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Half of people who suffer from depression once will go through it again. How can you recognize the symptoms and seek help quickly?

Clinical depression is one of the most common mental health problems out there, with research suggesting that one in four women and one in six men will suffer from it at some point in their lives. While even the most severe depression is treatable, typically with some combination of antidepressants and talk therapy, recovering doesn't, unfortunately, necessarily mean you're "done" with depression forever. Studies have also shown that fully half of people who have struggled with one bout of depression will have another later down the line, while 80 percent of those who have had two depressive episodes will suffer from depression again. 

Who is at risk of a relapse, how do you recognize it (in yourself or someone you care for), and what should you do if depression hits again?

Depression relapse: Understanding the risk factors

Women and people of lower socioeconomic backgrounds have a higher risk of becoming depressed in the first place, but interestingly, these factors don't seem to place people at a higher risk of relapse. However:

  • It seems possible that the younger a person was when they experienced their first bout of depression, the more likely they are to become depressed again later in life. Research is not conclusive on this, with some studies coming to different conclusions, but there are multiple studies to suggest this. 
  • Research also seems to point to the idea that people whose first depressive episode was severe have a higher risk of relapse. 
  • Data indicates that also having another mental disorder, such as anxiety disorders or substance abuse, increases a person's risk of recurrent depressive episodes.
  • People with a family history of depression are more likely to suffer several bouts of depression. 
Remember, though, that you don't need to have any of these risk factors to become depressed again — depression can strike anyone, recurrent depression can strike anyone who has been depressed before, and previous depression is itself an important risk factor.

Not your first rodeo: 9 possible symptoms of a depression relapse

"Recurrent depression", or a "relapse" of depression doesn't come with diagnostic criteria any different from the ones for major depressive disorder in general. This doesn't mean that people who become depressed after already having recovered from depression once will experience the exact same symptoms or state of mind as before, in the exact same severity. Nonetheless, already having experience with both depression and its treatment has the potential to put you at an advantage. You might be able to recognize the symptoms earlier, seek help, and even have a pretty good idea of what to expect. 

We'll include the obligatory "refresher course", though. If you notice a combination of the following nine symptoms, take action:

  1. A depressed mood on most days and/or the majority of the day — which can more concretely show up as feeling sad, tearful, hopeless, empty, and irritable — for at least two weeks.  
  2. Diminished interest or pleasure in everyday or once meaningful activities.
  3. Weight loss or weight gain that go along with appetite changes — not feeling like eating, or feeling like eating a lot.
  4. A physical slowing down or speeding up. 
  5. Fatigue or low energy on most days and for most of the day.
  6. Feelings worthlessness or guilt. 
  7. Feeling indecisive.
  8. Being unable to focus well. 
  9. Plaguing feelings or thoughts about death or suicide, or making suicide plans. 

Always seek help if you feel suicidal or if you think you are depressed, regardless of whether you think you meet the full diagnostic criteria — something that is up to your healthcare provider to determine.

You may like to keep in mind that depression can be preceded by a particular trigger or set of triggers. Even if your depression didn't have an identifiable cause last time, it's entirely possible that this time is different. Suffering a loss or going through a particularly stressful patch doesn't mean that you can't also be depressed. 

I think I'm depressed again: What now?

Many depressed people are reluctant to seek treatment, for many reasons. Perhaps they're not sure if they're depressed, are afraid of what will happen in treatment, or don't believe they can recover. If you have already been depressed before and received successful treatment, you'll hopefully be aware that antidepressants and therapy can be very effective, and already being familiar with the process, not have the fears you may have felt the first time around. 

If you recognize the symptoms of depression, seek help right away. This can be from your primary care provider, but also perhaps from the psychologist or psychiatrist you have worked with before. 

It can sometimes take a while to work out which antidepressant is the right choice for a person with depression, so if you were previously on an antidepressant that worked well for you and had tolerable side effects with, the good news is that this antidepressant will likely help you again. It will almost certainly be the first antidepressant of choice this time, as well. Talk therapy can benefit you, as well, whether or not you had it before. 

What if you think a loved one is having a depression relapse?

Talk to them; mention what behavioral and mood changes you have noticed, share that you think they may be depressed again, and advise them to seek medical help. Offer any support you can. Your loved one has most likely already noticed depression symptoms in themselves, as well, and your nudge may be what encourages them to ring the alarm — or otherwise let them know that you're there for them. 

In conclusion

 A "relapse" — depression after depression — isn't that much different from the first time you were depressed. You are, however, more experienced the second or third time around. This can help you recognize your symptoms that much more quickly, which will enable you to get the help you need. 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Photo courtesy of SteadyHealth

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