Free Managing Your Depression by Susan J. Noonan Page A

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.
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Sample Completed ACTION PLAN FOR RELAPSE PREVENTION
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My BASELINE
• Describe your baseline and what you need to do to maintain it .
When I’m feeling well, I …
get up and get showered and dressed every day
go to work and interact with my colleagues
go grocery shopping and prepare my meals
exercise after work and on the weekends—aerobics, jogging, swimming, bicycling, hiking
watch funny movies, read mystery novels, knit
visit with my friends
To stay well, every day I need to …
take my medications
sleep 7 hours
eat 3