How to Avoid a Depression Relapse

Recovering from depression brings relief, and a lot of questions: When should you stop treatment? How do you avoid relapse? Read on for experts’ answers to all your top concerns… Your depression has lifted – finally. But don’t be tempted to stop medication or cancel therapy sessions right away. Post-depression, doctors may adjust treatment to match your feelings and symptoms, says psychologist Shawn McClintock, Ph.D., assistant professor of psychiatry at the University of Texas (UT) Southwestern Medical Center in Dallas. “But it doesn’t mean abandoning your regimen," he says. Having one bout of depression increases your risk of another episode, adds Steven Hollon, Ph.D., professor of psychology at Vanderbilt University in Nashville, Tenn. So it’s important to continue treatment under a doctor’s care. The more you know about your options and risks during recovery, the better your odds of staying mentally healthy. Here, our experts address the most common questions: 1. When should I stop therapy? Your end date depends in part on the type of talk therapy you’ve had. Cognitive behavioral therapy (CBT), a common depression treatment, is designed to produce fast results in a limited number of sessions. Interpersonal therapy (IP), which focuses on relationships and events that trigger depression, is usually longer-term therapy. You and your therapist will determine treatment length based on your progress. McClintock and his colleagues at UT Southwestern, among other institutions, use a depression inventory or symptoms scale to assess mental state. Patients are asked to rate the severity of various depression symptoms – sad mood, insomnia, feelings of low self-worth – on a scale of 0-3. 0: No symptoms. 1: Symptom is mild. 2: Symptom is moderate. 3: Symptom is severe. The therapist tallies these scores to gauge depression levels. This scale pinpoints which symptoms have decreased and which remain. “That helps us target the ones that still need to be treated,” McClintock explains. 2. If I stop therapy, can I go back later? Regular talk therapy “booster sessions” are very helpful, says Susan Nolen-Hoeksema, Ph.D., director of the Yale Depression and Cognition Program at Yale University in New Haven, Conn. “It’s [like] when you fall off your exercise regimen,” she says. “You see your trainer and get back on the program." Returning to therapy helps identify current triggers and develop new ways of dealing with issues. It also reminds you of problem-solving skills learned during your original therapy. In fact, women whose depression was successfully treated with only interpersonal psychotherapy were less likely to suffer a recurrence if they had once-monthly follow-up sessions after formal treatment ended, according to a 2007 study published in the American Journal of Psychiatry. For women who’d been treated with medication as well as IP, maintenance therapy on its own wasn’t as effective. But following up with IP or CBT after any depression treatment plan can be “extremely helpful,” McClintock says. 3. Should I stop taking my meds? If you’re feeling better, you may be tempted to skip a few doses of antidepressents or stop taking them altogether. But quitting cold turkey is dangerous. It can cause headaches, sleep problems or other withdrawal issues. “Because your body has adjusted to the antidepressant, you have to acclimate to not taking it,” McClintock says. And many people need medication longer than they think. “An episode of major depression can last about nine months,” says Nada L. Stotland, M.D., professor of psychiatry at Rush University Medical Center in Chicago. “So you want to take an antidepressant for at least that long.” If you’ve had more than one depressive episode, you may need to continue medication for up to 24 months or longer. People who have had two or more episodes of major depression can benefit from long-term, preventive treatment, according to a 2007 review of depression drug information in the Journal of Clinical Psychiatry. Continuing treatment is also helpful if you still have residual symptoms, such as sleep problems, minor anxiety and trouble concentrating. In other words, you have to treat depression the way you would any other chronic health problem. “If you have diabetes, you have to take insulin every day. You make your peace with it. It makes you well. And that’s that,” Stotland says. “The same is true for people who have repeat episodes of depression.” 4. How likely is it that I’ll have a relapse? The research is sobering: Brown University researchers found that more than 85% of people will have a recurrence of symptoms within 15 years. After suffering from just one episode of depression, you have a 50% chance of having another within five years. After two episodes, that goes up to 70%; and after three episodes, your likelihood jumps to a 90% chance, according to a review of depression studies published in the American Journal of Managed Care. “Depression seems to have lasting biological effects on the brain,” explains Nolen-Hoeksema. As a result, she adds, “the threshold for developing depression goes down with each episode.” To reduce your risk – and increase how quickly you get help – take an active role in your recovery. Here’s how: Monitor your moods. Educate yourself and loved ones about the early warning signs of depression, says Stotland. That way you can get help as soon as symptoms arise. Watch for changes in normal daily behavior, McClintock advises. Ask yourself: 1. Am I no longer doing something I used to enjoy? 2. Have I experienced changes in sleep or appetite (significantly more or less than usual)? 3. Am I starting to feel sad or numb? If you notice these or other signs of depression – irritability over small matters, reduced sex drive, trouble concentrating, crying spells, loss of energy – contact your treatment team right away. Break the rumination cycle. Women tend to obsess about problems and never reach a conclusion, which can trigger depression, explains Nolen-Hoeksema, author of Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life (Holt). “It’s hard to think yourself out of rumination,” she says. To clear your head and lift your mood, interrupt the downward cycle by getting active. Take a walk, spend time on a hobby, or play with your children, she suggests. Can you change the situation you’re fretting about? “Do something to move yourself toward problem solving and a sense of control,” she says. (Read more about how to break this cycle in our interview with Nolen-Hoeksema: Overthinking? It Could Be Depressing You.) Don’t beat yourself up. If depression comes back, don’t blame yourself. “It’s an unfortunate part of the illness that just happens,” McClintock says. “Try to look at yourself through gentle eyes. This is a battle where you’re going to need all the strength you can muster.” To learn more about the signs, symptoms and treatment for this disorder, visit our Depression Health Center. How Much Do You Know About Depression? Despite all the progress in diagnosing and treating this disease, many people still are in the dark when it comes to understanding depression.