Managing Your Depression (10 page)

Managing Depression and Bipolar Disorder

Living with depression is a lot of hard work. For the best chance of success, you will need to take the following steps:

• Accept it as an illness.

• Follow your treatment plan.

• Understand the fluctuations (changes) in your symptoms and your symptom patterns.

• Define your baseline.

• Identify and monitor your Triggers (
chapter 5
).

• Identify and monitor your Early Warning Signs and Symptoms (
chapter 5
).

• Develop an Action Plan to use when things get worse, when you or others notice your Warning Signs (
chapter 5
).

• Use Relapse Prevention Strategies. Relapse Prevention is a day-to-day approach to help you stay well (
chapter 5
).

• Learn and use effective Coping Skills (
chapter 7
).

• Maintain social connections. Avoid isolation.

• Maintain self-care.

• Have a daily routine and structure. Schedule your time.

• Do something every day, even when you don’t feel like it.

• Build mastery (chapters 5 and 6).

• Develop a tolerance for feeling distress for a short time, during a moment of crisis (
chapter 7
).

Research has shown an improvement in depression symptoms when patients collaborated with their providers, were educated about the illness, shared decision making about medications, and used cognitive behavioral strategies to promote self-management. These strategies included keeping track of depression symptoms, monitoring yourself for early Warning Signs, socializing, engaging in pleasant activities, and developing a written self-care plan for situations that could lead to a worsening or recurrence of depression. Another study showed the importance of these factors in helping people with mood disorders stick with taking their antidepressant medications, which contributes to better depression outcomes.

Managing your mood disorder involves the following steps (which are also listed in the Managing Depression and Bipolar Disorder table, on
page 64
).

Acceptance

Accept your depression or bipolar disorder as an illness, an illness that affects your body and your mind. It is not a weakness or character flaw, or something that you have complete control over. It is an illness that can be treated and managed in a way that minimizes the effect of the illness on the quality of your life. Sometimes family or friends have a different opinion about your mood disorder or try to help by offering suggestions that are unfortunately misinformed. Do not listen to these differing viewpoints.

Follow Your Treatment Plan

The treatment plan developed by your providers, with your input and approval, is designed to help you. Take all medications as prescribed, and notify your doctor if you take any over-the-counter or nonprescription drugs. Keep taking your medications even after your symptoms have started to improve, and do not change the dose. Avoid alcohol and street drugs, which will only worsen your symptoms. It is also important to actively participate in your therapy sessions, do your prescribed homework exercises, and do not skip appointments.

Understand Your Fluctuations

Fluctuations are changes in your symptoms over time. You
will
have fluctuations up and down at different times during this illness. Use the Mood Chart on
page 46
to identify them. From looking at this chart and working with your therapist, learn to understand the fluctuations in your symptoms and the patterns that you have. When you are experiencing an episode of depression, remembering that things will change for the better is hard. Try to remind yourself of this during those dark times. Aim to minimize the depth, intensity, and duration of your symptoms by working with your therapist and using the suggestions in this book.

Define Your Baseline

With depression or bipolar disorder, you may have trouble remembering anything but your current mood state. Find a way to stay connected to your sense of who you are, your inner sense of self. Remembering your baseline self, or healthier state of mind, will help you keep each episode in context, and you will feel more in control of your life. You are not your depression.

Having a clear image of your baseline healthy self to draw on during your recovery will help you know what you are working toward. You may need to ask people who know you well to help you. Ask your friends or family to remind you honestly of your strengths and unique personal qualities, then write them down. Review that list periodically. See
chapter 3
for an exercise on how to do this.

Identify and Monitor Your Triggers

Triggers are events or circumstances that may cause you distress and lead to an increase in your symptoms. Being aware of what can worsen your symptoms is crucial to avoiding relapse (see
page 74
). You may not be able to change the Trigger itself, but you can learn to modify how you respond to it so that you do not feel as much distress. Work with your therapist to identify, monitor, and modify your response to your Triggers.

Identify and Monitor Your Early Warning Signs and Symptoms

Warning Signs are distinct changes from your baseline that precede an episode of depression or mania (see
page 75
). Each person has a characteristic pattern of Warning Signs. These are changes in your thoughts, feelings, behaviors, routine, or self-care that are noticeable to you or others. Being aware of the changes that are Warning Signs for you will help you recognize the signs early. This will give you a chance to intervene and change the course of the depression or bipolar episode.

Symptoms that might be Warning Signs are those characteristic to depression or mania that last for two weeks or longer (see
chapter 2
). They may include changes in appetite, sleep, thinking, or concentration; loss of interest; sad, worthless, hopeless, or guilty feelings; negative or elevated thoughts or feelings; or behavior that is slowed down, irritable, restless, or overactive.

Develop an Action Plan

An intervention Action Plan for Relapse Prevention is a written self-care plan to help you deal with a worsening or a recurrence of depression. It outlines the steps you will take to manage, cope with, and distract from the intensity of a depression or manic episode. In your plan, you also list the people you will ask to help you: health care providers, family, and friends. Work with your therapist to develop an intervention Action Plan to use when things get worse, when you or others notice your Warning Signs or a change in your emotional state. Create your Action Plan now and have it ready to use before you have any intense symptoms. See
page 78
for a sample Action Plan.

