18 Ways to Prepare for (and Cope with) Difficult Days of Treatment-Resistant Depression as Told by the Mighty Community.
Depression sometimes feels like it comes in waves. One day, you’re floating in calm waters; the next, it’s as though you’re being pulled under. With treatment-resistant depression (TRD), these waves may seem to roll in constantly – requiring you to remain vigilant about managing your mental health, especially when the waters are – for the moment – calm.
Some doctors may define TRD differently, but the diagnosis is commonly given to adults with major depressive disorder (MDD) whose symptoms have not adequately responded to two or more antidepressant medications during the same depressive episode.1
We asked members of our Mighty community who live with TRD to share the strategies they use to take care of their mental health in addition to their current treatment plan. They also shared the tools they use to prepare for and cope with a depressive episode when one hits. Take inspiration from their answers and let us know in the comments what tools you use to get through a depressive episode. No matter where you are in your journey with TRD, you are a TRD Warrior, and you are not alone.
What are some ways you take care of your mental health/wellness when you are feeling okay that help you during the times when you are not feeling well?
“I find, when I am feeling okay, if I listen to songs I really enjoy singing and dancing along to, I can train myself to really get into the song and have fun. Then, when I am not feeling well and I find it harder to escape, I can use those same songs to connect to happier times and escape my reality even for a few minutes and give myself a break. In the same vein, I like to use movies, TV shows, and books.”
- Going Back to the Basics
“I often find myself going back to basic needs, both in times when I’m doing okay and times when I’m not. Making sure that I’m eating something every day, trying to get enough sleep, and allowing myself space to take mental breaks when I need to are some of the main things that help me stabilize when I’m not doing well, but also keep me from crashing when I’ve been doing okay.”
- Regular Therapy
“When I’m doing well, I always make sure I don’t stop therapy. I may reduce the frequency of appointments, but I have found that it’s good to stay connected and consistent. When I’m not doing well, therapy is essential, and this way I am still connected to my provider.”
- Daily Goals
“I find setting a daily goal to be helpful even when I’m feeling well. It can be as simple as taking a shower when I’m depressed or going out for my favorite coffee when I’m feeling well. The most important thing I keep in mind when creating my routine is to keep the goals simple and achievable, even during my worst depressive episodes.”
- Planned Activities
“I use activation techniques such as physically going out and doing activities like going for a walk. I make sure, when I am feeling okay, to try to program an activity into my day. This way, when I am depressed, this activity is already programmed as part of my day, so it is more likely I will be able to convince myself to get out of bed and do it.”
- Physical Exercise
“I run to help with my mental health. The physical release of chemicals, but also the quiet time to clear my mind, are incredibly helpful to manage my mood.”
We also asked our community: What are the tools or strategies you use to prepare for and cope with a depressive episode?
- Mindfulness Techniques
“I use mindfulness – clearing my mind to focus on the present – when I am feeling okay and when I am depressed. It is a great tool to help you be aware and present with what you are feeling and thinking. This tool helps me become aware that a depressive episode is coming, so that I can begin to implement coping mechanisms before it really hits me. I also use mindfulness to cope with the depressive episode while it is happening by drawing my mental attention to the depressive weight I am feeling and separating it from who I actually am as a person.”
- Breathing Exercises
“When I am preparing for a depressive episode, or while I am in a depressive episode, I tend to get very tense and weighted down. By doing breathing exercises (one example is the 4-7-8 method of breathing: breathe in for 4 seconds, hold it for 7 seconds, and breathe out for 8 seconds), I can really lighten the weight and muscle tension that I feel, as well as calm some of my racing thoughts.”
- Soothing Sounds
“I like to put on calming sounds like peaceful rain. I lay on my bed, close my eyes, and think of the rain hitting the ground. I smell and feel the rain. I bring all my senses in on the experience. This can really help me clear my mind.”
- Art and Writing
“I use art, writing, and visualization to prepare for and cope with my depressive episodes. Whether the art is my own work, has been commissioned by me, or was given by a friend, contemplating objects I find beautiful helps me recall fond memories and visualize moments that have meaning for me.”
- Preparing for Episodes
“If I know something is coming up that will trigger a depressive episode, I set up a plan to try to prevent things from crashing too far. This includes making sure I don’t have too much time by myself when I’ll get stuck in my head, while also making sure that I’m not over-functioning and that I have time to myself, too.”
- Telling Friends and Family
“I try really hard to communicate to my friends and family that I’m not doing well. Sometimes that can be difficult — admitting that you’re not okay. But by doing so, I have more support in place and people who care enough to check on how I’m doing.”
- Daily Reminders
“My go-to for preparing and coping with depression is using an erasable white board that I have right next to my bed. On it I have three things that I change every night so I can see it first thing in the morning. I write my goal for the next day, something I’m grateful for, and one thing I’m going to do that I enjoy. It’s helpful because I can change it daily and seeing what I write helps me track my symptoms. It also reminds me to do something fun, something that gives me hope and my life more meaning.”
“One tool is journaling every day. Even if it’s one sentence, getting my thoughts and feelings out on paper helps me ‘get out of my head.’ This can also help me track my mood by noticing how hard it is to write because it’s something I truly enjoy. If I don’t have the energy or motivation to write, I know my mood is getting low.”
- Safety Box
“I have a safety box. I decorated the box myself and keep it under my bed. In it, I have some of my favorite comfort things which include essential oils, a picture of my family, a fidget spinner, a coloring book, and my weighted blanket. Having everything together and easily accessible makes it easier when I’m depressed and have little energy to find comfort objects and use them.”
- Holistic Approach
“I always take my medications. I also try to walk most days, even when I am down. If the walking itself does not help my mood, the sense of accomplishment does.”
“A tool I utilize is self-compassion. My days become a blur, consisting of primarily sleeping and watching television, and if I’m not careful, self-loathing seeps in. Instead, I give myself permission to withdraw from my life, if needed. Blaming or shaming myself only hinders the episode.”
- Having Hope
“Since I typically shut down and step out of my life when depression strikes, I remind myself that the episode is temporary – that I have been in the same spot countless times. And even though it seems unimaginable, the depression will lift at some point. Believing this and having hope are important because the illness feeds us lies and makes us feel helpless and hopeless.”
We hope you find these methods and tools used by some of our community members helpful as you continue to build your “toolkit” to support some of your harder days. Please talk to your counselor, therapist, or physician about other techniques they might recommend for you. Please remember to talk to your doctor if you are struggling. You aren’t alone.
 Agency for Healthcare Research and Quality. Definition of treatment-resistant depression in the Medicare population. https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/id105TA.pdf. Published February 9,2018.