If it does go away — which is the goal of treatment — you might naturally start to worry that the symptoms will come back. According to Mental Health America, more than 21 million children and adults battle depression every year, fewer than a third of whom receive adequate treatment. Consequently, many people risk a depression relapse.Treating depression can be frustrating, especially given the trial and error often involved with finding the right medication and the right therapist. Getting to a good place in your therapy may take months or even years, during which time you might ask yourself, “Will this feeling ever go away?”
Dan Collins, 49, a senior director of media relations in Baltimore, knows all too well what depression feels like — the first and second time around. Collins experienced his first depressive episode at age 16 and then had a depression relapse more than a decade later, at age 28.
“I had a very deep feeling of hopelessness, like there was nothing I could do to fix my situation,” Collins says. “I also had a high degree of anxiety, almost panic sometimes, that made concentration on anything nearly impossible. I couldn’t find a therapist fast enough, someone to ‘please stop the pain,’ and I drove from bookstore to bookstore, trying to get my hands on every book I could find on the topic of how to treat depression.”
Howard Belkin, MD, JD, an assistant professor at the Oakland University William Beaumont School of Medicine and a psychiatrist at the Birmingham Counseling Center in Royal Oak, Mich., says that Collins’ experience is fairly common. “Sometimes even with excellent expert treatment, depression can return and become chronic,” he says.
Compounding this is the fact that relapses seem to feed on themselves. Experts say it’s likely that at least 60 percent of those who've had a depressive episode will have a second, 70 percent of those who have had two episodes will have a third, and 90 percent of those who have had three will have a fourth.
Why Depression Relapse Happens
There is no single answer to explain relapses, says Michael Brodsky, MD, a psychiatrist and medical director of Bridges to Recovery, a mental health facility with multiple locations in California. “For some, the life stressors that triggered the initial depression become intensified and re-trigger a depression,” he explains. “For others, no treatment or inadequate treatment prevents the depressive syndrome from ever really resolving. Instead, more serious depression symptoms become dormant before a different stressor causes them to flare up.”
Some research suggests there may even be a biological predisposition to recurrent depression. And other evidence indicates that people may relapse because they discontinue depression treatment prematurely. “Often, patients begin to feel a little better and stop therapy or medication before they are completely well,” says Dr. Belkin.
Potential Triggers for Depression Relapse
Each person also has personal relapse triggers, some of which you can control and some you can't. These may be interpersonal or family stress, financial problems, job loss, and other real-world issues. “The stress of our fast-paced modern world certainly has an impact,” says Thomas Gazda, MD, a psychiatrist with Banner Behavioral Health in Scottsdale, Ariz. What is pleasurable to one person, he says, can be a trigger for depression in someone else: “For some, the holidays are stressful, and for others, they are enjoyable and relaxing.”
One common trigger for depression relapse is a dangerous love entanglement. It’s a phenomenon that engulfs people who become depressed within a high-conflict intimate relationship, says Dr. Brodsky. “They receive depression treatment and recover, then stop their treatment and return to the relationship, only to become depressed again in a matter of months.”
Being aware of and avoiding such situations or triggers that set off depression symptoms are steps you need to take whether you’re going through depression treatment or have recently recovered.
Signs of a Depression Relapse
Expect all-too-familiar feelings — signs of depression relapse are similar to symptoms of the initial onset of depression. “The earliest sign is often a change in sleep patterns,” Dr. Gazda says.
Sadness, irritability and anger, problems with appetite, feelings of guilt, lack of energy, and feelings of hopelessness are also potential signs. “And, of course, suicidal feelings are signs of serious illness,” Belkin adds.
Avoiding the Return of Depression
To prevent a depression relapse, continue to follow your doctor’s advice. “Go to therapy sessions, talk with family members, take prescribed medication, and avoid alcohol and drugs,” Belkin says.
It’s also important to keep busy with productive activities and be around other people, strategies that have worked well for Collins. “I have continued the sport of fencing, which I first started at age 23," Collins says. "Making friends and getting exercise are great for mental health. And last year I decided to audition for roles in a community theater production and got cast as Jimmy Tomorrow in Eugene O’Neill’sThe Iceman Cometh.”
Renew your commitment to positive lifestyle habits — get restorative sleep, engage in meditation or other stress-reducing techniques, and eat a diet that includes all colors of the rainbow, says Gazda, who notes that relapsing more than three times may mean maintenance therapy for life is a must.
Most important in the prevention of depression relapse is to stay aware of its very real possibility, not as a source of anxiety but as a proactive step for well-being. If you sense depression symptoms returning, get help immediately.