When it comes back

Twenty-two months after I came out of the first episode, I noticed on a Wednesday morning that I'd been waking at 4am for six straight days. By Friday, I'd cancelled two gym sessions. By the following Tuesday, I'd booked the GP. The second episode was three weeks long. The first one had been seven months. The difference was knowing what I was looking at.

Relapse is part of the picture

For roughly half of men who have one major depressive episode, there will be a second one. The numbers don't get better; the gaps between episodes do. And the episodes themselves get shorter, if (and only if) you catch them early.

This isn't said often enough at the GP visit.

The work is to know the early signs of your specific recurrence and to act on them in week one, not month three.

Your specific early-warning signs

For me it was, roughly:

1. Waking at 4am, three or four nights running.
2. Skipping one gym session, then two.
3. The phone moving back into the bedroom.
4. Snapping at my wife over the dishwasher.
5. The "I'm fine, just tired" sentence.
6. Cancelling on a friend's birthday with a vague excuse.
7. The flat feeling in the morning, three days in a row.

Your list will be different. Write yours down. Keep it somewhere you'll find it.

The early-warning checklist, common version

If three or more of these are true for two weeks running, treat it as a relapse signal:

• Sleep slipping.
• Withdrawal. You've cancelled on people you'd normally see.
• The cancelled gym sessions.
• The "I'm fine" minimisation.
• The 4am ruminations.
• The food becoming mechanical again.
• The cold shower of irritation at small things.
• Drinking slightly more.

Three of those. Two weeks. That's enough information.

The fast-response protocol

When the early-warning fires:

Day 1. Tell your partner. Same script as the first time, shorter: "I think it's coming back. I'm catching it early."

Day 2-3. Run the 72-hour stabilise from module 1.

Day 3-7. Book the GP. Long appointment again. The opening sentence: "I had depression in [year]. I think it's recurring. I want to renew the Mental Health Treatment Plan."

Week 2. Back to your psychologist if she's available.

Week 2-3. Medication conversation. The same medication that worked first time usually works second time.

The first time it took me eleven weeks to get from symptoms to GP visit. The second time it took eight days.

Why the second time is shorter

Three reasons:

You recognise it. The diagnostic delay is gone.

You have the operating manual. You know how the GP visit works.

You have the people. Your wife knows what this looks like.

Episodes for most men shorten in this exact pattern: 6-12 months for the first, 6-12 weeks for the second, 4-6 weeks for the third if caught early.

What relapse is not

• Failure. The wiring just does this for some men.
• A sign that the protocol "didn't work".
• A reason to start over from zero. You're starting from a higher floor.
• A permanent diagnosis. Two episodes do not mean a lifetime of episodes.

What to do when you're well

The work in the well years is to keep three things current:

• The early-signs list. Update it after each episode.
• The relationships. The partner, the GP, the psychologist, the two mates.
• The base habits. Sleep, food, exercise, modest alcohol.

Watch the markers. Move fast. The map is already in your hand.

Further watching

• Relapse Prevention: Early warning signs and important coping skills
• Coping Skills for Anxiety or Depression 13/30 How to Process Emotions