Healthy Mind

When Depression Comes Back, You Haven’t Failed

Photo: Getty Images/Jasmin Merdan
I was 7 years old and in the bottom bunk of my bunk bed when my grandma called out to my mom. “She’s not waking up," she said. "She just wants to sleep." That is the earliest memories I have of one of my depression’s symptoms: lots of sleep.

Now, at 29 years old, my depression isn’t much different. I get sleepy. I lose my appetite for food and activities I love. I grow frustrated with how quickly my depression comes on and how surprised I am every time it does. I'm far from alone. According to the National Alliance of Mental Illness, 19.4 million Americans have a major depressive episode every year. National Institute of Mental Health shares that “an estimated 2.5% of U.S. adults experience persistent depressive disorder at some time in their lives.”

And yet, it’s still really hard to not feel like a failure when your depression “comes back.” My latest depressive episode started right after we moved our family back east in a sudden cross-country move. My boyfriend had a job opportunity lined up that we couldn’t turn down and even though I was completely on board, I still struggled once we got settled into our new place. This episode was especially triggering because it had been over a year since my last one and I had felt somewhat out of the woods.

How mental health experts view recurrent depression

Justin Puder, PhD, a licensed psychologist and mental health content creator, says that if you’re feeling frustrated by your depressive episode, the best thing you can do is practice grounding yourself in a few simple facts.

“It’s important to remind yourself that it is normal to go through lows and difficult stretches in life,” says Dr. Puder. “This [current episode] doesn’t mean you did something wrong or you will be back in the same spot you once were… it’s just accepting that these fluctuations are part of life" He suggests getting curious and writing down the factors that have changed to make life more difficult: perhaps a shift in workload, the end of a relationship, or a personal loss. "Any factor or change you’ve noticed can be helpful on the road back," Dr. Puder says.

Ashlyne Mullen, PsyD, a clinical psychologist in New York City who practices at Alma, offers another exercise in defusion, or getting distance from emotions. “Rather than believing or buying into this thought (and experiencing negative emotions) you can practice responding differently to your own thoughts by being mindfully aware and using defusion practices to distance from the thought, essentially see it from a different perspective," she says. She suggests using language such as "I am having the thought that…" when having a specific thought. Another way to practice defusion? Imagine you're placing thoughts on individual clouds in the sky, seeing them from a different perspective, and watching the clouds drift away.

Every time I had defeating thoughts about the return of my depression, I tried my best to practice what Dr. Mullen now suggests: reframing and reminding myself that a thought is just a thought.

Behavior activation: a tactic for navigating depression

Allowing yourself to move past shame and guilt also leaves room for self-care practices that can help you navigate this new season with depression. One of my favorite tactics, that I’ve used during this and other depressive episodes, is something Dr. Mullen calls “behavior activation.”

“When someone notices feeling down or depressed, I often ask clients to recall things that were once fun in their life,” explains Dr. Mullen. “When we are depressed, we become less active, leading to fewer opportunities to connect with what we enjoy." That's where behavior activation comes in. "Behavior activation involves scheduling activities that you once found enjoyable, even when you don’t want to do them. In this way, you can reconnect with things that are meaningful and fun for you."

Practicing behavior activation takes, well, practice. It can feel uncomfortable at first because things don’t immediately feel like they're clicking, but over time even the practice of committing to behavior activation will start to feel like self-care. This past summer, I used a note on my phone to keep track of things that brought me joy, so that when hard days presented themselves, I had done the leg work for a few minutes of behavior activation.

No matter how similar each depressive episode may feel, the most important thing anyone can do for themselves is remember that similar doesn’t mean the same. “Even when we have similar feelings or difficulties in life, we have still learned something from our past struggles,” notes Dr. Puder. “Taking time to write down what helped with the healing last time can show we know more about ourselves than we think.”

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