly, it gets me out of the house and because I go there regularly, I feel comfortable doing it when my mood deteriorates.

Self-care

I must admit I really don’t like the phrase 'self-care', but, I think the concept is valuable. Taking time to focus on doing something to recharge your energy reserve or make you feel that bit happier is essential. This can be anything you prefer. I like playing computer games, putting on a facemask, baking, and going to the gym (not all on the same day, though…). It doesn’t have to be £50 candles and expensive/hipster yoga classes. It is about doing what you like doing without any pressure on you. I do not meditate personally but I have heard that the Headspace and Calm apps are a good way to start as they are cheap and accessible from your mobile phone. Lots of people find meditation beneficial so for the sake of downloading an app or two, it may be worth a punt!

Make hay while the sun shines

My boyfriend jokes that I am preparing for the apocalypse by stockpiling all manner of supplies. Over time I have accrued many towels, sets of bedding, tea towels and kitchen cloths. There is a logic to this: I do not have to do my laundry as often but can keep things fresh.

I also stockpile kitchen roll, loo roll, cleaning products, toiletries, dried food, jars of pasta sauce etc. I worry much less about running out when I hit a bad patch because I have so much in the house. This is where the money comes in: you need access to cash and space to store additional products. If you are short on either, then prioritise what is most important to you. I have built up my stockpile over time because of the initial cost of buying surplus items. If you think this will help you, then it may be something you can work towards.

Bulk buying can be cheaper: Wilkos 32 pack of loo roll is super cheap (as a hint). Another handy tip to ensure you eat well during lows is to bulk cook and freeze. My go-to currently is Quorn Bolognese, which I pack full of: courgette, mushrooms and peppers (sorry to any Italians reading this). It is cheap, easy to make, and only requires reheating and a portion of pasta to be cooked, which is less than 10 minutes per meal. Additionally, I have jars of sauce in the flat and always have bananas, breakfast bars and tinned beans in. These will add fibre and nutrients into your diet.

One final thought from Matt Haig:

I found his "Reasons to Stay Alive" amazing at dark times; I highly recommend you read it as a pick-me-up.

Hopefully there has been something useful in this post for you!

Passing on my best wishes to all of you! 😊