Depression is that unwelcome guest that could sneak up on anyone. Life happens, hurt mounts, and can quickly morph into dark clouds big enough to threaten the mental health of even the strongest of us.
What's more sinister is going through therapy regimens, following every step as faithfully as possible, only to find yourself falling into depression again, with those familiar unhappy feelings returning. However, please do not be alarmed. It happens, and it is absolutely not your fault.
Of course, there must be a thousand and one questions swirling through your mind at this point.
"Can depression come back? Am I depressed again? Why am I depressed again? Can depression relapse? What does relapse mean in depression?"
In this article, we will answer all of these and more. Let's get to it.
What is a Relapse in Depression?
A depression relapse is a period longer than two weeks, during which symptoms of depression return to a patient who had initially recovered. It is not uncommon for people who have had episodes of depression in the past to experience relapses where depression symptoms return.
If you are experiencing a depression relapse or know someone who is, it’s likely that you are overwhelmed and frustrated, which can make you feel even worse. But, it may help you to feel better to know that about 50% of people diagnosed with depression experience relapses, usually triggered by stressors that remain in the patient's environment.
It is nothing to worry about. With the correct information and care, you can learn how to avoid stressors and prevent relapsing depression and how to treat it if it happens.
Before we continue, we want to mention two mental health conditions where recurring depression or relapses are expected — bipolar disorder and seasonal affective disorder. People who are diagnosed with either of these depressive disorders are typically informed by their doctor or mental health professional that episodes are likely to recur.
While bipolar disorder and seasonal affective disorder do have “depression relapses,” in this article, we will be discussing conditions where falling into depression again hits a person off-guard.
Triggers of Relapsing Depression
We assume that right now, you might be thinking, "I am getting depressed again, how can that be?"
Research has established that depression relapses are often due to situational or environmental triggers that may have played critical roles in causing previous episodes of severe depression in the patient.
Some triggers that can cause depression to come back may include:
Traumatic Events
Trauma is one of the most widely recognized causes of depression, so it makes sense that it can lead to a repeat depressive episode. For example, a divorce, losing a loved one, career failure or job loss, natural disaster, or abuse are traumatic and stressful life events well-known as triggers of relapsing depression.
Depression associated with a traumatic event is referred to as situational depression; however, a person who is predisposed to major depressive disorder may be more likely to experience severe depression when facing traumatic or stressful situations.
Important Dates
For most of us, specific dates bear the importance of whatever events may have occurred on that same day in the past. So, anniversaries of traumatic events like the loss of a loved one tend to be a common trigger of relapses. It is important to note that if your first episode of depression was connected to a traumatic event, the anniversary date is likely to be rough too.
Childbearing
Although this has only begun to come into general consciousness, women have battled post-partum depression for several centuries. The combination of hormonal swings and physical stress associated with the process often work together to trigger depression.
If you experienced depression during or after the pregnancy of your first child, you are at an increased risk of another depressive episode with the birth of other children.
Substance Abuse
The improper use of prescription drugs or the consumption of illicit drugs can also be significant triggers of relapsing depression. Drugs have a powerful influence on the hormones and the nervous system, which can quickly trigger an episode of depression relapse. Alcohol can also lead to a repeat major depression, especially if used as a coping mechanism when feeling “sad.”
And it’s not just “street drugs” and alcohol that you need to be concerned about. Different prescriptions and over-the-counter medications can cause depressive symptoms and raise your chances of a relapse. If you have a history of past depression, it’s important to share this information with your medical professionals.
Knowing Your Triggers Helps Prevent Depression Relapse
Triggers are unique to everyone, so there is no one-size-fits-all approach to avoiding them. We’ve listed some of the most common, but the things that bring back your depression may be different.
All that is important is that you, with the assistance of medical professionals, identify your specific triggers and warning signs and then develop mechanisms for reducing your exposure to them.
How Residual Symptoms Contribute to Depression Relapse
When we talk about “residual symptoms of depression,” we are referring to when most of the initial complaints go away or lessen significantly, but the person doesn’t feel 100% back to “normal.” Compared to patients in remission who have become entirely asymptomatic, the presence of residual depressive symptoms may put you at a greater risk of depression relapses. This study places it at about 39%.
However, the connection is not a definite straight line.
With appropriate situational awareness and management, you can avoid a depression relapse, guide your loved one away from one, and set about building resilient mental health.
What are the Residual Symptoms of Depression?
Several studies have identified these residual depression symptoms that tend to linger in patients in remission or partial remission. Some of them are:
- Fatigue
- Insomnia
- Inability to fully concentrate
- Apathy
- Loss of interest in activities you usually find pleasurable.
It is important to note that medications may cause all of these and may not be depression symptoms. Just because you have these symptoms does not mean you are experiencing residual major depressive disorder symptoms.
For example, one common complaint about some anti-depressants is reduced libido and loss of sex drive — both of which are also warning signs of depression. Even though they “feel better,” many people don’t like this side effect and go off their medications, which can actually cause depression to come back.
It is important that you discuss all symptoms with your doctor, especially if you are taking medication.
