Depression relapse is a period of at least two weeks during which your symptoms of depression have returned. Common signs of depression relapse are changes in mood, social interactions, and sleep. Relapses are usually triggered by one or more identifiable stressors. Fortunately, there is research supporting various ways to prevent relapse that you can begin practicing now.
What Is a Depression Relapse?
In order to understand what depression relapse means, it is helpful to first understand what meets the criteria for a depressive episode and remission. Depression, or Major Depressive Disorder, is diagnosed based on the presence of five or more symptoms listed in the DSM-5 within a two week period. The person must either be experiencing a depressed mood or loss of interest or pleasure, and a change in functioning at home, work, school, or socially.
Partial remission is a reduction of symptoms for less than two months. Remission from depression is a period of at least two months without depressive symptoms. Relapse is defined as a return of symptoms to the level of meeting criteria for a major depressive episode after a period of partial or full remission. 1,2
Signs of Depression Relapse
Since relapse is a return of most depressive symptoms, having just one of the two of the symptoms below doesn’t mean that your depression has returned, but it may be a sign that you’re heading towards relapse. It’s important to reach out to your doctor or care team if you’re experiencing several of the signs listed below, you’re distressed about your experience, or you are having trouble functioning. It’s also beneficial to reach out for help before your symptoms get worse.
The following are signs of depression relapse:
- Loss of interest or lack of pleasure: Otherwise known as apathy or anhedonia, these are common and bothersome symptoms often associated with depressive episodes.
- Irritability: Worsened mood presents for many people as irritability, frustration, and a short temper. Losing patience more easily is a common sign of irritability.
- Loss of attraction to your partner: People with depression sometimes report a loss of attraction to their partner. This may include a decreased libido.
- Social withdrawal: Social withdrawal or isolation may mean you stop answering friends’ and family’s calls and text messages. You may avoid social situations or interactions and not want to leave bed.
- Blunted affect: Someone with blunted affect will not show much of a change in expression despite experiencing a situation that is objectively sad or exciting. The person may experience or describe feelings of being numb.
- Lack of motivation or energy: Lack of motivation is often described as not being able to get moving. It can feel difficult to complete even basic tasks such as taking a shower, brushing your teeth, or getting dressed.
- Change in sleep: This includes trouble falling asleep, staying asleep, or sleeping more often, and it represents a change from your typical sleep pattern.
- Change in appetite and/or weight loss or gain: Unintentional changes in weight may signal a relapse of depression. Weight change often, but not always, accompanies change in appetite due to mood. You should always contact your primary care provider if you experience an unintentional weight change.
- Feeling helpless, hopeless, worthless, or purposeless: Changes in self-efficacy, self-worth, self-esteem, and the ability to realize a situation or feeling is temporary are common signs of depression relapse.
- Suicidal ideation: Suicidal ideation might be passing thoughts or the desire to no longer live, or it can be more intense. Regardless of the severity, it’s extremely important to reach out for support if you have any thoughts of suicide.
What Causes a Relapse in Depression?
There are different reasons why people experience a relapse in depressive symptoms and it’s helpful to be aware of your particular triggers. The type of depression and severity of symptoms someone has had in the past plays a role. Certain people are at higher risk for relapse due to factors such as prior episodes of depression, early age of onset, childhood trauma, and unstable remission.3
If someone is not taking their medication for depression as prescribed or is not actively engaging in therapy for depression, this increases the risk of recurrence. In addition, people who doubt their ability to manage their depression have an increased likelihood of relapse.4
Potential triggers of a depression relapse include:
- Hormonal changes, including pregnancy, childbirth, and menopause
- Loss of a parent or loved one
- Divorce
- Job loss or work stress
- Exams coming up
- Stopping treatment
- Ruminating on past situations or mistakes
- Substance use
- Current events
- Major life changes
- Trauma or abuse
- Medical events or illness
Treatment Options After a Depression Relapse
Treatment for a relapse of depression may be easier than the first time someone sought treatment. This might be the case because the person already has an idea of what resources they need, where to go for help, and which treatment or treatments were beneficial in the past. If the person already has a relationship established with a therapist and psychiatrist, all they will need to do is reconnect in order to get treatment.
There are some instances where depression becomes more difficult to treat over time, but relapse of depressive symptoms itself is not a predictor of treatment resistance. If one or more treatments has not been beneficial, continue to explore depression treatments, ask your doctor about different medication options, and seek out a different therapist if needed. If you don’t already have a therapist or need a new one, it can be helpful to search an online therapist directory to find a therapist that’s right for you.
How to Prevent Depression Relapse
Once you have achieved remission from depression symptoms, the best way to maintain progress is to continue with your treatment plan. Sometimes, people are tempted to stop their medication or discontinue therapy because they are feeling better but sticking with what’s working is the best plan to prevent relapse. Most studies suggest that people remain on their antidepressant for 9-12 months after symptomatic improvement to lower the risk of relapse. In addition to continuing with your treatment, there is research to support the following tips for relapse prevention.
Ways to prevent depression relapse include:3,5,6,7,8,9
- Taking medication as prescribed
- Focusing on your strengths
- Continuing to go to therapy
- Exercising regularly
- Eating a healthy diet
- Maintaining a consistent sleep schedule
- Participating in social group activities
- Using mindfulness and engaging in Mindfulness-Based Cognitive Therapy
- Engaging with a therapist in preventative cognitive therapy
Final Thoughts
Depression relapses are hard to deal with but they’re common and you’re not alone. It’s discouraging to realize depression is coming back after making progress, but it’s important to remember that growth is not linear. Setbacks are normal and you will be better prepared to handle depression this time since you’ve successfully dealt with it before. Don’t wait to take action and get help early on so that you have the appropriate support and can continue to make progress.
Depression Relapse Infographics
