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Depression: Chances of Relapse

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There has been a fair amount of research conducted and some pretty dismal statistics sighted around the chances of relapsing into depression. Researchers describe depression as a highly recurrent disorder: once the first episode has occurred, recurrent episodes will usually begin within five years of the initial episode, and, on average, individuals with a history of depression will have 5–9 separate depressive episodes in their lifetime.

According to Dr William Marchand, a clinical associate professor of psychiatry at the University of Utah School of Medicine,  ‘The risk of recurrence – “relapse after full remission” – for a person who’s had one episode of depression is 50%.’

Moreover, according to one source: for a person with two episodes, the risk is about 70%, whereas, for someone with three episodes or more, the risk rises to around 90%.

I believe that if you put a substantial effort into beating depression, you have a much greater chance of preventing relapse. There are those that simply wait for their depression to be resolved over time while they mask the symptoms. Some take a pill while changing no other piece of their life. In these such cases, I would imagine that the reported statistics would be quite accurate. Others, however, take multiple steps and implement many strategies in order to beat their depression. They may seek therapy, take medication, exercise, keeping a journal, attend support groups, etc. If these changes (or at least some of them) are continued, even after one’s mental health has returned to their baseline, I believe the chances of relapse are much lower than the statistics.

I believe that there is a correlation between the ‘amount of effort put in to remain mentally healthy’ and ‘relapse’ – The more effort and strategies one puts into remaining healthy, the much less chance there is of relapse.  My motto is, ‘Act early, act heavy’. It is important to consider and learn the signs and symptoms that appear early in one’s depression. This is different for everybody. Some people notice a feeling in their stomach. Others may notice that they are quicker to anger than usual. Some may catch themselves making excuses to avoid going out with friends or suddenly cease doing things that had normally given them joy.

Being conscious of signs and symptoms that occur early in one’s depression is important to know so that the strategies one uses to fight against the depression can be strengthened or added to. If I notice that my feelings are moving towards a downward spiral, I start to think carefully about the strategies I’ve been maintaining and what I could do in addition to these particular strategies. Perhaps I notice that I haven’t been exercising as often as I would like to. I would prioritise increasing my exercise routine. Maybe I notice that I haven’t journaled in a long time, so I would begin to journal religiously again. In my case, I like to ‘act heavy’ (strengthen current strategies and add others)… and I ‘act early’… as soon as I notice any signs or symptoms. Having been in a very deep, dark place with major depression has given me just enough fear, and a great deal of incentive, to do what it takes to never return there.

A final strategy that I recommend using in order to prevent (or minimise) a relapse is to solicit support from those you love and spend time with. It’s easiest, but not essential if the person is someone who lives with you. In my case, I’ve asked for support from my wife.  My wife is pretty certain that she saw my major depressive episode coming on before I knew it. I’ve since asked her to let me know if she notices any signs of depression. She knows me very well and I trust her opinion. Even if she’s wrong, at least the possibility of relapse will have been brought to my attention and I would have the opportunity to honestly assess the situation.

While a relapse from a depressive episode is a very real possibility, there are ways to work towards preventing it. Notice changes in yourself that resemble a past bout of depression and take strong, quick actions to work against it. Solicit the support of others who know you well to inform you if they notice changes that may indicate the possibility of a relapse. By actively working at maintaining positive mental health, I believe it is possible to greatly minimise the possibility of relapse.

Al Levin is an assistant principal in a public elementary school.

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