Depression is coming back

Top Relapse Triggers for Depression & How to Prevent Them

Also, “make sure you take extra special care of your mind, body and soul,” Serani said. “This means being attentive to your sleep cycle, moving your body with exercise eating wisely and well.”

Trigger: Ruminating

“Negative self-referential ruminations play…a key role in recurrence,” Marchand said. For example, individuals with depression tend to dwell on their (supposed) flaws and failures. They also may view neutral events with a negative lens.

That’s why it’s important to develop a strategy for managing these thinking patterns, he said. “Cognitive therapy or mindfulness-based interventions are particularly useful in this regard.”

Trigger: Not Knowing Your Personal Vulnerabilities

“Triggers may be very specific to each individual’s situation, since all of our emotional responses are unique to some extent,” Marchand said. To identify your triggers, “learn how to recognize the who, what, whys and whens of your emotional and physical life,” Serani said.

Look at your calendar for potentially difficult periods. For instance, this might be an anniversary of a divorce or death or anxiety about a mammogram, Serani said. Highlighting these days “allows you to anticipate and plan for threats to depression recovery.”

Also important is to “take an inventory of all the hats you wear in your life.” Serani suggested considering these questions: “What circumstances at work affect your mood and behavior? At home, do certain actions of those around you tend to upset you? Are you feeling supported or overwhelmed? What happens when you don’t get enough ‘me’ time?”

Check in with your physical state, Serani said. “If you find yourself excessively fatigued, irritable, having trouble eating or sleeping, you might be in the midst of a trigger event.”

Finally, you can identify triggers by “think about previous depressive episodes and determin if there were specific triggers,” Marchand said.

Navigating a Relapse

Sometimes it’s not possible to prevent a relapse. But by knowing the early signs and getting treatment right away, you can prevent a full-blown episode or lessen its severity and length.

“Generally, early relapse will take hold with subtle signs, like mild irritability and sadness,” Serani said. Tracking your mood states every day helps you spot these early, not-so-obvious signs. “Through journaling, mindful reflection, and even apps on the computer, keeping a running tab on mood states can help offset relapse.” For example, if you’ve logged in 7 to 10 days of negative measurements, contact your practitioner to get evaluated for a relapse, she said.

Marchand also stressed the importance of contacting your doctor or therapist “at the first evidence of recurrence. Interventions may include restarting medication or psychotherapy… f in maintenance treatment …adjusting frequency of therapy or the medication dose.”

If you have a relapse, you might feel overwhelmed, frustrated and deeply disappointed. But “don’t measure your success living with depression on whether relapse happens or not. Instead, realize that if relapse occurs, true success comes from rising after the fall,” said Serani, who’s had depression herself. Her mantra is the Japanese proverb: “Fall down seven times, get up eight.”

And, again, whether you have a relapse or not, take good care of yourself, seek support and show yourself some compassion. Depression is a difficult illness. But, with treatment and healthy strategies, you can manage (and possibly eliminate) your symptoms and get better.

Top Relapse Triggers for Depression & How to Prevent Them

7 Factors That Can Trigger a Depression Relapse

Major depression is a complex and challenging condition: Even when your symptoms are under control, you can potentially slide back into despair. However, knowing what might trigger a downward spiral can help you stop one from happening.

Depression relapse or recurrence is common, although these two terms aren’t the same thing. First, it’s helpful to know how recovery is defined: It’s when you’ve been free of depression symptoms (in remission) for at least four months. In clinical terms, a relapse is when depression returns after you’ve reached remission but before you’ve reached recovery. A recurrence is a new episode of depression after a recovery.

Whether it’s a relapse or a recurrence, about half of people who’ve had one episode of major depression go on to have another, says Deborah Serani, PsyD, a psychologist in Smithtown, New York, and author of the book Living with Depression.

If you’ve had two bouts of depression, you’re 80 percent more likely to have another, Dr. Serani says. If you’ve had three depressive episodes, you have a 90 percent chance that symptoms will return again, she says.

7 Possible Depression Relapse Triggers

While there are certain events that can be stressful for many people, that doesn’t mean that all of these factors will trigger an episode in a person with depression. “Triggers are usually very personal things,” Serani says. “For example, things that are stressors for one person may not necessarily be difficult for others.” The reason a trigger sets off a depressive episode is that it overwhelms a person’s ability to cope effectively, she says.

