“Depression is like many other common medical conditions, such as high blood pressure or diabetes,” said William R. Marchand, M.D., a clinical associate professor of psychiatry at the University of Utah School of Medicine and author of the book Depression and Bipolar Disorder: Your Guide to Recovery. It’s highly treatable, and effective interventions are available. But there’s a risk that symptoms will return.
According to Dr. Marchand, the risk of recurrence — “relapse after full remission” — for a person who’s had one episode of depression is 50 percent. For a person with two episodes, the risk is about 70 percent. For someone with three episodes or more, the risk rises to around 90 percent.
That’s why having a prevention plan is critical, he said. “Depression is often a chronic illness, but with a good prevention plan in place, it is often possible to prevent recurrences entirely or limit the severity and duration if depression does return.”
A prevention plan must include maintenance treatment, which is “treatment that is continued after symptoms are in remission to prevent recurrence.” This includes medication, psychotherapy or both, Marchand said. (If you’re currently receiving or have received treatment, make sure you have a prevention plan.)
It’s also important to understand what might trigger a possible relapse, and how you can prevent or minimize the influence of those triggers. Below, you’ll find three common triggers for depression, along with information on navigating a relapse.
Trigger: Not Following Treatment
“The biggest issue regarding relapse has to do with children and adults not following through on their treatment plan,” said Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression. This includes anything from skipping therapy sessions to missing doses of your medication to ending therapy too soon, she said.
If you don’t want to take your medication because of side effects (or other reasons), talk to your prescribing physician about these issues. They may reduce your dose, prescribe a different medication or recommend another strategy to minimize side effects and respond to your concerns. Similarly, if you’re dissatisfied with your therapy sessions (or you’re having a hard time getting to your appointments because of logistics), speak up.
Depression, like other chronic illnesses, requires “commitment and management. [Y]ou have to learn to live with it every day but not allow it to define you,” Serani said. How? Focus on celebrating your strengths. “While your life may involve psychotherapy, medication and the need for a protective structure that keeps your illness at bay, also realize that you have passions, desires, gifts and talents that require just as much attention.”
Also, “make sure you take extra special care of your mind, body and soul,” Serani said. “This means being attentive to your sleep cycle, moving your body with exercise [and] eating wisely and well.”
“Negative self-referential ruminations play…a key role in recurrence,” Marchand said. For example, individuals with depression tend to dwell on their (supposed) flaws and failures. They also may view neutral events with a negative lens.
That’s why it’s important to develop a strategy for managing these thinking patterns, he said. “Cognitive therapy or mindfulness-based interventions are particularly useful in this regard.”
Trigger: Not Knowing Your Personal Vulnerabilities
“Triggers may be very specific to each individual’s situation, since all of our emotional responses are unique to some extent,” Marchand said. To identify your triggers, “learn how to recognize the who, what, whys and whens of your emotional and physical life,” Serani said.
Look at your calendar for potentially difficult periods. For instance, this might be an anniversary of a divorce or death or anxiety about a mammogram, Serani said. Highlighting these days “allows you to anticipate and plan for threats to depression recovery.”
Also important is to “take an inventory of all the hats you wear in your life.” Serani suggested considering these questions: “What circumstances at work affect your mood and behavior? At home, do certain actions of those around you tend to upset you? Are you feeling supported or overwhelmed? What happens when you don’t get enough ‘me’ time?”
Check in with your physical state, Serani said. “If you find yourself excessively fatigued, irritable, having trouble eating or sleeping, you might be in the midst of a trigger event.”
Finally, you can identify triggers by “think[ing] about previous depressive episodes and determin[ing] if there were specific triggers,” Marchand said.
Navigating a Relapse
Sometimes it’s not possible to prevent a relapse. But by knowing the early signs and getting treatment right away, you can prevent a full-blown episode or lessen its severity and length.
“Generally, early relapse will take hold with subtle signs, like mild irritability and sadness,” Serani said. Tracking your mood states every day helps you spot these early, not-so-obvious signs. “Through journaling, mindful reflection, and even apps on the computer, keeping a running tab on mood states can help offset relapse.” For example, if you’ve logged in 7 to 10 days of negative measurements, contact your practitioner to get evaluated for a relapse, she said.
Marchand also stressed the importance of contacting your doctor or therapist “at the first evidence of recurrence. Interventions may include restarting medication or psychotherapy… [I]f [you’re] in maintenance treatment [it’ll include]…adjusting [the] frequency of therapy or the medication dose.”
If you have a relapse, you might feel overwhelmed, frustrated and deeply disappointed. But “don’t measure your success living with depression on whether relapse happens or not. Instead, realize that if relapse occurs, true success comes from rising after the fall,” said Serani, who’s had depression herself. Her mantra is the Japanese proverb: “Fall down seven times, get up eight.”
And, again, whether you have a relapse or not, take good care of yourself, seek support and show yourself some compassion. Depression is a difficult illness. But, with treatment and healthy strategies, you can manage (and possibly eliminate) your symptoms and get better.