One year without a depressive episode – a cautious celebration!

It’s been twelve months now since I have experienced a depressed period. Achieving this has been a long sought-after target after around 8-9 years of cycling through up and down periods, with the predominant and longer spells being depressed ones. So, why has this brought uncertainty and consternation rather than pure celebration?

I should be celebrating, but it’s not that straightforward.

This should, I feel, be a time of celebration and relief. A time to acknowledge all the work I have put into managing my mental health more effectively. The last three autumns and winters before the one just gone involved severe, prolonged depressive spells lasting around six months. Breaking this cycle has been a big aim of mine, and honestly, I didn’t think I would achieve it this year.

Not experiencing depression for a year now has been a blessed relief. However, the longer the stability remained over this autumn and winter, the more unsettled I became. It’s been odd experiencing my life and the world without the enforced withdrawal and isolation that depression tends to bring. My usual anchors and rhythms of life have been disrupted - in a good way, but it still requires processing and management.

The reality of living with recurrent depressive episodes

The impact of a depressed spell for me tends to be:

Loss of words and thoughts

This is a strange phenomenon, but my brain works much slower and finds it hard to form words, thoughts, and connections to ideas. There is nothingness, which is one of my most challenging aspects.

Loss of connection to others

I must withdraw from my husband, children, parents, other family members, and friends. I still communicate with them and proceed with the routines of life. Still, I avoid communicating whenever possible and find it a real effort to do the basics of talking and interacting.

Withdrawal from social media—I may scroll but don’t engage or interact. I limit my time there because I feel inferior and lack self-confidence. Hence, it tends to make me feel worse about myself even though I am pleased to hear about the successes of friends and contacts.

Loss of confidence

In my ability to be a good wife, mother, friend, worker and colleague.

Struggle to plan anything and make decisions.

Above standard day-to-day stuff; sometimes, even that becomes anxiety-inducing.

Loss of motivation and energy

No motivation to do things that I know I usually enjoy, with a loss of interest in my specialised interest areas and hobbies.

Loss of hope for the future

Loss of hope and, in my darkest and most challenging moments, suicidal ideation.

Cumulative effect

Experiencing the above impacts just once is hard enough, but experiencing it recurrently and before my bipolar diagnosis, being asked by my psychiatrist to look up 'treatment resistant depression' (a labelling that is unhelpful in many respects!), adds to the impact of each episode. Whilst I have gained the knowledge and ability to cope with the extreme lows, each time, there remains a question mark as to whether I can pull myself out of the latest dark, depressed hole. There's the ever-present fear of depression consuming me once again.

Adjusting to the familiar pattern being disrupted

Whilst these depressed spells were horrible to live through, they had been a recurrent part of my life for nearly a decade. The recognisable pattern of my moods and experiences was suddenly broken, and I found this destabilising and unsettling, whilst also being thankful that I had avoided the depression thus far. 

I felt vulnerable to a downward slide for the first couple of months this year, but it hasn’t materialised. Now, especially with spring and the good weather the last few weeks, I feel more confident in my stable/balanced state. 

This is the reality of living with a long-term mental health condition like bipolar. It’s possible to live well and manage symptoms, but the fear of depression returning never really goes away. Maybe it will in time, or perhaps, as I suggested to my therapist recently, expecting it to return does ironically make it less likely. Many times, I have recovered from a depressed episode and felt that I have the answer and that I can stop this from happening again. Only to be disappointed and distressed when it reoccurred.

What has helped me avoid depression this autumn/winter?

I’ve been considering this question with my therapist and have compared the autumn/winter of 2023-24 and the most recent autumn/winter to identify what has changed. My life, in terms of family and work situation, plus external local/national/global circumstances, has been particularly complicated over the last five years, with the previous twelve months being no exception. There have, therefore, been many changing variables between and within the two autumn/winter periods. So, in some ways, it is hard to draw specific conclusions of cause and effect. 

I have, though, been able to identify several interlinking factors which I believe have helped me avoid depression this time around. 

