On this web site, I have written that relapse prevention is a critical part of recovery from depression. Surviving an episode of depression is not like having the measles—one does not develop an immunity to the disease. Because the underlying predisposition does not go away, symptoms can always return.

I can speak to this matter personally. I recently had a “mini-relapse” into the anxious state that I experienced in the fall of 1996. The current episode was brought about by a series of Job-like calamities that occurred over summer, Finally, the accumulated stress reached a tipping point, which caused something in my nervous system “to snap” and brought about a biochemical state of hyper-arousal and hyper-sensitivity. I felt as if I no longer had an “outer skin.” Every environmental stimulus was magnified a thousand fold. I felt fragile, vulnerable and fragmented. Simply leaving the house seemed like a big deal.

After a few days of being in this state, I decided to call a good friend who also suffers from anxiety. When I explained to him that my symptoms were caused not by catastrophic thinking but by a genuine chemical imbalance, he said, “Well, if the problem is caused by chemicals, then it needs to be treated by chemicals.” (i.e. a benzodiazepine like Xanax or an SSRI antidepressant like Paxil.)  I replied that there are a host of other ways to affect the brain’s neurochemistry, and that I was going to return to these same strategies that I used to cope during my previous episode.

After our conversation ended, I remembered that I had committed to picking up a friend from a doctor’s appointment in 45 minutes. I still had anxiety about leaving the house, so I hopped into my elliptical trainer and worked out for twenty minutes. When I was finished, I felt calmer. The intense exercise had burned off some of the agitating chemicals in my brain.

I was then able to pick up my friend from the hospital. When I returned home. I consumed a meal of rice and lentils and added a B-complex vitamin (good for the nerves), which I washed down with a cup of chamomile tea. My rationale for the rice and lentils was that carbohydrates can boost tryptophan transport across the blood-brain barrier, and tryptophan is a precursor for the feel-good neurotransmitter serotonin. Afterwards, I felt calm enough to go back to my writing.

And so I manage this anxiety, one day at a time. I am learning once more that in the absence of medications, there are “low-tech” tools such as diet, exercise, touch, human love and caring, meditation, and spirituality that we can use to improve our mental and emotional state. If indeed there are no breakthrough psychiatric drugs on the horizon, it is even more important that we become familiar with  these tools, place them in our toolbox and apply them as needed.