Signs of a Depression Relapse: Depressive Symptoms to Watch For
So, what should you watch out for if you think you may be facing a relapse? Well, the symptoms of depression relapse are not usually far off from what you may have experienced in the previous episodes.
However, sometimes, they can be a little different. It’s not uncommon for symptoms to be worse the second time around due to a feeling of frustration that “going through it again.”
When you know what to expect — especially when you know you are not alone, and many people relapse into depression more than once — you are better prepared to handle it.
Here are some warning signs of depression to watch out for.
Social withdrawal: You may feel unusually disinclined to interact with friends and family and have an increasing urge to be isolated from everyone and everything.
Lack of motivation: You may feel increasingly demotivated to complete work tasks or other everyday tasks.
Feelings of hopelessness: Episodes of depression are usually accompanied by self-esteem issues. When depression comes back, there can be a renewed loss of hope which may be worse than the first time.
Increased agitation: It is common for people experiencing episodes to see increased anxiety and irritability.
Reduced attraction to romantic partners: It is not uncommon for people with depression relapses to feel increasingly unattracted to and distant from their romantic partners. As mentioned, reduced sex drive is common with some medications for depression.
Loss of focus: You may experience increasing difficulty concentrating on tasks, goals, or anything else.
Weight changes: As feelings of depression come back, some people turn to comfort eating, while others lose their appetite. Additionally, feeling down may also lead to much reduced physical activity. These combined factors can often lead to visible weight gain or weight loss.
Fatigue: Depression can often be manifested in increasing tiredness and drowsiness, stemming from an overall social apathy.
Changes in sleep pattern: People experiencing depression often see changes in their regular sleep schedules. For some, it’s an inability to fall asleep or stay asleep. Excessive sleeping, often stemming from the person's lack of motivation to engage with anything, is also common.
Suicidal thoughts: Thoughts of wanting to end one's own life usually signal the transition from a minor depressive episode to the onset of severe depression.
Treatment for Relapsing Depression
When it is determined that you are indeed experiencing a relapse, doctors will recommend a few treatment pathways. Depression for a depression relapse is similar to other depressive disorders, although your medical or mental health professionals might want to try different combinations or types.
Common interventions for relapsing major depressive disorder may include:
Medication
Doctors may advise mood stabilizers or antidepressants to help you cope and to boost your mental health during a depressive episode. It is possible that your doctor may want to try a different medication to help manage recurring bouts of depression. However, this may be contingent on your vulnerability to the potential side effects of these drugs. For example, if the doctors realize that the drugs may be responsible for some enduring cognitive symptoms, they may want to avoid prescribing them.
Psychotherapy
Another mode of treatment is for psychotherapists to guide you through it with counseling. Talk therapy for depression typically takes either of two forms (or both) — cognitive behavior therapy (CBT) or interpersonal therapy (IPT).
CBT involves guidance toward changing harmful behaviors that may constitute triggers and endanger your mental health. In comparison, IPT involves assistance in negotiating interpersonal relationships that may be triggering depression relapse.
Physical Exercise
Increased rates of physical activity and movement have been associated with a higher quality of emotional health and help with relapse prevention. As nature's antidepressant, exercise causes the release of endorphin hormones, which generally help moods, and thus lift our emotional and mental health.
Track your Mood
One way to keep those residual symptoms subdued, and major depression relapse at bay, is to keep track of your moods. By watching your feelings, you can better learn how to detect your emotional triggers and ensure that you don't get overly exposed to put your mental health in danger.
Reach Out to Family or Friends
A support system is vital for making it through episodes of depression relapse. Not only can family and friends assist you in achieving the steps toward recovery, but the sheer presence of a great camaraderie can help significantly boost your mental health. You may also ask your doctor about joining support groups, where you can improve through shared experiences.
And if you're a family member or friend who wants to know better about how to help a loved one going through a depressed mood or who is showing signs of depression relapse, read this article.
Coping With Relapsing Depression
The best way out of depression relapse and episodes of clinical depression is medical therapy provided by qualified medical personnel. When a patient has recurring bouts of depression, doctors may deem it fit to put them on maintenance treatment to prevent future depression relapse. Typically, this involves a course of antidepressants for a year or longer.
However, for some, considering the potential side effects of being on pharmaceutical therapy for such a prolonged period, this form of maintenance treatment may be less than ideal. In such cases, you may opt to keep your triggers at bay instead, avoid stressful life events as much as you can, and start medication only when any symptoms arise.
But, for any treatment plan for recurring depression to work - whether for major depressive disorder, reactive depressive disorder, seasonal affective disorder, or bipolar disorder - you must stick with routines recommended by your doctors, whether physical, mental, or pharmaceutical. With consistency, you can soon begin to see results and enter remission.
You, Too, Can Beat Depression
You do not have to face depression alone or solely bear the burden of caring for a family member or friend who is depressed. There are tons of resources specially designed to provide whatever help you may need.
If you or someone you know is in crisis or experiencing severe symptoms, please contact a professional.
Help is also available through crisis hotlines — studies show that just talking to someone can make a difference in relapse prevention! That's why talk therapy is so effective.
People have beat depression in the past, it's your turn.
