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Another variable is age of onset--the age at which you first experience your depressive symptoms. The earlier the age of onset for unipolar or bipolar depression increases the probability of a return of depressive illness. Severity and length of depression, sometimes called "chronicity," will heighten the odds for relapse and/or recurrence as will having a coexisting mental illness.17 Though the official onset of my depressive illness occurred in my late teens, it could be traced back to early childhood. The course of any mental illness usually goes this way: (1) the earlier the symptoms, the more guarded the prognosis, and (2) if you've had a recurrence, you are likely to have another. So, add together the intensity of my depressive episode, having two recurrences since recovery, and a coexisting posttraumatic stress disorder from sexual abuse--and my risk for recurrence skyrockets. Stressful life events (SLEs) are challenging for anyone, but tend to bear down more so on an adult or child living with depression. With regard to relapse and recurrence, issues that weren't present during the onset of your depressive illness but are operating during your recovery can weaken your resolve. Another example can be an unrelenting series of SLEs that burden your state of well-being. Stressful life events were tipping points for my depression. It wasn't a series of SLEs but rather singular life events that proved formida-ble. Going to college sent me into my first major depressive disorder. Researchers at Stanford and Columbia Universities looked into why this might be the case by offering one group of subjects thirty different types of chocolates from which they could choose a sample, and another group just six types of chocolate. The subjects then answered a few questions about how much satisfaction they felt about their selection. Those choosing from the larger variety reported more regret and dissatisfaction with their final decision. When given the option, they said they were less likely to choose chocolates instead of money as compensation for participating in the study, while those with fewer to choose from were more eager for more chocolate. The researchers suggest that "[p]erhaps it is not that people are made unhappy by the decisions they make in the face of abundant options, but that they are instead unsure--that they are burdened by the responsibility of distinguishing good from bad decisions." * Use a bracket approach when making a decision between many options, cutting down each choice to a selection between two things: Do you like A or B more? If you like A more, how does it stack up to C? And so on. Speaking of finding happiness in limited options, you don't have to travel to far-flung places to boost your well-being. Happy hour at your favorite bar might be a more accurate term than you realized.

A team of Oxford psychologists and anthropologists in England found that people who have a "local" that they frequent had more close friends on whom they could count for support, and were found to be happier with their lives, more embedded in their communities, and more trusting of others. These conclusions drew on a poll from UK-based data analytics firm YouGov of 2,254 UK adults, in which the 22 percent of respondents who said they had a favorite pub had an average of 7.2 close friends, compared with the average of 6.0 friends for those who did not have a favorite bar. Lead researcher Robin Dunbar chalked it up to the personal connections created at the local watering hole, stating that making and maintaining friendships is "done face-to-face: the digital world is simply no substitute." Find your own Cheers in your neighborhood and get to know everybody's name. Positive music can help you feel happier--if you want it to. A pair of psychology professors looked at how music affects happiness levels. They asked a group of subjects to listen to twelve minutes of music, including the "positive" (i.e., upbeat) Rodeo by Aaron Copland and the less-cheery Rite of Spring by Igor Stravinsky, noting how the music impacted their moods. The more positive music did indeed boost the subjects' happiness levels--but only when listeners put "intention" behind their listening. Over the two-week period the test was conducted, those who listened to the positive music after being asked to try to feel happier reported a more positive mood. Those participants who listened to Stravinsky's piece, regardless of instructions, and those who listened to Copland without being told to think happy thoughts, had no significant change of mood. The researchers concluded that the combination of the right music and the right thoughts is important in increasing positive feelings. One without the other is not enough. Listen to upbeat music to increase your happiness level--but pause to think positive thoughts before pressing play. I already talked about meet-up groups and clubs, but sports in particular can be a very effective way to meet new people. Remember the camaraderie you feel when you and a few of your classmates would team up for 20 minutes in gym class for a game of basketball or football? It's exactly the same as an adult, except with far more opportunities to extend those interactions outside the playing field. Most cities and towns have some form of social league you can join for sports. The problem for most people is finding a league that fits their athletic skill level. If you're just interested in meeting people, it can be hard to find a purely social league with minimally non-competitive people. For this, I recommend looking for sports that don't breed that hyper-competitive nature. Kickball and ultimate Frisbee are both very good options if they are available in your area.

