Depression Relapse: Warning Signs, Causes, & Prevention

What Is Depression?

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.

Depression Symptoms

While there can be many depression symptoms, and these symptoms can vary by individual, their circumstances, history, trauma, and other factors, there are some common characteristics to be aware of.

Common symptoms of depression include:

• Hopelessness and feeling discouraged about the future
• Feeling low sense of worth
• Lacking motivation
• Believing oneself to be a burden
• Suicidal thoughts

What Is Depression Remission?

Partial remission of depression is a reduction of symptoms for less than two months. Remission from depression is a period of at least two months without depression symptoms.

What Is a Depression Relapse?

Depression 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

10 Warning 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 of depression, you’re distressed about your experience, or you’re having trouble functioning. It’s also beneficial to reach out for help before your symptoms get worse.

Here are ten signs of depression relapse:

1. Loss of interest or lack of pleasure: otherwise known as apathy or anhedonia, these are common and bothersome symptoms often associated with depressive episodes
2. Irritability: worsened mood presents for many people as irritability, frustration, and a short temper. Losing patience more easily is a common sign of irritability.
3. Loss of attraction to your partner: people with depression sometimes report a loss of attraction to their partner. This may include a decreased libido.
4. 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.
5. 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.
6. 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.
7. Change in sleep: this includes trouble falling asleep, staying asleep, or sleeping more often, and it represents a change from your typical sleep pattern.
8. Change in appetite and/or weight loss or gain: unintentional weight gain 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.
9. 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
10. 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 types 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
• Rumination 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 depression relapse may be easier than the first time someone sought treatment. This might be 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, they simply need to reconnect.

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 resistant depression. If one or more treatments has not been beneficial, continue to explore how to treat depression, ask your doctor about different medication options, and seek out a different therapist if needed.

How to Find a Therapist

If you don’t already have a therapist or need a new one to help treat a depression relapse, it can be helpful to search an online therapist directory to find an online 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 feel better; however, sticking with what works 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

Depression Statistics

Depression is a manageable mental health condition. Due to ongoing stigma around depression and mental health, it is also important to consider that these rates could be much higher as many people do not seek support, have access to care or want to self report.

Here are several depression statistics to be aware of:¹⁰

• 7.1% of all adults experience at least one major depressive episode
• 2.6% of adults struggle with bipolar disorder
• 5% of adults experience seasonal affective disorder
• 20% of adults with depression also have an addiction
• 40% of those with depression can link it to genetic factors
• 60% of those with depression can link it to environmental factors

Final Thoughts on Depression Relapse

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.