Limiting and controlling episodes of depression

Many of the people we interviewed who had had depression wanted to limit the impact of further episodes. They did this at a number of points:

(1) in between episodes when feeling well
(2) at the point where the person notices that an episode of depression or mania may be starting (i.e. noticing the forerunners)
(3) during the depression (i.e. noticing the pattern).

The trouble is that it can be difficult for people to know when they are going into a depression. Also, people's experiences differ so much that it is not possible to identify the common warning signs for everyone. Nevertheless, people had identified their own signs that they might be going into a depression. Some took lack of sleep and tiredness as a warning of looming depression. These people attempted to get extra rest and sleep to prevent depression.

One woman realised that her warning signs were intolerance of noise, wanting to isolate herself, having a feeling that things were not right, and wanting to 'lose' herself. A man who was vividly aware of his signs of going into a depression could take it as a warning to get to a doctor. Another man in his late thirties found it so difficult to judge a looming depression that he resorted to using the Beck Depression Inventory at regular intervals to monitor himself. Those who also experienced mania could notice the forerunners of getting high (or ask their friends to watch them) in order to prevent mania and subsequent depression. For instance, one man made conscious decisions to try to stick to routines, particularly sleep, when at risk of mania.

Some particularly experienced patients had arrangements with their doctors so that they could start taking (or increase) their medication to prevent or limit a possible depression. One older man had so much experience of noticing the forerunners to depression, and managing it with medication (as well as positive thinking), that his episodes of depression now felt considerably less severe.

Limiting the impact of an episode of depression is still possible after depression has set in. People can adopt an 'attitude' to control the impact of their depression. One common thing that people did was to try to think of depression as self-limited. The problem is that it can be very difficult for deeply depressed people to hold onto the idea that they will recover - they tend to think this episode is the one they will not recover from. As one young woman said, 'you still really kind of believe that this is it, and it's really bad.' Nevertheless, many people have noticed the self-limited nature of depression. The same woman said 'but at the back of your mind, at least you know that it's going to get better at some point.'

The knowledge that depression will not last has helped some people to accept and endure their depression, as well as reduce the impact of depression on their lives. An older man said that noticing the pattern of depression, and accepting depression, meant that it was more manageable and did not 'hit me as hard'.

Last reviewed September 2017.


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