8 Common Triggers of Depression Relapse
Major depression often isn’t a one-and-done type of condition. Many people with depression who’ve gotten treatment and experienced some level of improvement will find that their symptoms worsen again before they reach more prolonged remission, research shows. This is what’s known as a relapse.
Despite treatment, depression relapse is very common, according to Kimber Shelton, PhD, a licensed counseling psychologist in Duncanville, Texas.
In fact, about half of all people who receive treatment for one episode of depression or anxiety will experience another within a year, with most people relapsing within six months, according to a study published in the July 2017 issue of Behaviour Research and Therapy . The risk of relapse increases to 70 percent following two depressive episodes and 90 percent after three, the study authors noted. These rates may vary based on the type of treatment received — in the aforementioned study, participants underwent low-intensity cognitive behavioral therapy (CBT).
“Relapse is a part of recovery. When you have this mindset, you’re less likely to feel hopeless when you feel depressed at another point in your life,” Dr. Shelton says. “Allowing yourself to be imperfect is important.”
The more depression relapses you experience, the harder it may become to recover fully as feelings of hopelessness, shame, and guilt accumulate and discourage you from seeking help, adds Shelton. That’s why it’s important to talk to your doctor or a mental health professional early about all your symptoms, including worsening ones, so they can provide help and support.
The result of a relapse is even more stress that can affect your mood, relationships, career, and more, Shelton says. A relapse can also raise your risk of unhealthy behaviors, like turning to drugs and alcohol or not exercising, she adds.
8 Factors That Can Trigger a Depression Relapse
Remember that depression is personal — triggers differ from person to person and can change over time. But some commonly linked to relapse are:
1. Medication Changes
It’s normal to ask your doctor to try new medications or drug dosages if you’ve tried your current treatment for some time, and it just doesn’t seem to be working for you. But keep in mind that doing so can lead to relapse, as can stopping your treatment altogether, Shelton says.
It’s important to give an antidepressant at least four weeks to work before asking your doctor to switch to a new one, according to the U.K. National Health Service. One reason: A medication change can disrupt the balance of dopamine, serotonin, and endorphin levels in your body — chemicals that are involved in mood, pain relief, and general well-being, Shelton explains.
A dip in mood can even happen if you feel well enough to consider tapering off of your antidepressants. A study published in September 2021 in The New England Journal of Medicine found that depression relapse within one year occurred more often among people who slowly stopped taking their antidepressants compared with those who continued their treatment. People who paused their treatment also experienced more symptoms of anxiety and withdrawal. The study participants had all been taking antidepressants for at least two years.
2. Stressful Life Events
The death of a loved one, loss of a job, end of a friendship, or separation from a romantic partner are all stressful life events that can trigger depression relapse, research shows.
It’s normal to feel sad, angry, or irritable after a major life stressor, but if symptoms persist for more than two weeks, you may be experiencing depression. “There’s good stress, which helps you feel motivated to get things done,” Shelton explains. “And then there’s chronic distress, which is when you feel like you lack the ability or competence to work through issues.”
3. New Medical Diagnoses
About one-third of people diagnosed with a serious chronic illness, such as heart disease, Parkinson’s disease, cancer, diabetes, arthritis, and multiple sclerosis, will experience depression, according to the Cleveland Clinic.
The process of adapting to an illness, as well as treatment for it, can also increase the likelihood you experience depression relapse, says Manish Sapra, MD, who is the executive director of Behavioral Health Services at Northwell Health in New Hyde Park, New York.
Many people may experience drastic changes in their ability to move, eat, communicate, and do necessary tasks like brush their teeth, Dr. Sapra says, which can be difficult to accept.
4. Substance Abuse
It’s common for people to fall back on sources of comfort, such as drugs and alcohol, when experiencing depressive symptoms like low-self worth and hopelessness.
Up to one-third of people with depression misuse drugs or alcohol to cope with feelings of despair, according to the American Addiction Centers (AAC). Although substance use may provide instant gratification, it ultimately intensifies negative thoughts and self-destructive behaviors, per the AAC. This in turn may raise your risk for a severe depressive episode.
Traumatic life events, such as abuse, can trigger a new depressive episode, research shows.
Hearing about events like mass shootings, systemic racism, and sexual harassment or assault can also have vicarious effects on you that can lead to depressive feelings, especially if you have a personal connection to the matter, Shelton says. Vicarious trauma occurs among people who engage empathetically with survivors of traumatic events, according to the British Medical Association. It largely affects doctors, law enforcement, and other emergency responders, states the Office for Victims of Crime.
Race-based trauma has been linked to depression, too, Shelton adds. A study of more than 1,600 Black women ages 23 to 34 in Detroit, published in January 2022 in the Journal of Urban Health, showed that 65 percent reported experiencing racism, and nearly 37 percent had high depressive symptoms. The study also found that experiencing racism before age 20 was linked to an increased risk for high depressive symptoms in adulthood.
6. Holidays, Anniversaries, and Other Important Dates
Certain holidays, like Mother’s Day or birthdays, for instance, could remind you of the death of a loved one or a traumatic childhood experience. They may also require you to visit estranged family members you’d rather not see, Shelton says, thus potentially triggering depression relapse. Anniversaries of big moments in your life, like a divorce, could also spur depressive symptoms, she adds.
7. Giving Birth
Experiences like giving birth could cause depression relapse. Data from the Centers for Disease Control and Prevention show that 1 in 9 new mothers develop postpartum depression, a form of depression that occurs shortly after birth that affects a birthing parent’s ability to take care of themselves or others, according to the Anxiety and Depression Association of America. Because having a history of depression is a risk factor for postpartum depression, developing this disorder after giving birth could be considered a type of depression relapse, says Shelton.
8. Certain Seasons
Specific seasons could also lead to a worsening of depressive symptoms that triggers a relapse, says Sapra; this is called seasonal affective disorder (SAD). The condition is most common during the fall and winter months, when the weather is colder and daylight is shorter, but some people can experience seasonal depression in the summer.
Ways to Reduce Your Risk of Relapse
There’s no guaranteed way to prevent depression relapse, but there are steps you can take to reduce your risk. Above all, be mindful that depression — for many people — is a chronic illness, and that relapse is common, Sapra says.
“Treatment can help reduce the amount of time you have depression and the probability of relapse, but the condition is a part of you, and you have to actively work on it every day,” says Sapra.
Some strategies to lower your odds of depression relapse:
Identify Your Triggers and How to Avoid Them. Recognizing the factors that trigger your depression could help you reduce your risk for future relapses. Try tracking them in a journal. Setting boundaries with people or certain behaviors that pose relapse risks, are also key to staying well, says Shelton.
Lean on Support Networks. Getting support from family and friends can help relieve depression. What’s more, research shows that being a part of social groups helps relieve current depressive symptoms and protects against future depressive episodes. “Your relationships and support system can be a sanctuary to feel nourished and better about life,” Sapra says.
Maintain Healthy Routines. Prioritize getting enough sleep each night and exercising regularly, among other self-care activities, because they can reduce the impact your depression triggers may have on you and lower your risk of relapse, Sapra says. But don’t let your daily schedule prevent you from trying new things, like dance classes or a book club, that bring you joy, he adds.
Find a New Treatment Plan if Your Current Plan Isn’t Working. Mental health care is a very personal service, Sapra says. If you feel your treatment plan isn’t helping, don’t be afraid to change doctors, therapists, or other forms of treatment like medication. Once you find someone or something that works, stick with it, Sapra suggests.