Preventing relapses in people with depression

A relapse is a recurrence of the symptoms and signs of depression. It is very common in people with major depressive disorder, who don't always realize they are feeling unwell again. Relapses, even mild ones, interfere with the daily lives of those affected and prevent them from appreciating and enjoying life.

When a person, for whatever reason, begins to think more negatively on a consistent and prolonged basis (worries, negative thoughts, etc.), depression can return. After repeated depressive episodes, strong associations are formed with everyday life events, meaning that even a minor trigger, such as a normal dip in mood, can be interpreted negatively and become a critical starting point for a relapse.

From this critical point, a spiral of ruminative negative thoughts is unleashed, which can gradually lead to a feeling of hopelessness. Feeling hopeless then leads to social isolation, to increasingly avoiding situations involving contact with other people. Once these old thoughts are activated, often unconsciously, it is difficult to break free from the vicious cycle that triggers a new depressive episode, because it is usually an instinctive reaction, like climbing out of quicksand.

Risk factors for relapse

There can be multiple factors that cause depression, and they are not the same for everyone. Having previously experienced a depressive episode increases the risk of having another. But a single factor is not responsible for depression, as several factors can occur simultaneously.

Some of the factors that can increase the likelihood of relapse are:

• An "unhealthy" lifestyle (e.g., lack of exercise , being overweight or underweight) can increase the risk of experiencing new episodes.

• Having trouble relating to others and increased perceived loneliness (feeling lonely).

• Stressful events, such as conflict situations in the environment (home or work), the end of a relationship, the loss of a loved one, having suffered physical or psychological trauma (physical abuse, sexual abuse), financial problems or continuous stress.

• The use of legal and illegal drugs can affect mental health. If you are taking antidepressants prescribed by a doctor or psychiatrist, it is important to take them exactly as directed. Do not lower or increase the dosage or stop taking them without a doctor's advice. On the other hand, some people drink alcohol because they feel it can relieve anxiety or depression. However, scientific evidence suggests that if you drink regularly or abuse alcohol or other drugs, you have a higher risk of developing depression (Boden, 2011).

Key Elements of Depressions

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• Certain times of year , usually winter, can affect your mood. Some people may feel better in summer and others in winter.
• There may be some familiarity with depression, but there is no clear pattern indicating that depression is inherited. Some researchers have suggested that people with a parent or sibling with depression have a 40% chance of also developing this disorder. In this regard, some studies suggest that genetics may play a role in the development of depressive disorders (Lohoff, 2010; Mullins & Lewis, 2017). For example, a recent review of scientific articles (Shadrina et al., 2018) mentioned that certain genes may play a key role in the development of recurrent depression (experiencing more than one relapse).

• Changes in hormones and body chemicals can cause depressive symptoms. For example, many women experience mood swings in the weeks leading up to menstruation, a condition known as premenstrual syndrome (PMS), while others may have premenstrual dysphoric disorder (PMDD), with symptoms similar to PMS but more severe. Thyroid problems or low vitamin B12 levels can also be linked to depressive symptoms. Additionally, some women are more vulnerable to postpartum depression, as the hormonal and physical changes, along with the lifestyle changes that come with having a child, can be difficult to cope with. (Alba & Rodriguez, 2014).

• Having a dependent, insecure, self-demanding, hypochondriac and very perfectionistic personality can also influence relapses.

• Depression can be associated with other mental or physical illnesses , such as cardiovascular problems, diabetes, or cancer. Physical changes can also trigger depression in some people.

What signs indicate that I'm going to have a relapse?

There are different signs that can indicate a possible relapse, but they cannot always be identified.

• Mood swings are one of the main signs: a tendency to become easily irritated, tearful or sad, a lack of interest in most activities, and being less interested in doing things that are normally enjoyed.

• Variations in eating habits , with a lack of appetite alternating with moments of ravenous hunger, which can lead to weight loss or gain.

• Changes in social relationships , a desire to spend more time alone and not wanting to leave the house, make phone calls or send messages.

• Changes in sleep: sleeping less, difficulty falling asleep, or fear.

• Difficulty concentrating and frequently forgetting things.

• Speak and move more slowly.

• Reduction of sexual interest and desire.

• Tachycardia, fatigue, and reduced physical activity.