Depression: 17 ways to keep it from coming back

Recovering from depression is a long and difficult journey. Unfortunately, 50% of people who have one major episode of depression will relapse, and the likelihood goes up if you've had more than one episode, says Dr. Eve A. Wood, medical director of the Eating Disorder Center of Denver and author of "10 Steps to Take Charge of Your Emotional Life."

Your relapse risk can vary, depending on the severity of your symptoms and family history.

From our friends at Health.com, here are some steps that may help you avoid depression relapse.

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Don't take on too much

While staying busy isn't a problem, doing too much, too soon could be.

Feeling overwhelmed creates stress, and stress is a risk factor for depression, says Dr. Nancy Irwin, author of "You-Turn: Changing Direction in Midlife." What's more, stressful experiences can make the symptoms of anxiety and depression additionally severe.

"Thwart stress by creating balance and knowing your limits," Irwin says. "If you are prone to depression, this is your responsibility - just like brushing your teeth or obeying the speed limits."

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Exercise regularly

One of the best ways to prevent depression? Exercise.

"Exercise appears to be an antidepressant in its own right and may act like an antidote to stress," says Dr. Gerard Sanacora, professor of psychiatry at Yale University and director of the Yale Depression Research Program, in New Haven, Conn.

A 2009 analysis found that exercise lightens depression as well as cognitive behavioral therapy (CBT) or antidepressants.

A resistance and aerobic combo seems better than aerobic exercise alone. Workouts with a meditative focus, such as tai chi and yoga, also help, according to a 2008 study.

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Work on a positive attitude

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Is your glass half empty? It can help to try to have a more positive attitude. In fact, certain depression treatments, such as CBT, can help you develop a more upbeat outlook - although this treatment doesn't work for everyone.

"Not all respond to CBT interventions," says Dr. Wood. "The underlying philosophy of CBT is that the thoughts are what cause the distress and if you change the thoughts you can change the depression, but that's true for only a subset of people."

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Take care of your health

Now is the time to focus on both your mental and physical health, because the mind-body connection plays a role in depression and relapse.

"The more we take care of ourselves, the less vulnerable we might become to depression, as well as to a recurrence," says Dr. Wood.

Depression is associated with a greater risk of heart disease and diabetes. "There's very good evidence that people with depression have higher rates of medical illnesses than people without depression, and the more medical illnesses you have, the more likely you are to have depression and to relapse," explains Dr. Sanacora.

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Put off big decisions

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You may feel like a new person, but it's not the time to make major changes - even ones that you think will make you happier.

"Both good and bad 'big decisions' are stressful," says Dr.Susan L. Marusak, research physician and clinical faculty at the Mood Disorder Research Program at UCLA Medical Center and a private practitioner, in Santa Monica, Calif. "I often advise patients to wait, if they can, until they are feeling stable and 'euthymic' before making a major life-changing decision."

Irwin recommends putting off big decisions until you're at least a six on a happiness scale of one to 10 (where zero is misery and 10 is elation).

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Stop blaming yourself

If you're prone to depression, you may mentally berate yourself for missteps, either real or imagined. But a constant barrage of "I should have done this differently" or "If only I would have done that" is counterproductive, and could send you spiraling downward into depression.

You need to learn to accept what you can't change and focus on changing what you can, says Dr. Sanacora, who recommends seeing a therapist with expertise in techniques like cognitive behavioral therapy to help change your thought patterns.

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Watch your diet

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Diet and exercise go hand in hand when it comes to maintaining mental and physical well-being.

"A low-fat diet, rich in fish, especially omega-3s, and folic acid can be helpful for mood. And avoiding alcohol and minimizing caffeine use is also helpful," says Dr. Marusak.

A Mediterranean-style diet, rich in veggies, fruits, nuts, whole grains, and fish, is linked to a lower risk of developing depression, according to a 2009 study in the "Archives of General Psychiatry."

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Don't stop treatment

Doctors recommend taking medication for six to nine months after symptoms lift and you start to feel stable, says Dr. Marusak.

