Recurring depression is something that isn’t always spoken about. But many of us have experience of it. It can become frustrating when it lingers and won’t go away.
What Is Recurring Depression?
Recurring depression, or ‘recurrent depression’ can be defined as “Two or more major depressive episodes”.
For episodes to be considered recurrent, we need to be in remission for at least two consecutive months between separate episodes.
To be considered in remission, we need to have at least two months where we don’t meet the criteria for depression. The longer we’re in remission, the less likely it is that we will have another episode of depression.
It’s Not Just Us
Recurring depression is common. Far more common than we might expect.
Of everyone who’s diagnosed with depression, 50% will have at least one more episode in their lifetime. If we’ve had two episodes of depression, the likelihood that we will have a third episode is 70%. Following three separate episodes of depression, the likelihood that we’ll have a fourth increases to 90%.
Stuck In The Middle
When living with recurring depression, it can be hard to relate to other’s experiences.
On the one hand, the nice, neat ‘fine-ill-better’ story arc, that we’ve seen portrayed in books and films doesn’t match our experience. Because rather than an arc, our illness forms a wavy line of ‘fine-ill-better-fine-ill again-better-fine…’.
But on the other hand, we can’t relate to those who live with chronic, persistent depression. Because we have times where we’re virtually symptom-free. Depression isn’t a constant feature in our life, but it is one that appears from time to time.
How Recurring Depression Feels
As humans, whatever our situation, we often compare ourselves to others.
In terms of depression, we might look at those who have little respite from their illness and think that we don’t have a right to struggle or complain, because ‘others have it worse‘. But the challenges we face aren’t more or less than the challenges others face. They’re different.
When we become unwell, we often work really hard to get to a point where we feel somewhat better. With recurrent depression, even after all of this effort, depression comes and knocks us down again at some point. This can be so disheartening.
Sometimes, the fact that we have periods of relative ‘wellness’ can almost feel cruel. We’ve had a taste of depression-free life, and it almost taunts us. A little voice whispers in our ear, repeating ‘this is what you could have had’.
It wears us down and can make it hard to hold on to hope. There are times when we might resent getting better only to become unwell again, because if we’d never had a ‘better’ period, then the hope of getting to a ‘well’ point would still exist. But that hope’s been snatched away from us because we got to that point, we were there for a while, and now we’re back in a depression hole again.
The Frustration Of Recurring Depression
There might be times when we just want to pull the depression out of our head and lob it at something.
We question why. Why is it back again, why won’t it stay away? Why is this happening to us? What have we done to deserve this?
Anger and frustration can be taboo feelings. Feelings that we feel we should hide from those around us. They’re feelings that can often provoke a cloak of shame, and shame can breed frustration and anger making it worse and worse.
But these feelings are totally valid. It’s understandable that we’d feel angry and frustrated. Working hard on our recovery only to become unwell again is a frustrating and maddening situation.
Rather than hiding these feelings and shoving them down as far as we can, it can help to (safely) release them. Otherwise, they often build and build.
The Unpredictability Of Recurring Depression
One of the most difficult things about recurring depression can be the unpredictable nature of it.
If we knew that we had a depression recurrence every 13 months, and that each recurrence lasted for three months, then we could plan around it.
But that’s not how it works. There’s usually no pattern or regularity to our episodes of depression. This can make some things really difficult to plan.
There are things, like arranging to meet up with a good friend next month, that we can still plan. Because hopefully, a good friend would understand if we had to cancel due to low mood. But other things, such as booking holidays, can be much harder.
We might want to plan for the holiday of a lifetime and need to book it more than a year in advance. But the last thing we want is to be struggling to get out of bed each morning when away from home. Without knowing when, or if, our depression will reappear, we can’t say with any certainty that we won’t be mid-relapse at the time of our holiday.
Anything that would be difficult to reschedule or ‘get out of’ can be hard to plan. Our partner’s 40th, a theatre trip, a reunion of some kind, the deadline for a big piece of work… our head can fill with doubt and fear when trying to plan any of these things.
Some of us take the risk and plan stuff anyway, but for others, it can have a big impact on our ability to book in anything more than a month away, because our worry surrounding our relapse risk is so high.
