Tips for Keeping a Jaundiced Eye on Encroaching Depression?

September 28, 2016 1:38 PM

I have a history of depression but am fine for long stretches. How do I manage the swamping of depression that still happens from time to time?

I am on a low dose of a well-known antidepressant. It works well for me and I feel good when things are fairly even-keeled.

But, when there is a major stressor (difficult job change, a family issue, some personal setback), I still go into depressive mode and don't really "catch" it for a long time.

It feels like life is chugging along with normal ups and downs, I am doing fine and then suddenly, I "come to." I realize I've once again been in a dark hole for weeks or months without knowing it was self-imposed, and I've gained back a bunch of weight, and I skipped out on social things I should have done. It's "Oh, hey, that was depression again," and now I have to try to get things back on track. The thing is, it's never dramatic enough to catch while I am really in it -- I still work and attend my life, but that life is muted, and I overeat, and get stuck in a bunch of small ways, and I don't enjoy things very much. None of those things are enough for me to realize it's depression and not just a (long, long) string of lousy days. But it IS depression. I always recognize it after the fact.

I'd like to have some skills or tools in place so that I don't get that far down the grim road before I catch myself and try to reroute.

How do I set a warning system in place so I can see I am getting into trouble? Because, at the time, it always feels normal. My brain says, "Why wouldn't I feel too tired to shower or ramp up on work, etc., and eat an entire cake when XYZ is happening?" as if my higher functioning "Hey! This sure looks like depression!" detection ability is gone.

Do you have any tricks for catching when your depression is creeping up on you again?

posted by Ink-stained wretch to Health & Fitness (10 answers total)

Best answer: I've used an app called T2 Mood Tracker (Android, iOS) for this.

It lets you record your emotions/feelings/happenings on a scale - preset or customized - along with notes and it has great data visualization to show you how your moods, weight, social life, appetite, desire to shower, or whatever have ebbed and flowed over a period of days, weeks, or months, which makes it very easy to see when you're on a downturn.
posted by amnesia and magnets at 2:22 PM on September 28, 2016 [1 favorite]

Best answer: This happens to me too and part of the insidiousness is that it makes me so avoidant and then becomes a vicious cycle of feeling shitty --> not taking care of myself --> feeling shitty. Do you see a therapist at all? What works for me is having a standing check-up appointment every 3 months (or sometimes every month if I'm in a stressful stretch.) That way I have an external gauge of how I'm feeling and whether I need to adjust anything I'm doing.
posted by tatiana wishbone at 2:57 PM on September 28, 2016 [1 favorite]

Best answer: If I notice I've had several bad days in a week, I take a depression inventory, like the Beck or the MDI. It's a good check on "is this normal sadness or something more."

It may also work to just note the stressful event and scale up your depression management on that alone. Make a list now of coping strategies that make you feel good for a little while and aren't just skipping things that are good for you.

It's also okay to have ebbs and flows. It sounds like these are fairly limited low periods that you snap out of on your own, and they have an external cause. It's okay to not function at high capacity when you're stressed.
posted by momus_window at 3:37 PM on September 28, 2016 [1 favorite]

It's pretty normal that you aren't noticing. Depression doesn't have a reliably clear prodromal phase (like obvious ramping up in patterned ways), unlike something like bipolar disorder.
posted by listen, lady at 6:32 PM on September 28, 2016

What works for me is that I notice changes in my self care routines. For whatever reason, when I'm starting to go down the spiral, one of the first things to happen is I just can't find the energy to brush my teeth at night (gross, I know). Still it helps because not only is it a clear line that helps me to recognize that I'm slipping, it is also a routine that I can do to help get back on track.
posted by brevator at 6:36 PM on September 28, 2016 [2 favorites]

Track it in some way. If you have "early warning-sign" symptoms, those are the best (and probably easiest) to track. And by "track," I mean writing it down. Stick a mood/symptom/behavior calendar on your fridge, or download an app.

Learning to recognize those early warning signs early is a skill, and like all other skills, it takes practice. There's no trick about it -- it's just tracking it manually until the skill becomes more automatic (though even once it becomes automatic, depression sometimes gets in the way of noticing, so tracking manually is still a good idea).
posted by lazuli at 7:18 PM on September 28, 2016

Agree with the suggestions to track it somehow. When I was going to therapy it became my habit to casually write things down throughout the week to take to therapy with me. This eventually made it a lot easier for me to notice stressors and my own responses to them before things went too much off the rails.
posted by fairlynearlyready at 8:54 PM on September 28, 2016

I have a mental check-in questionnaire that I give myself whenever I think the clouds might be gathering. It goes something like this:

- How am I feeling?
- What could have brought this feeling on?
- When was the last time I felt good (or calm, clear-headed, energetic, etc.)?
- How likely am I to feel good again in the next 48 hours?
- Is there anything [non-destructive] I can do right now to feel better?

If the answer to two or more of these is "I don't know" or a noncommittal mumble, I know I'm in trouble.

It may also help to have a short list of quick but productive things you can do to shake things out a bit: exercise, going for a walk, small chores like doing the dishes or taking out the trash, reading a book or listening to an album. Depression and inactivity feed off of each other; if you can get your body or brain moving, it can keep you afloat, and if you can't bring yourself to do anything it's a warning sign.
posted by Metroid Baby at 7:31 AM on September 29, 2016 [6 favorites]

Best answer: I like the list from Metroid Baby, above.

Also, this:
Identify two or three friends/family who care about you, and whom you trust. Ask these people to check in with you on a regular basis. Let them know what behaviors/changes to look out for. If one of these people tells you they're concerned about you, take it seriously. This method is a safeguard against the tendency to ignore one's own symptoms.
posted by valannc at 9:43 AM on September 29, 2016

Response by poster: Follow up: I have instituted some Red Flag rules that seem to be helping. Example: Once a week, I assess and if it's been 'too hard' to go work out that week and/or some of my other early warning behaviors have begun to appear, I take measures to get back on course. It's not easy, but picking my speed back up is way easier that starting again from a standstill (or facedown). I also have someone in my life who has promised to tell me when I start sliding.
posted by Ink-stained wretch at 7:43 AM on November 2, 2016