• Change in anti-depressant medication – not feeling drowsy and numb often, a change made over twelve months ago in February 2024 and has remained consistent throughout.
• Starting HRT in December for perimenopause possibly also had a positive impact this year.
• Ongoing regular therapy sessions and more regular input from a psychiatrist.
• I have a better understanding of how being autistic impacts me and how it interacts with being bipolar.
• I have a much better understanding of bipolar disorder and how I can manage the symptoms more effectively – particularly on controlling the hypomanic ups to help prevent burnout and recognising early signs of burnout and resting.
• Focused on Seasonal Affective Disorder (SAD) and how to mitigate its impact by using a SAD lamp and pre-planning for autumn and winter activities and events during the summer (see my earlier newsletter about my Strategies for coping with SAD for more detail on that).
• I have maintained a good connection with my husband, children, and close family.
• I have maintained engagement on social media and written these newsletters—a form of connection and means of keeping my words flowing. Crucially, I have not pressured myself to write posts or newsletters when time hasn’t allowed or I’ve not felt inspired to write. I write for myself as much as for others.
• Regular exercise. Although it wasn’t as regular as I had planned or would have liked, I didn’t experience the complete stopping of attempts I did the previous winter. Having a race booked in as a target or something to aim for, beyond just doing the training, has been helpful, even though I won’t now be able to participate in the race I had planned due to injury. Switching from running to swimming has been particularly helpful in the last month.
• Peer support I have engaged with for both the bipolar and the SEND parenting side of things—regular opportunities to talk to those who truly understand.
• Being self-employed and having the opportunity and flexibility to do volunteer work alongside paid freelance work in my areas of interest. This has undoubtedly given me the time to put all the above in place.

What do I need to do now to maintain this stability in the long term?

One of the most problematic aspects of living with bipolar is the contrast between the highs of hypomania and the lows of depression. It has meant that I spent a good chunk of the last couple of years since my diagnosis trying to work out what stable and balanced looked and felt like for me. What is my ‘normal’? 

I have said on numerous occasions that I enjoy the periods of hypomania. I find the boost in energy, the lack of need to sleep for as long, my brain operating at multiple times the speed it does when depressed, the ideas and connections my brain makes during those periods, the confidence it gives me – it does feel like what I imagine (as I’ve never taken any) taking drugs which make you feel high do. It is tangibly and noticeably different. 

However, one of the most important realisations I have had is recognising that whilst hypomania is enjoyable and arguably productive initially, the consequences, both during periods and for the months following, can be severe. I am much less inhibited and reticent in giving my opinion to others when hypomanic. I can do so without my normal levels of tact and diplomacy, which can result in confrontations and misunderstandings. This can negatively impact my relationships with others. I also tend to take on too much, leading to burnout if left unchecked. 

This is where I believe my bipolar and autistic needs have interacted most noticeably in the past. Hypomanic episodes in recent years have increased in intensity and led to me becoming dysregulated and exhausted physically and mentally. What I have managed to achieve within the last twelve months, which seems to have helped, is to recognise when I am veering towards hypomania and to keep a lid on activity levels as far as possible. I will take more regular rest and recuperation breaks when exhaustion is approaching. 

Previously, I would have continued to push on through when starting to feel like my energy levels and mood were dipping because I would assume that what I was experiencing was the onset of depression – and typically, the advice is to activate for depression. However, recognising that what I am, in fact, experiencing is autistic burnout means that resting and withdrawing can be a more effective management strategy. That rest and withdrawal for a few hours, days, or a week even seems to have enabled me to reset and then reengage without depression occurring. 

From now on, I will be trying to do more of the same. Evening out the edges of my bipolar symptoms whilst not expecting myself to stay at a constant mood level and recognising the needs I have as an autistic person. Maintaining connections to others is incredibly important, both in person and virtually. I need interactions, feedback, informed debates and discussions, and I need to feel understood without overexplaining myself. 

Valuing and nurturing my most important relationships is essential to me, and my husband, children, and close family and friends will always come first. But I’ve recognised that to be there for them, I also need time for myself, to pursue my interests and hobbies, to have time for friendships and more professional relationships to build and nurture. I must be clear and comfortable with my identity, beliefs, and values. 

I haven’t figured this out conclusively yet and probably never will; it is a constant learning curve, and life never stands still. I'm learning to be more flexible and adapt to circumstances as they are rather than wish they were different (without taking any action to change things) or getting annoyed when they’re not as I want. It’s hard work and takes considerable time and effort, but I hope it is starting to pay dividends.

About the author

I am Joanne (Jo) Feaster, a late-identified autistic and bipolar woman. I started self-identifying as autistic in May 2023 and was diagnosed with bipolar type 2 in July 2023. I am married and live in Leeds with my husband, John, and my two exceptional children, both of whom were diagnosed in late 2023 and early 2024 as autistic and with ADHD. 

I write to aid my mental health and to share my lived experiences as an autistic and bipolar woman and parent-carer of my neurodivergent children. I subscribe to the social model of disability and the neurodiversity paradigm. I see our strengths, positive qualities, and spiky profiles just as much as I recognise the barriers we face from society.