Major depressive disorder is typically not a one-and-done type of condition. Many people with depression who have been treated and experienced some level of improvement will find that their symptoms worsen again before they reach a more prolonged remission, research shows. This is what’s known as a relapse.
Despite treatment, depression relapse is very common, according to Kimber Shelton, PhD, a licensed counseling psychologist in Duncanville, Texas. “Relapse is a part of recovery. When you have this mindset, you’re less likely to feel hopeless when you feel depressed at another point in your life,” Dr. Shelton says. “Allowing yourself to be imperfect is important.”
If you seek help, rather than letting feelings of hopelessness, shame, and guilt accumulate and discourage you, it may be easier to recover. That’s why it's important to talk to your doctor or a mental health professional early on about all your symptoms, including worsening ones, so they can provide help and support. The result of a relapse can be even more stress that can affect your mood, relationships, career, and more, Shelton says. A relapse can also raise your risk of unhealthy behaviors, like not exercising or turning to drugs and alcohol, she says.
About 70 percent of people who achieve partial remission of major depressive disorder will relapse, usually within the first four months, research shows.
Remember that depression is personal — triggers differ from person to person and can change over time. But here are some that are commonly linked to relapse.
It’s normal to ask your doctor to try new medications or drug dosages if you’ve tried your current treatment for some time, and it just doesn’t seem to be working for you. But keep in mind that doing so can lead to relapse, as can stopping your treatment altogether, Shelton says.
It’s important to give an antidepressant up to eight weeks to work before asking your doctor to switch to a new one. One reason: A medication change can disrupt the balance of dopamine, serotonin, and endorphin levels in your body — chemicals that are involved in mood, pain relief, and general well-being, Shelton says.
A dip in mood can even happen if you feel well enough to consider tapering off your antidepressants. One study found that depression relapse within one year occurred more often among people who slowly stopped taking their antidepressants than those who continued their treatment. People who paused their treatment also experienced more symptoms of anxiety and withdrawal. The study participants had all been taking antidepressants for at least two years.
The death of a loved one, loss of a job, caregiving for someone, or experiencing a natural disaster are among the many stressful life events that can trigger depression relapse, research shows.
It’s normal to feel sad after a major life stressor, but if a low mood persists nearly every day for more than two weeks and includes other symptoms in addition to sadness, you may be experiencing depression. “There’s good stress, which helps you feel motivated to get things done,” Shelton says. “And then there’s chronic distress, which is when you feel like you lack the ability or competence to work through issues.”
People diagnosed with a serious chronic illness, such as heart disease, Parkinson’s disease, cancer, diabetes, arthritis, and multiple sclerosis, have a higher risk of depression.
The process of adapting to an illness, as well as certain treatments for it, can also increase the likelihood you experience a depression relapse, says
Manish Sapra, MD, who is the executive director of behavioral health services at Northwell Health in New Hyde Park, New York. In many cases, such as with inflammatory conditions, the disease activity of the chronic illness itself can also cause depression.
People may experience drastic changes over time in their ability to move, eat, communicate, and do necessary tasks like brush their teeth, Dr. Sapra says, which can be difficult to accept.
Traumatic life events, such as abuse, can trigger a new depressive episode, research shows.
Hearing about events like mass shootings, systemic racism, and sexual harassment or assault can also have vicarious effects on you that can lead to depressive feelings, especially if you have a personal connection to the matter, Shelton says. A form of trauma called vicarious trauma can occur among people who engage empathetically with survivors of traumatic events. It largely affects healthcare workers, law enforcement, and other emergency responders.
Race-based trauma has been linked to depression, too, Shelton says. A study of more than 1,600 Black women ages 23 to 34 in Detroit showed that 65 percent reported experiencing racism, and nearly 37 percent had high depressive symptoms. The study also found that experiencing a high frequency of racism before age 20 was linked to an increased risk for high depressive symptoms in adulthood.
Certain holidays, like Mother’s Day or birthdays, for instance, could remind you of the death of a loved one or a traumatic childhood experience. They may also involve visiting estranged family members you’d rather not see, Shelton says, thus potentially triggering a depression relapse. Anniversaries of big moments in your life, like a divorce, could also spur depressive symptoms, she says.
Giving birth could cause a depression relapse. One study of nearly 450,000 births found that 19.1 percent of new mothers developed postpartum depression. This is a form of depression that occurs shortly after birth and can affect a birthing parent’s ability to take care of themselves or others. Because a history of depression is a risk factor for postpartum depression, developing this disorder after giving birth could be considered a type of depression relapse, says Shelton.
There’s no guaranteed way to prevent depression relapse, but there are steps you can take to reduce your risk. Above all, be mindful that depression — for many people — is a chronic illness, and that relapse is common, Sapra says.
“Treatment can help reduce the amount of time you have depression and the probability of relapse, but the condition is a part of you, and you have to actively work on it every day,” says Sapra.
Here are some strategies to lower your odds of depression relapse.
- Identify your triggers and ways to avoid them. When you recognize the factors that trigger your depression you can take steps to you reduce your risk of future relapses. Try tracking them in a journal. Setting boundaries with people or certain behaviors that pose relapse risks for you can also be key to staying well, says Shelton.
- Lean on support networks. Get support from family and friends to help relieve depression. Research shows that participation in social groups helps relieve current depressive symptoms and protects against relapse. “Your relationships and support system can be a sanctuary to feel nourished and better about life,” Sapra says.
- Maintain healthy routines. Prioritize getting enough sleep each night and exercising regularly, among other self-care activities, because they can reduce the impact your depression triggers may have on you and lower your risk of relapse, Sapra says. But don’t let your daily schedule prevent you from trying new things that might alter your current routines, like dance classes or a book club, that bring you joy, he says.
- Find a new treatment plan if your current plan isn’t working. Mental health care is a very personal service, Sapra says. If you feel your treatment plan isn’t helping, don’t be afraid to change doctors, therapists, or other forms of treatment like medication. Once you find someone or something that works, stick with it, Sapra says.