Finding social leagues for softball and soccer is feasible too, but make sure to vet the league first. If you're not sure, there is always a risk that it is a more competitive than you're ready for and that you'll be uncomfortable pushing yourself that much. Creating your own league is a bit harder than just joining one. Additionally, if you're in a city, the cost of doing so can be prohibitive. Getting permits to use ball fields or courts is tough and generating enough interest will take both time and money. However, you will find quite a few people interested in most areas and if you can find the space to play, starting a league, or just putting together a pickup game every few days or weeks is a great way to meet new people. If you're already in school, this isn't really an "option", but a necessity. However, if you're interested in meeting people and you're currently out of school or never attended, taking an extension class can be a fantastic way to meet new people and build a collection of new correspondences. Most community colleges offer a number of adult extensions that are usually very affordable and local. These classes include practical topics like software instruction, accounting and foreign languages, and fun stuff like pottery, music, or dance. Choose a class based on the type of person you want to meet and the situation you're most comfortable in. The last thing you want is to be out of your element and uncomfortable around new people and therefore unable to talk to them. This is when you stop writing and think it through. What choice are you going to make? You're at the choice point. Now what? We have arrived at the final stage of getting through a low-intensity triggering moment. In the example, you want to nurture yourself. Your immediate urge is to do that by grabbing the most readily available resolution: the TV show. Since you've taken a breath and can evaluate the situation, can you run through the likely outcome?

In general, at this choice-point moment, it's vital to ask yourself: Can you validate that need and also make a choice that supports your best interests, goals, and values? Here I pick up the example again to show how you might answer these questions once you have taken a few breaths and tracked the choice point. What need do you want to meet? Relaxation, pleasure, relief. What will acting on the urge for momentary relief cost you later? I will feel more tired tomorrow morning, so I'll be more likely to either continue feeling tired or snooze late. Either way, I'll start off the day feeling stressed. Then at work I'll be more likely to express irritation or feel overwhelmed when something goes wrong. Can you validate that need and also make a choice that supports your best interests, goals, and values? Here are a few ideas for a balanced solution that takes into account both short and long term needs. Make a playlist of three favorite songs and listen to them in bed with your eyes closed. When it ends, it's time to go to sleep. Set the TV's sleep timer so the show goes off after ten minutes. You can resume watching tomorrow night--and looking forward to it might help you get through your day. Promise yourself something special for tomorrow as incentive to go straight to sleep. Maybe stop at Starbucks instead of making coffee at home. Pick up the book on your nightstand and read until you become too sleepy to continue. If your bed partner is still awake, you could kiss or cuddle. Engage any of the strategies listed in Principle 2 for winding down at night. They can help your body feel tired and ready for sleep.

Giving birth plunged me into the next one. The loss of social support and high levels of negative thinking can trigger relapse and recurrence.19 When the social network of family and friends that cared for me during my depression diminished, I felt fragile and alone. It didn't take long for negative thinking to creep in, and as soon as hopelessness took root, I fell back into a depression again. Another cause of relapse and recurrence involves neurobiology. "Antidepressant tachyphylaxis" (AT) occurs when your body no longer functions to counteract or control serotonin, norepinephrine, or other neurotransmitters.20 Sometimes called "poop-out syndrome" or "drug tolerance," AT can be regulated by increasing the dosage of your current medication or by adding a supplementary medication to augment therapy.21 If you're at risk for either relapse or recurrence, consider setting up a relapse-recurrence prevention plan to monitor early signals. Creating a unique plan and solutions will ensure that you can avoid or minimize the potential for a return of depressive symptoms. Designing a way for you to keep track of relapse and recurrence will also teach you how to use self-monitoring for your well-being. Self-observation, sometime called an observing ego, helps you to view your inner thoughts and external behaviors, detect the reasons for them, and make proactive changes by taking action. Pay attention to warning signs. Warning signs can be subtle changes of thinking, feeling, and behaving that mark either a return or a repeat of your depression. Stressful life events and triggers are more-obvious warning signs that can jolt your well-being. Warning signs can range within these extremes, so take stock and listen to your instincts. Think about how you'll know that what you're experiencing are warning signs and not just a temporary bump in the road. What will convince you that a relapse or recurrence is occurring? What will you do for subtle warning signs? What will you do if your symptoms are serious? Ask others to keep you informed. Don't be shy to invite trusted people to let you know if they detect any changes in how you present. Sometimes others can detect a resurgence of depressive symptoms before we do. Take action if symptoms return.