depressive episode

I live with depression. Sometimes it’s major, sometimes it’s minor, and sometimes I can’t tell if I have it at all. But I’ve been clinically diagnosed for over 13 years, so I have gotten to know it pretty well. Depression presents itself differently in each person. For me, depression feels like a deep, heavy sadness. Like a thick fog that slowly rolls in and envelops every part of me. It’s so hard to see my way out, and it blocks my vision of a positive future or even a tolerable present.

Through many years of treatment, I have worked hard to understand how I feel when depression comes back, and I’ve learned how to take the best care of myself when I feel sick.

1. Don’t panic

For me, depression has been nothing short of devastating. It’s hard not to freak out when I feel it coming on.

When I feel that first tinge of sadness, or when I feel more tired than usual, alarm bells start to go off in my head: “NOOOOOOOOOOOOOOOOOOOOOOOO, NOT DEPRESSIONNNNNN!!!!!!”

For me, depression has been nothing short of devastating. It’s hard not to freak out when I feel it coming on. When I remember how sick I was, the thought of a relapse is absolutely terrifying —especially if I have been having a really good, upbeat streak. I feel my thoughts start to race ahead to the worst-case scenario, and a panicked feeling grows in my chest. This is a critical moment for me. This is a moment when I do have a choice. I have to stop and take a very deep breath. And then 10 more. I talk to myself, sometimes out loud, and tap into my own strength and past experience. The conversation goes something like this: It’s OK to be scared of getting depressed again. It’s natural to feel anxious. You are a survivor. Remember how much you have learned. Whatever happens next, know that you can handle it.

2. Know your red flags

When I notice these warning signs, I try to pause and reflect on what might be triggering the thoughts or behaviors.

I have found it necessary to understand what my thoughts and behaviors are like when I start to spiral downward. This helps me catch myself before I hit the bottom. My first red flag is catastrophic thinking: Nobody understands me. Everyone else has it easier than me. I will never get over this. Who cares? It doesn’t matter how hard I try. I’ll never be good enough.

Once I start thinking or saying things like this, I know that my depression is flaring up. Another clue is if my energy is low for several days and I find it hard to complete daily tasks, like cleaning, showering, or cooking dinner. When I notice these warning signs, I try to pause and reflect on what might be triggering the thoughts or behaviors. I talk to someone, like my family or my therapist. While it’s tempting to ignore red flags, I have found that it’s super important to acknowledge and explore them. For me, avoiding or denying them only makes depression worse further on down the line.

3. Remember that depression is an illness

Shifting my perspective has helped me to react with less fear when my symptoms present themselves. They make more sense within the context of depression as a legitimate medical condition.

For a long time, I didn’t think of depression as an illness. It felt more like a personal defect that I needed to try to get over. Looking back, I can see that this perspective made the symptoms of my depression feel even more overwhelming. I didn’t view my feelings or experiences as symptoms of an illness. Sadness, guilt, and isolation loomed large and my panicked reaction magnified their effects. Through a lot of reading and conversation, I have come to accept that depression is, in fact, an illness. And for me, one that needs to be treated with both medication and therapy. Shifting my perspective has helped me to react with less fear when my symptoms present themselves. They make more sense within the context of depression as a legitimate medical condition. I still feel sad, afraid, and lonely, but I am able to recognize those feelings as connected to my illness and as symptoms that I can respond to with self-care.

4. Realize that these feelings won’t last

Allowing myself to feel the depression and accept its presence alleviates some of my suffering.

One of the hardest features of depression is that it makes you think it will never end. Which is what makes the onset so scary. A difficult piece of my work in therapy has been accepting that I have a mental illness and building my ability to tolerate it when it flares up. As much as I wish it would, depression won’t just disappear. And somehow, as counterintuitive as it seems, allowing myself to feel the depression and accept its presence alleviates some of my suffering. For me, the symptoms don’t last forever. I have made it through depression before and, as gut-wrenching as it was, I can do it again. I tell myself that it is OK to feel sad, angry, or frustrated.

5. Practice self-care

I practice coping skills every day, not just when I am at my worst. This is what makes them more effective when I do have an episode of depression.

For a long time, I ignored and denied my symptoms. If I felt exhausted, I pushed myself harder, and if I felt inadequate, I took on even more responsibility. I had a lot of negative coping skills, like drinking, smoking, shopping, and overworking. And then one day I crashed. And burned. It took me two years to recover. Which is why, today, nothing is more important to me than self-care. I had to start from the bottom and rebuild my life in a healthier, more authentic way.

For me, self-care means being honest about my diagnosis. I don’t lie anymore about having depression. I honor who I am and what I live with. Self-care means saying no to others when I am feeling overloaded. It means making time to relax, to exercise, to create, and to connect with others. Self-care is using all my senses to soothe and recharge myself, body, mind, and spirit. And I practice coping skills every day, not just when I am at my worst. This is what makes them more effective when I do have an episode of depression; they work because I have been practicing.

6. Know when to ask for help

I believe that I deserve help in treating my depression and I recognize that I can’t do it on my own.

Depression is serious. And for some people, like my dad, depression is fatal. Suicidal thoughts are a common symptom of depression. And I know that if and when I have them, they are not to be ignored. If I ever have the thought that I would be better off dead, I know that this is the most serious of red flags. I tell someone I trust immediately and I reach out for more professional support. I believe that I deserve help in treating my depression and I recognize that I can’t do it on my own. In the past, I’ve used a personal safety plan that outlined specific steps I would take in the event of suicidal thoughts. This was a very helpful tool. Other red flags that indicate I need to step up my professional help are:

  • frequent crying
  • prolonged withdrawal from family or friends
  • no desire to go to work

I always keep the national suicide prevention lifeline’s number (1-800-273-8255) programmed into my cell phone, so that I have someone to call at any minute of the day or night. While suicidal thoughts don’t mean that suicide is inevitable, it’s so very important to act immediately when they come up.

7. You are not your depression

It’s critical for me to remember that I deserve to, and will, feel better.

I am not my diagnosis or my mental illness. I am not depression, I just have depression. When I am feeling especially blue, this is something I say to myself every day. Depression impacts our thinking and makes it difficult to appreciate the whole picture of who we are. Remembering that I am not depression puts some of the power back into my hands. I am reminded that I have so much strength, ability, and compassion to use in support of myself when depression strikes. While I can’t control my symptoms and while nothing is more difficult for me than experiencing depression, it’s critical for me to remember that I deserve to, and will, feel better. I have become an expert in my own experience. Developing awareness, acceptance, self-care, and support have shifted the way that I cope with depression.

To paraphrase one of my favorite internet memes: “I have survived 100% of my worst days. So far I’m doing great.”

Amy Marlow lives with depression and generalized anxiety disorder, and is a public speaker with the National Alliance on Mental Illness. A version of this article first appeared on her blog, Blue Light Blue, which was named one of Healthline’s best depression blogs.