Do you, a loved one or someone you know suffer from depression? If so, you are aware that depression can be tough to live with – tough to understand and tough to treat.

For many people, depression is not just a single “episode”, but a long-term, chronic disorder requiring long-term management. Research tends to be more focused on resolving the first episode, rather than maintaining good health and developing positive habits of self-care after the depression has resolved. Unfortunately, relapses are very common.

Episodes of depression can become a learned habit.  Habits are developed through repetition and become deeply ingrained. Resolving depression becomes more challenging when depressive habits have become part of a person’s personality.   The depressive thinking, helplessness, body sensations, energy loss and shut down becomes part of the behavioral ritual when a stressor hits making intervention more difficult.

As an Addictions Counselor and Behavior Therapist, I see this a lot in my practice in Chestnut Hill, Philadelphia and West Chester, Pa.  Many of my clients have struggled with addiction(s), chronic medical illness, early life trauma, and unexpected life events, which have challenged their resilience and ability to cope in a helpful way. At times, stressors have compounded over time and have outstretched the person’s ability to move forward.

Some self help groups and organizations which tend positive support include:

National Alliance on Mental Illness (NAMI)

Depression and Bipolar Support Alliance (DBSA)

Each group has a local Philadelphia and Tri-state presence with regular support meetings.

It is important to identify and understand the depressive pattern and to construct a plan to dismantle the behavior chain as promptly as possible as it gets tougher as additional episodes occur, and the pattern reinforces itself. Being able to “head off” depressive episodes in their early stages is important in minimizing their impact and ceasing their progression.

Early intervention is paramount; this includes identifying the warning signs of relapse.

Some early warning signs of depression relapse include:

–    Becoming more isolated and withdrawn; not responding to emails or phone calls,

–    enduring some loss; personal or professional,

–    moving or changing jobs,

–    suffering through some disappointment, or

–    stress at work or home.

It is at this point that many people drift from their treatment providers, losing confidence in their ability to make progress. Termination of treatment is usually done unilaterally, with little or no response to outreach.

Sometimes people with a long history of depression or several relapses may have to stay on medication for several years. Developing a strong collaborative relationship with a prevention-minded primary care physician is a key part of the treatment plan.  Improving and optimizing health status is a foundational part of developing resilience.  The body must be as healthy as possible for the brain and mind to heal. Sleep, nutrition, and exercise are all part of improving one’s health.

What helps?

The conditions of our lives are directly related to our health and sense of well-being. Creating conditions for our well-being and growth enhance self-esteem and satisfaction.

A few things that can help, include:

–    Seeking pleasurable emotions and sensations each day (through healthy means, of course!),

–    pursuing goals and activities that require full engagement,

–    doing things for other people,

–    being connected to good friends and a strong social support network, and

–    having a healthy partnership or marriage, affection, and physical intimacy.

Staying focused in the “here and now” rather than past, future, or other topics and places are what it means to be “mindful.”  Study after study has demonstrated that happiness and satisfaction come from the ability to “live in the moment” and “being in the moment” – Experiencing life in the moment versus living in the fiction and anxieties associated with thoughts of past and future.

To successfully prevent depression developing strength of focus and attention is most important.  Without mindfulness, there can be no treatment or progress for there is no presence in order to receive the help that is offered.