After experiencing depression once, it can be worrying to feel the symptoms creeping in again. But how common is depression relapse and what are the warning signs? Noticing the red flags early is often the key to preventing a full-blown episode from developing.
Depression is a mental health disorder with a high rate of relapse. About half of the people who experience an episode of depression for the first time will remain well. For the other half, depression can return one or more times throughout their lives.
For those people who do experience repeat episodes of depression, the warning signs may be different each time.
Depression relapse can occur days, months, or years after recovering from an earlier bout of depression. Sadness or a loss of interest in everyday activities can be a perfectly normal part of life. But if these feelings continue almost daily for more than 2 weeks, and if they begin to affect work or social life, then this may be depression.
According to the National Alliance on Mental Illness (NAMI), depression affects around 7 percent of adults in the United States every year.
After the first episode of depression, the American Psychiatric Association’s (APA) practice guidelines say that depression can return in two ways.
“Depression relapse” happens when a person slides back into depression during recovery from an earlier episode. Relapse is most likely to occur within 2 months of stopping treatment for a previous episode.
“Depression recurrence” happens when symptoms return months or years after a person has recovered from the last episode. This is most common within the first 6 months. Around 20 percent of people will experience a recurrence, but this can rise when depression is very severe.
After a person’s first episode of depression has ended, the APA estimate that between 50 and 85 percent of people will have at least one more episode of depression in their lifetimes. After two or three earlier episodes, the chances of depression returning are much higher.
Some depression-like disorders will frequently return and are usually identifiable by their name. These conditions include seasonal affective disorder (SAD), which comes back during winter months, and premenstrual dysphoric syndrome (PDS), which is a severe form of premenstrual syndrome.
12 early signs of a depression relapse
Social withdrawal, and a loss of interest in pleasurable activities, may be signs of a depression relapse.
A person can often recognize the same warning signs of depression from their previous episodes.
The symptoms of a new episode can also be different, however, so it pays to look out for all possible warning signs each time.
Here are some key warning signs of depression:
Depressed mood: Feeling sad, empty, or hopeless.
Loss of interest in things usually enjoyed: Taking less pleasure from hobbies, reduced interest in sex.
Social withdrawal: Avoiding social situations, losing touch with friends.
Fatigue: Daily tasks may feel more difficult and take longer, such as washing up and dressing in the morning.
Feeling agitated: Restlessness, pacing.
Changes in sleep patterns: Insomnia or excessive sleeping.
Changes in appetite: Loss of appetite or an increased appetite.
Increased irritability: Getting annoyed more easily than usual.
Feelings of worthlessness and guilt: Thinking over past events.
Concentration and memory problems: Thoughts and speech may feel slower.
Physical aches and pains: Unexplained headaches, stomach aches, or muscle pain.
Suicidal thoughts or suicide attempts: This may signal a severe depressive episode.
Diet and depression: Foods and nutrients for recovery
Diet and depression: Foods and nutrients for recovery
Learn about the connection between diet and depression, and how the foods a person eats can impact symptoms.
Possible relapse triggers
Specific triggers are more likely to cause a depressive episode in people who have a history of depression compared with those who have never experienced depression.
Common triggers for depression relapse or recurrence include:
Stressful life events that happen during or after recovery. These can include family conflict, relationship changes, and grief.
Incomplete recovery from the last episode of depression. If the main symptoms are not fully treated, depression is more likely to return.
Stopping treatment early. Depression is not always a quick fix — sticking with treatment for 6 or more months after feeling better can reduce the risk of future depression.
Medical conditions, such as diabetes, obesity, and heart disease, can lead to higher rates of future depression.
Tips for preventing a relapse
Man talking to his therapist during counseling session.
Continuing with treatments, including taking medication or going to therapy sessions, may help to prevent a depression relapse.
These prevention strategies can help to stop depression from making a comeback:
Keeping up with treatment: Finishing the full course of a prescribed medication can significantly reduce the risk of relapse. This can be especially important during the critical 6 months after treatment begins.
Mindfulness-based therapies: Mindfulness can help a person to become aware of negative thought patterns, and to develop ways of dealing with them. One study shows that practicing mindfulness three times a week may reduce depression relapse by up to 50 percent within a year.
Educating friends and family: Telling friends and family what warning signs to look out for might help to catch an episode of depression early.
Prepare for a relapse: Even if symptoms of depression have not returned, it may help for a person to make a plan so that if warning signs do appear, they can act upon them quickly. A doctor can help with this.
Treating and coping with a relapse
When worrying symptoms of depression come back during treatment, it might mean that the current treatment methods are not working as they should.
A doctor may recommend that a change in treatment style, or an increase in medication dosage, could help to keep depression under control.
Depression treatments recommended by NAMI and APA include:
Talking therapies: Options include interpersonal therapy (IPT) and cognitive behavioral therapy (CBT). Both are shown to reduce the risk of depression returning.
Medication: Doctors can prescribe antidepressants or mood stabilizers. Continuing to take antidepressants for 6 or more months even after symptoms have subsided can reduce the risk of relapse.
Exercise: Keeping active can act as a natural antidepressant. It releases endorphins that can improve mood. A recent review of studies suggests that exercise can be as effective as antidepressants or psychotherapies in mild to moderate depression.
When depression is very severe and does not respond to usual treatment, a doctor may recommend electroconvulsive therapy (ECT).
Depression is an illness, not a personal flaw, and it is very treatable. Between 80 and 90 percent of people will respond well to the prescribed course of treatment.
The risk of depression returning is higher when the previous episode was more severe, or when other conditions are present, such as anxiety disorder, personality disorder, or substance abuse.
The good news is that people who have depression can improve their long-term outlook by taking steps to prevent or treat each new episode that may arise.