Potential depression triggers include:

  1. Quitting treatment. Most people whose depression returns have strayed from treatment, Serani says. “They begin to feel better and stop taking their medications or quit psychotherapy.” As a result, they don’t reach full remission and depression symptoms slowly return, pushing them into another episode, she says. Keeping a healthy sleep schedule, exercising regularly, eating well, and avoiding alcohol, drugs, and toxic people are all part of effective depression treatment, Serani says. “Maintaining a healthy consistency with your life can dramatically lower your chance for depression relapse.”
  2. Death of a loved one. About 1 in 5 people develop major depression after a loved one passes, according to the American Cancer Society. “Grief is expected after a loss, but if symptoms of mourning go on for a long time, normal grief may turn into a depressive disorder,” Serani says. “If a person is still struggling with depression months after a death, they may need professional help to address prolonged grief and major depression.”
  3. Divorce. If you’ve already had depression, getting divorced significantly raises your risk for another episode, according to a 2014 study published in the journal Clinical Psychological Science. Researchers found that nearly 60 percent of divorced adults with a history of depression experienced another depressive episode. Only 10 percent of divorcees without a history of past depression experienced it.
  4. An empty nest. Although “empty nest syndrome” isn’t a clinical diagnosis, it’s common for parents to feel sad when a child leaves for college or moves out of the house, according to the Mayo Clinic. But such a change might trigger depression in some people. Get help if these feelings last a long time or interfere with your work or social life.
  5. Traumatic events. Frightening events like terrorist attacks and natural disasters can bring on a relapse or recurrence, Serani says. Anniversaries of such events can be triggers, too. A study published in The British Journal of Psychiatry in February 2016 found that people involved in attacks, disasters, and military deployment are at a much greater risk for depression.
  6. Hormone changes. Hormonal changes unique to women can trigger depression, according to the U.S. Department of Health and Human Services. Hormones affect the brain chemistry that controls emotions and mood. Women are more vulnerable to depression at puberty, during and after pregnancy, and at perimenopause (when a woman starts to experience menopause symptoms but hasn’t reached full menopause). Having a depressive disorder before you become pregnant puts you at the greatest risk for post-partum depression, Serani says.
  7. Addictive behaviors. It may not be a surprise that alcohol and gambling can create a potentially-addictive temporary escape, but even too much TV can be a depression trigger too, Serani says. Binge-watching — viewing many TV episodes in a row — can bring on the common depression triggers of stress and anxiety, according to a 2015 survey presented at the American Public Health Association annual meeting in Chicago. “When a person stops binge-watching, it can lead to a sudden shift in neurochemistry and a psychological feeling of loss, just like those who stop taking drugs or alcohol,” Serani says.

Ways to Minimize Depression Triggers

Some depression triggers can be avoided, but others can’t. “A person has to learn how to move through the event or the experience as best as possible,” Serani says. If you’re starting to feel stressed or overwhelmed by something in your life, Serani suggests taking these steps:

  • Get through it with positive talk. Tell yourself, “This is temporary,” “I’ll feel better soon,” or “I’m just experiencing a bad moment, I’m not stuck in a bad life.”
  • Nurture yourself. “It’s essential to feed your senses when triggers loom in your life,” Serani says. “Listen to music, or savor a cup of tea, soup, or coffee.” You might stimulate your sense of smell with soothing peppermint, florals, or woodsy scents with aromatherapy, candles, or a walk outside. Taking a warm bath can also be soothing.
  • Reach out to others. “It’s easy to want to be alone when stress hits, but isolating yourself from people can worsen depression triggers,” Serani says. “Let others know you’re struggling and talk about it openly as much as you can.” Consider joining a depression support group to be able to talk to other people who also understand what it’s like to live with depression.

If you suspect you’re experiencing a new bout of depression, don’t hesitate to contact your doctor or therapist. Remember that depression relapse is common and nothing to be ashamed of.

There are a number of risk factors associated with developing major depressive disorder, including temperament, environmental factors (adverse childhood experiences, stressful life events, etc.), genetics, and other mental health and medical disorders.1 Most of these triggers of depression are out of the realm of control for the depressed patient. There are, however, some habits within the realm of control that can worsen symptoms of depression.

Depression is a serious medical condition that can be treated with counseling, medication, or a combination of the two, but people struggling with depression can also make lifestyle changes to help alleviate symptoms. It helps to look at choices and habits that can contribute to depressive symptoms to understand how to make healthy choices during the treatment process.

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Inactivity

The essential feature of a major depressive episode is a period of at least two weeks in which there is either a depressed mood or a lack of pleasure in nearly all activities. 2 This can make it difficult to find the energy to do much of anything.

