Depression usually strikes more than once in a lifetime. For many people, it can become a chronic or lifelong illness, with several relapses or recurrences. On average, most people with depression will have four to five episodes during their lifetimes.
Doctors define relapse as another episode of depression that happens fewer than six months after you've been treated for acute depression. A recurrence is a new episode that comes after six months or longer since the previous episode has resolved. Regardless of the timeline, it can be demoralizing to feel depression symptoms, such as sadness, fatigue, and irritability, creeping back into your life.
If you believe that you're facing depression a second time (or more), talk to your doctor, psychiatrist, or therapist right away about getting treatment again.
A depression relapse or recurrence can be treated in various ways, sometimes through a combination of therapies. For example, your doctor may recommend both antidepressant treatment and psychotherapy.
Doctors use several drugs to treat depression, including:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Norepinephrine and dopamine reuptake inhibitors (NDRIs), which include bupropion
Older classes of antidepressants can be effective, too, but aren't used as frequently today because they pose the potential risk of serious side effects. These older drugs include:
- Monoamine oxidase inhibitors (MAOIs)
In addition, your doctor may pair your antidepressant with atypical antipsychotic medicines, mood stabilizers, anti-anxiety drugs, stimulants, or other medications.
Ask your doctor if you need to take antidepressants or other medications for your new episode of depression. If you're already on "maintenance therapy" -- for example, using an antidepressant to prevent recurrence -- your doctor may alter the dose of an existing medicine or otherwise change your current drug regimen to find more effective treatment.
Counseling, or "talk therapy," can help you to understand your problems, including new issues that have arisen since you were last treated for depression. You'll explore better ways to cope or to solve problems. Through psychotherapy, you can also learn how to manage your own thoughts and actions so that you feel less depressed.
Many types of psychotherapy are effective. Here are two that are commonly used:
- Cognitive-behavioral therapy (CBT): This form of counseling helps you to identify and change negative beliefs and behaviors that contribute to your depression. By replacing these patterns with healthier, more realistic thoughts and actions, you can avoid the traps that worsen your depression.
- Interpersonal therapy (IPT): This type of therapy aids you in understanding and working through difficult relationships that may be contributing to your depression.
If you're open to joining a depression support group, ask your counselor or doctor for a recommendation.
If your depression is severe or life-threatening and does not respond to treatment with multiple antidepressants and other medicines, another option is electroconvulsive therapy. The treatment involves giving general anesthesia to the patient, along with a muscle relaxant to prevent body movement. ECT passes electrical currents through the brain to induce a seizure. Although doctors aren't sure why, it is thought that the treatment changes the functioning and efficiency of brain areas that regulate emotion.
Other types of brain stimulation therapies can also treat severe depression, including vagus nerve stimulation (VNS) and repetitive transcranial magnetic stimulation (rTMS).