After having depression once, it is understandable to worry when symptoms start appearing again. But spotting the red flags early may help prevent a more severe episode from developing.

Many people who have depression may experience a relapse or recurrence. According to one review, it usually happens within 5 years, but it can occur weeks, months, or even many years after the first episode.

About half of the people who experience an episode of depression for the first time will remain well. For the other half, depression can return one or more times throughout their lives.

For those people who do experience repeat episodes of depression, the warning signs may be different each time.

Doctors and researchers do not know why some people experience a relapse, but others do not.

This article looks at the signs that depression is returning, its possible triggers, and ways to prevent, treat, and cope with this condition.

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A depression relapse can occur days, months, or years after recovering from an earlier bout of depression.

Many people experience sadness or a loss of interest in everyday activities as a normal part of life.

These feelings can stem from a variety of factors, such as the loss of a loved one or overwork.

However, if a person has these feelings almost daily for more than 2 weeks, and if they begin to affect work or social life, then they may be experiencing depression.

According to the National Alliance on Mental Illness (NAMI), depression may affect around 7% of adults in the United States every year.

After the first episode of depression, the American Psychiatric Association say that depression can return in two ways.

A depression relapse happens when symptoms start to reappear or worsen again during recovery from an earlier episode. Relapse is most likely to occur within 2 months of stopping treatment for a previous episode.

A depression recurrence happens when symptoms return months or years after a person has recovered from the last episode. This is most common within the first 6 months. Around 20% of people will experience a recurrence, but this can rise when depression is severe.

After the first episode of depression has ended, the APA estimate that 50–85% of people will have at least one more episode of depression in their lifetimes. After two or three earlier episodes, the chances of depression returning are much higher.

Some depression-like disorders return frequently.

These include:

Seasonal affective disorder (SAD): SAD is common during winter months.

Premenstrual dysphoric syndrome (PDS): PDS is a severe form of premenstrual syndrome.

A person can often recognize the same core warning signs of depression they experienced during previous episodes, but sometimes, symptoms can be different.

Key warning signs of depression include:

Depressed mood: Feeling sad or anxious.

Loss of interest in activities: Taking less pleasure in hobbies, sex, and other interests that the individual usually enjoys.

Social withdrawal: Avoiding social situations and losing touch with friends.

Fatigue: Daily tasks, such as washing up and getting dressed, may feel more difficult and take longer.

Feeling agitated: Agitation, including restlessness and pacing.

Changes in sleep patterns: Insomnia or excessive sleeping.

Changes in appetite: This can lead to weight gain or loss.

Increased irritability: Getting annoyed more easily than usual.

Feelings of worthlessness and guilt: Thinking over past events.

Concentration and memory problems: Thoughts and speech may feel slower.

Physical aches and pains: Unexplained headaches, stomach aches, or muscle pain.

Suicidal thoughts or suicide attempts: This may signal a severe depressive episode.

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

Specific triggers can cause a depressive episode in people who have a history of depression compared with those who have never experienced depression.

Common triggers for depression relapse or recurrence include:

Stressful life events that happen during or after recovery: These can include family conflict, relationship changes, and grief.

Incomplete recovery from the last episode of depression: If the person does not receive full treatment for the main symptoms, depression is more likely to return.

Stopping treatment early: Depression is not always a quick fix — sticking with treatment for 6 or more months after feeling better can reduce the risk of future depression.

Medical conditions: Conditions such as diabetes, obesity, and heart disease, can increase the risk of future depression.

These prevention strategies can help to stop depression from returning:

Keeping up with treatment: Finishing the full course of a prescribed medication can significantly reduce the risk of relapse, especially during the critical 6 months after treatment begins.

Mindfulness based therapies: Mindfulness can help a person understand any negative thought patterns and find ways of dealing with them. One study shows that practicing mindfulness three times a week may reduce depression relapse by up to 50% within a year.

Educating friends and family: Telling friends and family what warning signs to look out for might help catch an episode early.

Prepare for a relapse: It may help to make a plan so that, if warning signs do appear, the individual can act upon them quickly. A doctor can help with this.

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Talk therapies, such as IPT or CBT, may help to treat a relapse.

When worrying symptoms come back during treatment, it might mean that current treatment is not working as it should.

A doctor may recommend changing the treatment style or increasing the medication dosage.

Treatments that can help include:

Talking therapies: Interpersonal therapy (IPT), cognitive behavioral therapy (CBT), or both may reduce the risk of depression returning.

Medication: Antidepressants or mood stabilizers can help some people. Following the doctor's recommendations for taking these drugs can help reduce the risk of a relapse.

Exercise: Keeping active can act as a natural antidepressant. It releases endorphins that can improve mood. A 2015 review of studies suggested that exercise could be as effective as antidepressants or psychotherapies in mild to moderate depression.

Electroconvulsive therapy: In some cases, a doctor may recommend electroconvulsive therapy (ECT). However, the use of ECT is controversial, as some experts do not believe that the benefits outweigh the risk of possible brain damage.

When a person has depression, it can be hard to find the motivation to carry out new or even everyday activities. Get some tips here to help manage this challenge.

Depression can have a severe impact on a person's life, but up to 70% of people who seek treatment find their symptoms improve substantially.

The risk of depression returning is higher when the previous episode was more severe. Having other conditions, such as anxiety disorder, personality disorder, or substance abuse, can also increase the risk.

Taking steps to prevent or treat each new episode that arises can improve the long term outlook for people who have depression.

Q:

I have had depression for 2 years, but I am finally starting to feel better. One thing that gets me down is the idea that it might come back. If I keep following the doctor’s instructions and doing the right things, such as getting exercise and doing mindfulness, will that really help?

A:

It can. The crucial thing with depression treatment is to continue communicating with your provider and to keep appointments.

Sometimes your provider can see signs of depression returning that you may not notice, and they may suggest alterations in treatment. Continuing treatment will also allow you to discuss your concerns with your provider.

Keep in mind that it is not always possible to avoid recurrences of depression, but treatments are available.

Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.