Depression can negatively impact employment, school, relationships, and other important areas of functioning. Depression can make it difficult to even get out of bed in the morning.

While depression might make you feel like staying in bed all day is the only doable option, studies show that moderate exercise (walking 20-40 minutes, 3 times per week) is effective in decreasing depression and improves long term outcomes for depressed people. 3

Moderate exercise boosts the “feel good” neurochemicals dopamine and serotonin. Look to your support network to find a walking buddy to schedule 3-4 walks per week to help counter inactivity.

Poor sleep habits

Sleep disturbance is actually one of the symptoms of depression, and it can set a negative sleep cycle in motion. Sleep disturbance can take the form of either difficulty falling and staying asleep, or sleeping too much. 4

To complicate matters, chronic sleep deprivation is also a trigger of depression. Sleep disturbance is both a symptom and a trigger of depression. One study of adolescents found that reduced quantity of sleep increases the risk of depression, which in turn increases the risk of reduced sleep. 5 It can feel like a never-ending cycle.

Set up good sleep habits to help stop the negative sleep cycle associated with sleep deprivation and depression. Keep sleep and wake times consistent, shut off all electronics a few hours prior to bedtime, and remove all screens from the bedroom.

Social isolation

When life is overwhelming, it’s natural to turn inward. It’s difficult to reach out for social support when getting out the door in the morning feels like an impossible chore. Meaningful social support is, however, exactly what you need during this time.

Research shows that social support moderates genetic and environmental vulnerabilities for mental illness by providing coping strategies and building up resilience to stress. 6

Social support is more than just a quick phone call to check in. Time spent with supportive friends or family members can help you work through your thoughts and feelings in a safe environment.

Poor diet

Believe it or not, the food you eat can negatively impact your emotional health. A study in The American Journal of Psychiatry found a link between diets high in processed foods, refined grains, sugary products, and beer and increased rates of depression and anxiety among women. 7

Many people reach for “comfort” foods when struggling with difficult emotions, and one of the symptoms of depression includes changes in eating habits resulting in significant weight loss or weight gain. It helps to track eating habits by journaling appetites, food choices, and emotional responses to get a baseline of eating habits.

Rumination

People with depression are prone to rumination, or dwelling on negative thoughts. Negative thought patterns include dwelling on rejection, loss, failure, and other sources of stress. Dwelling on difficult problems compulsively exacerbates symptoms of depression. The best bet for putting an end to rumination is to seek professional help.

Cognitive behavioral therapy can help depressed people identify negative thought patterns and learn to replace them with positive thoughts and adaptive coping strategies.

Changes in habits alone won’t “cure” depression, but they can assist in the treatment process.

Article Sources Last Updated: Aug 8, 2019

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Some people have an increased risk of developing depression, due to their genes, biology or personality type.

This does not mean these people will automatically develop depression, but in these cases dealing with life events are more likely to trigger an episode of depression.

  • Genetics — people with a history of depression in their close family members have an increased risk of developing depression, due to genetic factors. No single gene is responsible, but it is caused by a combination of genes.
  • Hormones — hormone changes during pregnancy, after you have a baby, during menopause and if you have thyroid problems can cause depression.
  • Recent events — depression can be triggered by negative events such as bad news or losing a job, although usually other factors need to be present too.
  • Long-term stress — ongoing issues can cause depression over time, such as abusive relationships, constant work stress and prolonged isolation. These are more likely to cause depression than isolated events.
  • Personality — certain personality types are more prone to developing depression. Those with low self-esteem, perfectionist tendencies, who are self-critical or overly sensitive to criticism may be more susceptible. Beliefs such as ‘I must get people’s approval’ or ‘I must do things perfectly or not at all’ can make people vulnerable to depression.
  • Serious illness — the ongoing worry and stress associated with having a long-term illness can take its toll and lead to depression. Some illnesses or medications can also directly trigger depression.
  • Drug and alcohol use — can worsen depression, and sometimes leads to a vicious cycle when substance abuse is used as a coping mechanism. Depression and substance abuse often occur together and treatment is more likely to succeed if drugs and alcohol are avoided.
  • Changes in the brain — some people with depression have been shown to have abnormal levels of neurotransmitters (brain chemicals) such as serotonin, noradrenaline and dopamine. Antidepressants that change these levels can be effective in treatment in some people with depression.

Not sure what to do next?

If you or someone you know are finding it difficult to manage mental health issues, try healthdirect’s Symptom Checker and get advice on when to seek professional help.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self care, talking to a health professional, going to a hospital or calling triple zero (000).

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