Many people who have experienced depression worry about the chance of relapsing. This article explores some of the evidence surrounding depression relapse and some strategies to help you reduce the likelihood of experiencing a relapse.
“Depression is the most unpleasant thing I have experienced... It is the absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts, but it's a healthy feeling. It is a necessary thing to feel. Depression is very different.”
– J. K. Rowling
What's more, in 2019, research found that a substantial number of people who recover from depression go on to achieve the highest possible levels of psychological functioning and wellbeing.
However, we also know:
35% of all persons who have at least one episode of depression will experience another episode.
15% of all depressed persons will experience chronic, unremitting, depression.
The average duration of a mild depressive episode is 14-17 weeks.
The average duration of a severe depressive episode is 23 weeks.
The average number of depressive episodes per sufferer is four.
According to the World Health Organization, depression is the leading cause of disability worldwide in terms of total years lost.
That is, years of a healthy and productive life, lost.
Recovery from Depression
Treatment of depression distinguishes between:
Response: A reduction in symptoms of depression. That is, feeling better, but not fully well.
Remission: Showing no symptoms of depression. That is, returning to your pre-episode level of functioning.
Recovery: A prolonged period of remission where depression is unlikely to occur in the near future. Recovery has been defined as the absence of symptoms for at least 4 months after the onset of remission.
Predicting Relapse & Recurrence of Depression
A 2018 review published in the Clinical Psychology Review investigated the factors that predict which people who have experienced major depression are at an increased risk of relapse & recurrence of the illness.
Relapse: The return of depressive symptoms while a person is in remission.
Recurrence: The onset of a new episode of depression following recovery.
The review found strong evidence that three factors placed certain individuals at an increased risk of relapse & recurrence of depression. These factors were:
Having residual symptoms of depression following treatment.
A history of childhood maltreatment including physical, sexual, or emotional abuse, family conflict or violence, and/0r neglect.
A history of prior episodes of depression.
There was also supportive evidence that high levels of anxiety and rumination were associated with a greater risk of relapse & recurrence.
Younger age of first onset, higher neuroticism, greater severity and duration of previous episodes of depression, having a genetic vulnerability to depression, cognitive biases (i.e., errors in thinking), and dysregulated REM sleep, appeared to be predictive of relapse & recurrence, but were not universally found so. There was very limited and inconsistent evidence that age, socio-economic status, gender, and having a family history of depression predicted relapse.
How to Lower Your Risk of Future Depressive Episodes
1. Seek Professional Help
“We are not to blame for our illness, but we are responsible for our health.”
– Victoria Maxwell
The review findings suggest that if you want to reduce your risk of a future depressive episode, you must firstly recognise whether you are at an increased risk of relapse, and then seek appropriate professional help.
If you have previously received treatment for depression and are still experiencing residual symptoms of depression (e.g., a loss of interest in activities you used to enjoy, feelings of worthlessness, or thoughts of death) you should seek additional psychological treatment that specifically targets these symptoms.
If you think you experienced trauma as a child - be it familial physical, sexual, or emotional abuse or incest; assault, molestation, or bullying from someone outside of your family; physical, medical, or emotional neglect; witnessing domestic violence; or neglect in being cared for as a child, for example, due to your caregiver experiencing mental illness, substance abuse, criminal involvement, or your being separated from them - it is incredibly important to seek help from a psychologist to address any consequences of this abuse/neglect. Sadly, the experience of childhood trauma is extremely common, and can have a profound impact on our psychological and physical health.
If you have a history of depression, it is important to meet with a psychologist to discuss strategies for preventing future depressive episodes.
If you experience anxiety or problems with rumination (i.e., you repeatedly overthink or obsess about the negative aspects of your life), seeking psychological treatment to address these problems may reduce your risk of future depression. Anxiety and rumination can lead to people thinking more negatively about themselves, their problems, and their future, which can lead to feelings of depression. A psychologist can help you to manage these problems.
To find a psychologist in Australia, click here.
2. Don't Terminate Treatment Early
If you are being treated for your first episode of depression, it is important to continue treatment - whether psychological and/or pharmacological - until you reach full remission.
If you are currently receiving psychological treatment and you do not think it is helping, try the following:
Try a different psychological treatment. There are many different psychological treatments for depression (to learn more click here). It is important to make sure you know what evidence-based treatment you are receiving, and if you do not feel the current treatment approach is helping you, ask your psychologist to try a different treatment.
Consider a different psychologist. The professional relationship you have with your psychologist is incredibly important. Seeing a psychologist involves sharing intimate details of your life and you must feel comfortable to do so and be able to work collaboratively with your psychologist. If you do not feel it is a good fit, then find someone new! Psychologists' realise the importance of the therapeutic alliance when providing psychological treatment, and ultimately, they only want to see you get better. So it is perfectly acceptable to tell a psychologist you do not think it is a "good fit" and move on - do not feel guilty about this (or assume this will be a problem with all psychologists!). To find a psychologist in Australia, click here.
Ask for a medication review. There are many effective drug treatments for depression. If you are currently receiving medication for depression and your symptoms are not improving, then: 1) ask your doctor for a medication review; and/or 2) seek the advice of a specialist - a psychiatrist - who is a medical doctor who specialises in the prevention and treatment of mental disorders.
3. Be Proactive
If you have previously experienced depression, it is important to monitor your mood, thoughts, and behaviour for signs of returning depression. If you notice any of the symptoms of depression outlined below, be proactive and seek help early:
Feeling depressed most of the day
A reduced interest or pleasure in activities you previously enjoyed
Excessive feelings of worthlessness or guilt
A slowing down of your thinking and/or a reduction of physical movement
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Weight loss or gain (when not dieting) or decreased or increased appetite
Fatigue or loss of energy
Thoughts of death or suicide
“Getting better from depression demands a lifelong commitment. I've made that commitment for my life's sake and for the sake of those who love me.”
– Susan Polis Schutz
4. Boost your Wellbeing
Growing research recognises that, following treatment for depression, focusing on improving your wellbeing can both reduce the residual symptoms of depression and prevent relapse & recurrence of depression.
Evidence shows a focus on building wellbeing can reduce the residual symptoms of depression - which are one of the strongest predictors of relapse.
The aim of EBW is to talk about evidence-based strategies that can enhance wellbeing.
To try a Positive Psychology exercise that has been found to enhance wellbeing - click here.
Please take care of yourself, and if you don't know who to turn to, contact these services for help.