Relapse prevention for depression

28. February 2020

Depressive episodes can be treated well. After some time, the symptoms improve and those affected gradually find their way back into everyday life. Nevertheless, the subject of depression should not be lost sight of. Because: depressive illnesses have a high risk of relapse.

Preventing relapses in depression – Getting to know your own illness well

When the symptoms of depression subside, it is time to think about preventing further episodes. At the end of inpatient or outpatient therapy, patients are guided to develop an early warning system for crisis situations. In this way, a renewed depressive episode should be recognized as quickly as possible. This is particularly important because the earlier depression is noticed, the faster treatment and recovery can begin.

There are seven questions that patients with a history of depression should ask themselves in order to quickly recognize an emerging depression and apply strategies in the event of a crisis (adapted from Losekam & Konrad, 2017).

1. What do the early symptoms of my depression look like?
In retrospect, after a depressive episode, patients can often say that it did not occur overnight. There were warning signs beforehand, but they were (often) not noticed. Typical early warning signs of depression are:

  • Sleep disturbances: Difficulty falling asleep or early awakenings
  • Loss of appetite or increase in appetite
  • Ruminating and constant circling of thoughts
  • Giving up leisure activities out of a sense of not having the time or desire
  • Neglect of appearance or home
  • Lack of concentration

This list is not meant to be exhaustive, because every patient has different early warning symptoms. So it’s worth taking a close look: What are my individual early warning signs?

2. How can I recognize a depressive slump?
Sometimes these early warning signs of depression are difficult to recognize and early intervention is no longer possible. Then it is nevertheless of importance to admit that a depressive episode is present. The classic symptoms of depression are well known, but many sufferers can describe “their” depression in a very personal way. Here are a few examples from the field:

  • One patient described her depression as “humming top syndrome.” Physically and mentally, she just can’t get any rest, everything inside her was restless and unstoppable.
  • Another patient cited tunnel vision as very typical of his depression.
  • Another patient realized that depression was on the way because her face seemed like a mask to her and she could no longer show any emotion.

It is also important to pay attention to certain thought content. For example, if the inner critic becomes excessively loud and constantly brings to light destructive thoughts (eg, “You’re not worth anything” or “You can not do anything”), then attention should be directed to the psychological well-being.

3. How can I distinguish harmless mood swings from incipient depression?
Many patients who have experienced a depressive episode think back to that time with uneasy feelings. There is often great concern about a recurrence of the disease. Therefore, some are even too sensitive to negative moods and quickly fear that a new episode is approaching. But negative feelings are part of life and they will happen from time to time.

If you are in a bad mood, you should not immediately fear the worst. First, one should check whether there is a specific cause. If so, then the bad mood is quite understandable! In addition, you should always keep an eye on the period of the mood. If it passes again after a while, then the all-clear is given for the time being.

4. At what point should I apply certain strategies independently?
It makes sense to use the strategies (see next question) as early as possible. At an early stage, the ability to act is still high. There is the necessary energy to apply countermeasures.

5. Which strategies do I use then?
There are strategies that help against the early symptoms of depression. However, each patient must decide individually which measures are useful in his case. Proven strategies that help many sufferers are:

    • Behavioral activation: Doing something, exercising or socializing
    • Interests/Hobbies: Reading, going to the movies, playing sports
    • Relaxation techniques: Meditating, yoga, progressive muscle relaxation
    • Stress reduction: Hand over tasks, reduce working hours
    • Self-care: wellness, taking time off
    • Seek conversation with trusted person or professional
    • Defuse and/or question thoughts
    • Browse through old therapy material and remember valuable content
    • Apply Skills : Emergency methods to distract oneself (e.g., concentration exercises, strong tastes, smells, balancing etc)

6. At what point should I contact my therapist / psychiatrist?
You should always have these important contact details at hand. If the premonition about a new depressive episode lasts longer than a week, the treating professionals should be informed. The therapist can link to previously learned techniques or general resources, while the psychiatrist can adjust medication if necessary.

Importantly, correct medication use is also part of sustained relapse prevention. Antidepressants should be taken for a while after an episode has subsided. Under no circumstances should medication be stopped abruptly or without consulting a psychiatrist.

7. At what point should I call a clinic?
As soon as the feeling of deep despair sets in and possibly suicidal thoughts occur, a specialized clinic should be informed immediately (if necessary, after consultation with the therapist and the psychiatrist). In an emergency, inpatient admission can be initiated.

Acting quickly with symptoms of depression

It is important to think about these questions after a depressive episode. If answering the questions is difficult, the therapist and even family members can help answering them. Effective relapse prevention is an essential part of successful depression treatment!

References

(1) Losekam, S., & Konrad, C. (2017). Psychoeducation. In Therapy of depression (pp. 15-30). Springer, Berlin, Heidelberg.

Categories: Depression

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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