The decision to end therapy or medication should be made with your doctor's help. "Some drugs, if you go off them, may not work for you again when you go back on them - (there's no) guarantee that if it worked once, it will work next time," says Dr. Sanacora.

For some people, the best way to prevent a relapse is to continue treatment.

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Volunteer

Reaching out to others may help you too. One 2005 study in the "Journal of Health and Social Behavior" found that volunteering had a beneficial effect on depression among older adults, and preliminary findings conducted at the Institute of Psychiatry at King's College, London, suggest a "strong link" between volunteering and recovery from mental health problems, with about 85% of participants reporting positive outcomes after volunteering.

"Usually when we can get out of ourselves in some way, we can feel a lot better," says Dr. Wood.

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Avoid alcohol and drugs

Steer clear of alcohol and especially illegal drugs, which can interfere with depression medications and alter your mood - and not in a good way.

"Alcohol is a depressant, and many street drugs deplete serotonin and dopamine, which are important neurotransmitters in relation to mood," says Dr. Marusak. "We usually recommend patients abstain from alcohol, even socially."

Irwin says that you can be setting yourself up for a relapse if you take unprescribed drugs. "Alcohol gives depressives 'permission' to slip into that abyss, because it underscores or verifies your negative mood state," she says.

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Manage stress

Chronic stress can actually cause physical changes in the brain, which can affect moods and emotions. In fact, a number of studies have led researchers to suspect that stress produces changes in the brain similar to those caused by depression.

"Stress might have a large effect on some of the brain regions that control emotion and memory," says Dr. Sanacora. "If it is chronic and uncontrollable, stress might actually cause physical damage to the brain."

Develop stress-busting strategies, such as exercise, yoga, pilates, meditation, acupuncture, hypnosis, talk therapy, or turning to friends and family for support.

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Have an attitude of gratitude

Although it sounds simplistic, research suggests that for many, gratitude is a road to greater happiness. In fact, a 2005 study published in the journal "American Psychologist" found that people who performed daily gratitude exercises, such as making a list of three good things in their life, had lower levels of depression.

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Join a support group

"Support groups are particularly helpful, because there will be people there who have learned how to manage their depression and can provide excellent advice," says Anne Sheffield, author of "Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond." To find one near you, check out the National Alliance on Mental Illness or the Depression and Bipolar Support Alliance.

"Being with people who share your problem forces you to realize that you're not alone and that others have battled the same problems and can help you find solutions," says Sheffield.

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Reconnect

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Depression can make you feel alone, so it's important to reconnect with friends and family.

"We know that for all aspects of wellness, community has a healing and protective effect," says Dr. Wood.

In fact, a 2009 study published in "American Journal of Psychiatry" found that people 65 and older with a history of depression were at greatest risk of developing major depression if they believed they had poor social support.

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Build your self-esteem

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While self-esteem isn't something you can grow overnight - learning to accept yourself takes time - there are things you can do if you've lost that loving feeling. For example, make sure you spend time doing things you enjoy, and try to surround yourself with people whom you like and who make you feel good about yourself.

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Talk to people you trust

Many people don't want to talk about depression because they think they should be able to handle it on their own, or don't want to burden others. But confiding in close friends, a spouse, or family member can give you the social support you need to stay on the path to recovery.

"Health, purpose, and love are your weapons against depression," says Irwin. Just remember, your friends or spouse aren't licensed therapists and may not know how to help you, warns Sheffield. So if you start having depression symptoms again, you should reach out to your doctor or therapist as well.

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Get your rest

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It's important to get sufficient rest as you recover, since sleep helps regulate moods and is necessary for both mental and physical health.

Insomniacs are almost 10 times as likely to have depression compared to their well-rested counterparts, according to a 2005 study in the journal "Sleep."

"Sleep is a cornerstone of health, like food," says Irwin. "If it goes unattended, the body and mind cannot function properly. Regulating sleep can really help prevent depression and relapse."

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