Up until recently, we believed that one episode of depressive illness had a fifty per cent lifetime risk of returning.  Recent research indicates the risk is probably higher than that.

 

Having had two episodes of depressive illness brings with it an even higher risk of a further episode of depressive illness, being approximately seventy five per cent.

 

Having three or more episodes of depressive illness in one’s lifetime makes it almost inevitable that a further episode of depressive illness will return.

 

Your brain learns to repeat depression

While depressive illness is a stress-induced break down in your chemistry, it also involves changes in the electrical pathways within your brain.  Our brain is continuously learning, and we believe the brain also learns inappropriate electrical patterns, such as people who get repeated epileptic seizures.  We also believe that having prolonged and / or repeated episodes of depression teaches your brain to more easily allow the illness to return, and eventually your brain can almost spontaneously cause depression to recur, even in the absence of significant stresses, a phenomenon technically known as “kindling”.

 

Drugs which are used to prevent further episodes of convulsion in people who have epileptic seizures (called anticonvulsants), prevent the brain learning and repeating the abnormal electrical patterns involved.  These anticonvulsant / anti-kindling drugs not only prevent epileptic seizures, but can also prevent episodes of depression.

 

Preventing the return of depression

There are a number of options, of which you may take one or a number, designed to prevent the return of depressive illness:

  1. Long-term or indefinite antidepressants.  This is considered a very useful way of preventing depression returning, and brings with it the advantage that your dose of antidepressants can be raised or lowered, depending on the stresses and side effects.
  2. Long-term Lithium.  Lithium has a moderately good effect in preventing relapses of depression, and is particularly valuable in those who have bipolar illness (manic depressive illness) especially if Lithium is taken for progressively longer periods of time.
  3. Long-term anticonvulsants.  The usefulness of anticonvulsants in preventing repeated episodes of depression is not yet clearly established, although they are very useful in patients with bipolar illness (manic depressive illness).
  4. Learning and practising Cognitive Therapy or Interpersonal Therapy.  These techniques of dealing with the stresses of life and early depressive symptoms in a structured way have been shown to be effective in preventing the return of mild to moderately severe depressive illness.  It is not certain however that these techniques can prevent the return of severe depressive illness, which has major biochemical imbalances involved.
  5. Avoiding stress.  Depression is a stress-induced illness, and avoiding overloading one’s life and schedule with pressures and negatives reduces the likelihood of relapse of depressive illness.
  6. Improving your relationships; the best protection against getting depressive illness under stress is having a good relationship, ideally with one’s partner, in which one feels emotionally supported, and having a supportive social network of friends and family members. Do you have someone you can talk to about the ups and downs of your day,  and of your life?

 

Detecting the return of depressive illness at an early stage

This is important, particularly if you have not been taking preventive medication on a long-term basis.

 

A useful technique is to write yourself a letter when you are well, describing to yourself how well you are, and the symptoms you had when you were depressed, while you can still remember them.  Should your symptoms return some years later, you may well have forgotten the early warning signs, and this letter to yourself can alert you.

 

It is also very useful to ask your partner, family or friends to tell you if they think you are slipping back into depressive illness, as the illness creeps up on many people before they themselves are aware of it.

 

In typical cases, the earliest signs of depressive illness are difficulty thinking or remembering clearly, lack of energy, lack of motivation, and reduction in sexual interest.  Some people can identify a particular emotional quality descending on them,  identical to the feeling they had during previous episodes of depressive illness.

 

Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.