Recurrent depression

The third week of Shrabon, and the rain over Shantinagar has not stopped since Tuesday. Nadia, 41, teaches Bangla to class eight. For a fortnight the exercise books have sat unmarked on the dining table, she has been waking at four, and the school WhatsApp group makes her chest tight. Then her two sisters arrive, umbrellas dripping, with a tiffin carrier of khichuri and beef bhuna.

“Ki re, all the windows shut in this weather?” Lina apa says, already opening them. Nadia sits down on the bed. “It’s back. I know its footsteps now.” Rupa, the youngest, lifts the lid and sniffs. “Apa put too much salt again. Eat it anyway, Nadia, it’s medicine.” For the first time in days, Nadia laughs, and then she cries, and her sisters stay.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding recurrent depression

When depression comes more than once, with months of feeling well in between, ICD-11 calls it recurrent depressive disorder. Each episode brings low mood or loss of interest most of the day, nearly every day, for at least two weeks, often with poor sleep, low energy, guilt, poor concentration and a sense that the future has closed. People who have lived through it before often recognise the early signs, a change in sleep, a pull to withdraw, a heaviness at a certain time of year, before anyone else does. That knowledge is useful: it is the basis of a plan.

How common is recurrent depression?

In a systematic review, depression returned in 60% of people within five years among those treated in specialist mental health services, and in 85% after 15 years. In the general population the figure seemed lower, about 35% over 15 years, though the authors note such data are scarce. The number of previous episodes, and symptoms that never fully cleared, were the strongest predictors of a return.

Signs and symptoms of recurrent depression

• Waking very early, or sleeping much more, for more than a few days
• Losing interest in things that usually matter, such as work, food or family
• Pulling away from people and messages
• A familiar heaviness, or a feeling that “it” is starting again
• Thoughts that you are a burden, or that life is not worth living

Treatment for recurrent depression

Each new episode is treated in its own right, with psychotherapy, medication, or both; in a network meta-analysis of 101 trials, the combination worked better than either alone. Care then turns to prevention. In a review of 31 trials with 4,410 people, continuing an antidepressant after recovery cut the odds of relapse by about 70%: 18% relapsed on treatment against 41% on placebo, mostly over a year. Mindfulness-based cognitive therapy, an eight-week group course, lowered the risk of relapse over 60 weeks (hazard ratio 0.69) in an analysis of nine trials with 1,258 people with recurrent depression. A psychiatrist also checks for physical causes such as thyroid problems, and for signs of bipolar disorder, which changes the treatment.

What getting better can look like

Nadia might keep a written plan on the fridge: her early signs, who to call, when to book. Next Shrabon, the sisters might still come with khichuri, but for an adda, with the windows open.

Common questions about recurrent depression

Will my depression come back?

Not always, but depression does often return, especially after several episodes or when some symptoms never fully lift. A review found it came back in about 35% of people in the general population over 15 years, and more often among people treated in specialist services. Ongoing treatment and a relapse-prevention plan lower that risk.

How long should I keep taking antidepressants after I feel better?

That depends on how many episodes you have had and how severe they were, and it is a decision to make with your doctor. In trials, people who continued their antidepressant after recovering were far less likely to relapse than those who stopped. Talk to your doctor before changing or stopping any medicine.

When to see a psychiatrist

If you recognise the early signs coming back, it is worth booking before the episode deepens. If you are thinking about ending your life, call 999 or go to the nearest emergency department now.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Hardeveld et al., Acta Psychiatrica Scandinavica, 2010 (PMID 20003092)
• Geddes et al., The Lancet, 2003 (PMID 12606176)
• Kuyken et al., JAMA Psychiatry, 2016 (PMID 27119968)
• Cuijpers et al., World Psychiatry, 2020 (PMID 31922679)