Depression Colouring Remission Times
Unfortunately, when we’ve had an episode or two, rather than enjoying our periods of remission, we might start worrying about or waiting for the next episode to appear.
It’s really hard to fully trust the happiness or ‘okayness’ we feel and to properly enjoy our depression-free times because we’re constantly waiting for the next crash. The worry and anxiety can build and build as we wind ourselves up wondering when (not if!) depression will appear again.
Living this way doesn’t usually help. It may or may not stop our depression from coming back – we can’t predict the future. But it will almost certainly negatively impact the now.
If we’re struggling to stay present, mindfulness or meditation can help to centre us and to keep us focussed on the present-day. We could also try grounding techniques if we can catch ourselves floating off into worry-land.
There’s nothing wrong with putting together a plan for if things do deteriorate again, but we don’t need to rewrite it on a daily or weekly basis. We can write it, put it away, and try to spend time in the present.
Something that can help us to live in the ‘good times’ without worrying about a depression recurrence as much as we often do, is radical acceptance.
To radically accept a situation is to accept it for what it is. We might not like it. It might hurt. We might not agree with it. But we accept it.
Essentially, there are a few ways we could look at recurring depression. One option, is we could spend our energy worrying ourselves into an anxious frenzy, fighting against our diagnosis and trying to control the uncontrollable. We could do the opposite and ignore it (and then crash with a big bump when a recurrence happens). Or we could accept it.
We say to ourselves: ‘okay, recurring depression seems to be part of my life. I don’t want it to be, but it is. There is only so much I can do to prepare for a recurrence and to manage my life in the most mentally-healthy way possible. After that, I just have to accept it for what it is.’.
This might sound quite blunt, but it can be incredibly freeing.
From Recovery To Management
If we’re someone who lives with recurring depression to the point where it’s likely to continue recurring for an extended period, then we might choose to switch our focus from ‘recovery’ to ‘management’.
This doesn’t mean that we’ve given up, or that there’s no hope.
What it means, is that we build things into our life to help us proactively manage our mental health.
This can mean things like sticking to a regular bedtime, having a (relatively) healthy diet, ensuring we have a good balance between ‘busy’ time and ‘down’ time, making space to process how we feel, building in helpful habits such as journaling or meditation, and anything else that we find helpful.
If we lived with a physical condition, such as asthma, then there might be certain things we have to do to manage it like taking medication, avoiding pets or grassy fields, remember an inhaler when we go on a jog, keeping our stress levels low, and having a yearly check-up with our asthma nurse.
Managing our mental health is no different. It’s not ‘admitting defeat’ or ‘giving up’. It’s just thinking about things we can build into our lives to reduce the risk of a depression recurrence.
Have A Plan
Once we have this plan we can shut it away and only pull it out if it needs updating or we need to use it.
Our plan might include things like our early warning signs of depression recurrence, what we need to do if we spot them, what we’d like others to do or say if they spot them, what our wishes are if we reach a point where we struggle to advocate for ourselves, any numbers we could/should ring, and a list of any medications we could/should take.
Having a plan like this can help us to feel reassured. The very act of shutting it away (until needed) can help us to feel like we’re shutting depression away. It can allow us to feel more able to get on with our life.
Feeling Like We Can’t Use Ask For Help Again
Reaching out for help is hard. Something that can make it feel even harder, is the number of times we’ve reached out for help before.
It’s very easy to talk ourselves into thinking that ‘we’ve asked for help too many times’. Or ‘they don’t want to hear from me again’. Even ‘ugh I’m fed up of myself, this depression keeps coming back again and again and I’m annoyed that it keeps returning, so others must be fed up with and annoyed with me, too.’.
Depression lies. There is no such thing as a ‘help quota’. A rule book stating that we’re only allowed to ask for help so many times does not exist. It’s not our fault that we have recurring depression, our struggles are valid, and we deserve the support we need to help us get through each episode we’ve reached out for support multiple times before.
Holding Onto Hope
Perhaps the lack of discussion around recurring depression is because the idea of depression ‘coming back’ doesn’t inspire bucketfuls of hope. But having hope and living with recurring depression aren’t mutually exclusive.
We can live a meaningful, hopeful life, and live with recurring depression at the same time.
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