Use Relapse Prevention Strategies

Relapse Prevention is a day-to-day approach to help you stay well. It is a way for you to identify, monitor, and respond early to changes in your symptoms. The approach also involves daily preventive
steps to strengthen your emotional resources. For more information on Relapse Prevention, see
chapter 5
. A Relapse Prevention Strategy includes five main steps that you and your treatment team will act on:

1. Identify in advance what your Warning Signs are.

2. Pay attention to your Warning Signs. Notice when changes from baseline begin to show.

3. Have an Action Plan prepared in advance and ready to use when your symptoms change.

4. Follow daily prevention steps to help you remain stable.

5. If you notice a change in your emotional health, follow your Action Plan. The plan will enable you to intervene early and modify or improve the course of the episode.

Use Coping Skills

Coping skills are the actions we take to lessen the effect of stressors and to get us through difficult times. These skills include problem solving, self-soothing, distraction, relaxation, humor, and managing the little things before they get too big. Learning and using effective coping skills are essential to managing your mood disorder. Coping skills are discussed in more detail in
chapter 7
.

Connect

Maintaining social connections can be difficult to do on your own, so enlist the help of friends and family to stay in touch with you. Being with people you like has a positive effect on your mood. Avoid isolation and withdrawal because they will only worsen your depression. Some people find help in support groups with people who share the same illness and concerns.

Maintain Self-Care

Get up, take a shower, shave, wash your hair, and brush your teeth. Every day. Get dressed in clean, nice clothes and avoid wearing sweat pants all day long. Get a haircut or a manicure without feeling
guilty. It does not diminish the seriousness of your illness. These things may sound simple, but they require a lot of energy and are challenging to do when depressed. They may also be the last thing you are interested in. But taking good care of your body will help you feel better about yourself. Don’t forget to give yourself credit for these accomplishments.

Have a Daily Routine and Structure

Having a daily routine and structure can help in many ways, such as helping you to avoid spending endless hours of empty alone time, which will only worsen your symptoms of depression (see
page 24
). It also gives you a purpose to your day, which will help improve your self-esteem. Schedule your time and try to follow it, but don’t be too rigid with yourself. Many people with depression struggle with their daily activities. Following a written schedule helps you to see and stick to everything you need to do, which feels good and is a daily accomplishment.

Do Something Every Day

With depression, your motivation to do anything seems to disappear, especially with how difficult it all seems to be during an episode. You may not feel like doing anything, but try anyway—at least
one
thing. Action precedes motivation. Do something every day, even when you don’t feel like it. Interest in doing it will come later.

Build Mastery

Mastery involves doing something that is difficult and that challenges you a little. This may be learning a new skill or hobby, or overcoming an obstacle. When you work on a Mastery activity, you will feel more competent and effective, and you will gain a sense of achievement (see
pages 25
, 102). Give yourself credit for trying.

Develop Distress Tolerance

Distress Tolerance strategies involve using skills to help you get through the crisis of a difficult moment. These skills include distracting yourself, soothing yourself, providing solace, and improving the moment itself (see
page 113
). In a crisis you may sometimes feel a sense of urgency or desire to act impulsively. This can interfere with your efforts to manage depression and remain stable. Working to develop your tolerance for distress over a short period can help you get through the rough moments.

CHAPTER 5
Relapse Prevention

Overview of Relapse Prevention

The symptoms of major depression and bipolar disorder often fluctuate, or change up and down over time. It is important to understand that you will have fluctuations as part of the illness. The frequency and pattern of these changes will vary with each person. One way to identify your patterns is to track your symptoms on a Mood Chart (
page 45
) each day and share it with your physician.

At some point following an episode of depression or bipolar disorder, you may have a return of symptoms, often called a recurrence or a relapse. A
relapse
is the return of full symptoms after an episode from which you have partially recovered (partial recovery means feeling improved but with a few remaining symptoms). A
recurrence
is the return of full symptoms following an episode from which you have fully recovered. Your chance of having a relapse or recurrence of depression depends in part on how many prior episodes you have had. This means that the more episodes of depression you have experienced, the greater your chance of symptoms returning at some point.

Cognitive behavioral therapy (CBT) has been shown to decrease the chance of relapse. Mindfulness-based cognitive behavioral therapy has also been shown to reduce the risk of relapse and recurrence in some patients. In addition to CBT and other psychotherapy, you can take some preventive steps to manage your own symptoms and in this way improve the quality of your life.

Relapse Prevention is an effective daily approach to help you minimize the chance of a relapse occurring and to help you stay well. Relapse Prevention means that you identify and respond
promptly to changes in your Warning Signs, Triggers, or Symptoms of mood disorder. With this strategy, you can intervene when an important change in your emotional health may be happening. Early identification and intervention helps to prevent your episode from worsening.

A Relapse Prevention Strategy includes five main steps that you and your treatment team will act on:

1. Identify your specific Warning Signs, Symptoms, and Triggers (see
pages 74
–76).

2. Pay attention to changes that are Warning Signs for you.

3. Prepare an intervention Action Plan for Relapse Prevention in advance for use when you notice a change in your Symptoms or Warning Signs. The Action Plan includes steps you will take to manage, cope, and distract from the intensity of the episode. It also includes the people you will ask to help you (health care providers, family, and friends). See
page 78
.