Authors: Susan J. Noonan

Managing Your Depression (11 page)

4. Follow your Action Plan when you first notice a change in your emotional health. An Action Plan enables you to intervene early when necessary and modify or improve the course of the episode.

5. Relapse Prevention also means that you follow some basic
preventive steps
every day. These will help you maintain emotional stability and to decrease your vulnerability to fluctuations, although they may not eliminate these changes completely.

Preventive steps include:

• Maintain good Sleep Hygiene (see
pages 8
–9).

• Eat three meals per day with balanced nutrition.

• Exercise regularly.

• Keep up with self-care.

• Maintain regular social supports and contacts.

• Avoid isolation.

• Include positive, pleasurable experiences in your life (
pages 102
–3).

• Keep a structure and routine to your day. Schedule your time (
page 24
).

• Use your coping skills, the actions you take to lessen the effect of stressors (
pages 105
–10).

• Remain on your medications as prescribed.

• Do not use alcohol or drugs.

• Continue to work with your psychotherapist.

• Continue to work on any exercises your therapist gives you.

Relapse Prevention for bipolar disorder is very similar. In addition to the recommendations outlined above, a few additional tips are especially helpful to follow:

• Keep your life routine, balanced, and structured.

• Simplify your life as much as possible.

• Avoid overstimulation.

• Pace yourself, breaking large tasks down into several smaller ones.

• Find sources of replenishment and take periodic breaks in the day.

• Decrease chaotic or stimulating input at the end of the day (try relaxing, meditation, writing in your journal, taking a bath).

• Avoid impulsive actions. Wait at least two days before making any major decision or purchase, and ask two trusted friends for their feedback.

• Try social rhythm therapy, which has been formally evaluated as an intervention for bipolar disorder. It can help you keep routine and structure in your day.

Triggers

Triggers
are events or circumstances that may cause you distress and lead to an increase in your depression symptoms. It is important to understand that certain circumstances have the potential to set off an episode of depression for you. Triggers can be different for each person, so to be aware of them in your everyday life, you have to first identify them for yourself.

Triggers may include such things as …

• external events, good or bad

• a sudden change in your life, such as a loss (of a loved one, job, home, etc.)

• change in a relationship, or a new relationship

• change in daily routine that interrupts familiar patterns (change in sleep, meals, or activities)

• physical illness

• change in medications

• anniversary dates

• traumatic news or event

• good news

• feelings of stress

• feeling overwhelmed

• rejection or criticism (real or perceived)

• embarrassment or guilt

• too many or unwanted responsibilities, obligations, or tasks to do

• change of seasons

Once you have identified what events are Triggers for you, you can figure out with your therapist what steps you can take to minimize their effect on you and improve the situation. You may not be able to change the Trigger, but you can change your response to it. Write your Triggers and these steps in your Action Plan.

Some Triggers for me are …

Warning Signs

Warning Signs are distinct changes from your baseline that precede an episode of depression or mania. Each person has a characteristic pattern of Warning Signs. Early recognition of yours gives you a chance to intervene and modify (change or improve) the course of the episode.

Warning Signs may be a noticeable (to you or others) change in your …

• thoughts

• feelings

• behaviors

• routine

• self-care

Some examples include a change from your baseline to

• having more negative thoughts

• having problems making decisions, concentrating, solving problems

• feeling more hopeless, worthless, sad, irritable, agitated, anxious, fatigued

• experiencing a lack of energy or interest, a loss of appetite, too much or too little sleep

• having difficulty getting up, going to work, shopping, maintaining your household, handling family responsibilities

• having difficulty preparing meals, eating (too much or too little), maintaining good personal hygiene, doing laundry, handling personal responsibilities

Once you have identified your Warning Signs, work with your therapist to determine the steps you can take to minimize or prevent the episode of depression or mania. Write these steps out in detail in your Action Plan.

Some Warning Signs for me are …

An Action Plan for Relapse Prevention

The intervention Action Plan for Relapse Prevention outlines the steps you will take to manage, cope with, and distract from the intensity of an episode of depression or mania. It also lists the people you will ask to help you: health care providers, family, and friends. Research has shown that having a written self-care plan for situations that would lead to a worsening or a recurrence of depression can help manage depression and decrease symptoms. Work with your therapist to develop an intervention Action Plan to use when you or others notice your Warning Signs or a change in your emotional state.

The Action Plan includes the following elements:

• A description of your baseline

• A list of your Triggers

• A list of your Warning Signs

• What to do in response to those Warning Signs

• Names and contact information for your healthcare providers and supportive family and friends

• Useful Coping Strategies

• Suggestions for how others can help

Create your Action Plan now, before you have any intense symptoms, so that you have it ready to use when you or someone else notices your Warning Signs.

Following is a sample Action Plan already filled out to give you an idea of its range of possibilities and how it can be used. Following that you will find a blank form to use for your own care.