A Guide For Sufferers and Carers
Chapter 17 – Setbacks, Relapses, and Bad Days
Recovery from depression is rarely a straight line.
There is a natural hope that once things begin to improve, they will continue to do so steadily. That each day will feel a little lighter than the one before. That progress, once made, will remain secure.
In reality, the path rarely even. There are better days and more difficult ones. Periods of progress, followed by times where symptoms return or intensify. Moments where you feel as though you are moving forward, and others where it seems as though you have been pulled back.
These experiences can be deeply discouraging. A setback can feel like a loss of everything you have worked towards. A return of familiar symptoms may bring with it the fear that nothing has truly changed.
You may find yourself thinking:
- “I was doing better. Why am I back here?”
- “Have I undone all my progress?”
- “Is this how it is always going to be?”
These thoughts are understandable. But they are not an accurate reflection of what is happening. Setbacks are not the same as failure. They are a normal part of recovery.
Depression is influenced by many factors, including biological, psychological, and social elements. Changes in any of these areas can affect how you feel. Stressful events, physical health, sleep, environment, and even subtle internal shifts can all play a role.
Because of this, it is not unusual for symptoms to fluctuate. A difficult day does not erase a week of progress. A challenging week does not undo months of effort. Progress in depression is not measured by the absence of difficult days. It is measured by how you respond to them.
When symptoms return or worsen, the first response is often self-criticism. You may feel that you should have done something differently. That you should have prevented the setback. That you have somehow failed to maintain your progress. This response can deepen the difficulty.
Self-criticism adds an additional layer of distress to an already challenging situation.
A more helpful approach is to begin with recognition.
Something has shifted. You are experiencing a more difficult period.
This acknowledgement is not an admission of defeat. It is a way of orienting yourself to your current experience.
From there, it can be helpful to return to the basics. The strategies that support you on more stable days are often the same ones that can help during more difficult periods.
- Small, manageable steps.
- Reduced expectations.
- Attention to rest, nourishment, and routine.
You do not need to and cannot solve everything at once. In fact, trying to do so can increase the sense of overwhelm.
Instead, you might ask:
“What is the next small thing I can do?”
This question brings the focus back to the present moment. It shifts attention away from the broader concern of “getting better” and towards what is possible right now.
It can also be helpful to reflect on previous experiences. If you have had difficult periods before, you have already navigated them in some way. You may not have done so perfectly, but you have moved through them.
- What helped, even slightly?
- What made things more difficult?
These reflections can provide guidance without requiring you to start from scratch.
At the same time, it is important to recognise that each setback may feel different. What worked before may not feel as effective now. This does not mean that the approach is no longer valid. It may simply need to be adapted to your current situation.
Flexibility is an important part of resilience. Another aspect of responding to setbacks is managing expectations. There can be a tendency to expect a quick return to how things were before. When this does not happen, it can lead to frustration and discouragement.
Recovery often involves moving through difficult periods, not around them. Allowing time for symptoms to settle, rather than forcing them to disappear, can reduce pressure. Connection, as discussed in the previous chapter, can also be important during setbacks. The instinct may be to withdraw further, particularly if you feel that you have “gone backwards.” There may be a sense of embarrassment or reluctance to let others see that you are struggling again.
However, maintaining even a small level of connection can provide support.
You do not need to explain everything. Sometimes it is enough to let someone know that you are having a difficult time. This can reduce the sense of isolation and create space for understanding.
If you are receiving professional support, a setback may be a useful point of discussion. Therapists, counsellors, and healthcare providers are familiar with the fluctuating nature of depression. Sharing your experience can help to identify patterns, adjust approaches, and provide reassurance.
It is also important to distinguish between a bad day and a relapse. A bad day, or even a series of difficult days, is a temporary increase in symptoms. A relapse may involve a more sustained return of depressive symptoms over a longer period. The distinction is not always clear, and it is not always necessary to define it precisely. What matters more is your response.
If symptoms continue or get worse, consider seeking extra support, reviewing therapy, consulting a professional, or changing your routine. Seeking help in this context is not a sign of failure. It is a continuation of the process of care.
Throughout all of this, it is important to hold onto a broader perspective. The presence of setbacks does not mean that recovery is not happening. It means that recovery is unfolding in a way that includes variation. You are not starting from the beginning each time.
Even when symptoms return, you bring with you the understanding, the strategies, and the experience you have gained. These resources matter. They may not remove the difficulty, but they can change how you move through it.
There is also value in recognising what has not been lost. Even in a difficult period, there may be aspects of your life that remain intact. Relationships, skills, moments of stability, small routines. These elements can provide a foundation. It can be easy to overlook them when symptoms intensify, but they are still there.
Resilience is not about avoiding difficulty. It is about continuing, in whatever way is possible, through that difficulty.
This may look like very small actions. Getting out of bed when it feels hard. Completing a single task. Reaching out, even briefly. These actions may not feel significant, but they represent persistence. Over time, these small acts accumulate. They create a pattern of response that supports recovery, even when progress feels slow or uncertain.
There may be moments when you feel discouraged. Moments when it seems as though the effort is not leading anywhere. In those moments, it can be helpful to remember that recovery is not defined by the absence of setbacks.
It is defined by your continued engagement with the process.
- You are still here.
- You are still responding.
- You are still moving, even if it does not feel like it.
Setbacks are part of the landscape of depression. They are not the end of the path. They are points along it. Each time you encounter one, you have the opportunity, however small, to respond with understanding rather than judgement. To return to what supports you. To continue, one step at a time, in a direction that allows for both difficulty and the possibility of change.
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© Richard J Kirk – 2026. If you want to know more, see: About Me…
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