Preventing Recurrence

One of the most daunting facts about depression is that it tends to return over time -- even when it is initially diagnosed and treated successfully. This can be discouraging news when you are at the early stages of facing depression. But the good news is that, although recurrences are common, there are steps you can take to minimize their severity and even prevent them altogether.

The first and most important step you can take is to see depression clearly from the very start, not as a single episode to be addressed and forgotten, but as a condition that will require your vigilance and care over time.  Only then can you prepare to do whatever it takes over the long run to get well and stay well.

Scientific evidence encourages us to view depression as a condition requiring care over a lifetime – not an episodic illness. This changes the focus from getting well to staying well.

This section of the website addresses why depressive illnesses recur, and what steps you can take to prevent recurrences and maintain wellness over your lifetime.  It may be some of the most important information in your depression toolkit.

What do we know about why depression recurs?

Historically, scientific research about depression has focused on individual disease episodes and how they can be resolved through one or more treatment methods. This is only part of the picture. Only recently have researchers begun to look at how depression comes and goes in patients over time.  We have not yet determined exactly why depression tends to recur, nor are we able to accurately predict which individuals face the highest risk of recurrence. But recent studies do shed light on just how frequently depression returns, and what we can do to prevent recurrence.

How common is recurrence?

Studies indicate that patients who are diagnosed with depression face a significant risk that their depression will recur over time. Many studies indicate that the most common behavior that precedes a recurrence of depression is discontinuing treatment.   Frequently, patients whose depressive episodes are successfully treated with medication and/or psychotherapy begin to feel better.  Thinking they are “cured,” they stop treatment, failing to refill their prescriptions, attend therapy sessions or follow through on their self-care program.  In time, their depression returns.  Many studies also suggest that each subsequent recurrence of depression tends to be worse than previous episodes. 

What can be done to keep depression from recurring once it has been successfully treated?

Clearly, recurrence is a significant factor to consider and plan for early in the diagnosis and treatment of depression, ideally even before starting treatment – when the patient, the family, and the healthcare team are working together to develop an effective treatment and prevention strategy.

Research also indicates that the risk of recurrence is highest when medications are discontinued, since their benefits stop promptly when not taken. Note that in addition to increasing the chance of recurrence, there are also significant and immediate health risks associated with abruptly discontinuing some antidepressant medications.  Dosages should not be discontinued or altered in any way without the oversight of your prescribing healthcare provider in order to maintain safety and effectiveness.  Even if discontinuation a medication is justified, it is generally wise to taper off gradually.

Although the benefits of psychotherapy may last for a longer period of time after sessions stop, there is evidence that it, too should be continued to avoid recurrences even when the symptoms of depression subside.  

Research has yet to outline a definitive treatment for chronic or recurrent depression, but it suggests that a combination of medication and psychotherapy may be more effective than either method alone in treating patients whose depression has returned.

The key to preventing recurrence is maintenance

Committing to ongoing treatment over a long period of time – perhaps for the rest of your life – is the best strategy for ensuring that depression remains in check, especially for those who have multiple episodes. That means continuing to “work” your treatment plan on good days as well as bad, so that you are equipped to cope with the unavoidable stressors that can ignite a recurrence of depression.