Can Depression Recur? - Quality Of Life, Self-development

“A couple of years ago, I was seen by a psychotherapist for a depression. Together with the doctor, we managed to cope with the problems that I had. I have already ceased to remember this - and here it is again! It seems to me that this wheel has begun to spin again. Tell me, can depression recur? And how to prevent it from the very beginning?"

Denis, 43 years old

Of course, depression can come back. And not just can. If we are talking about an endogenous disease (that is, developing according to its own, internal mechanisms) depression, then it simply, by definition, proceeds cyclically, with episodic exacerbations and remissions. The official diagnosis in this case is “recurrent depressive disorder”.

Recurrent literally means "recurring, repeating". With this variant of depressive suffering in case of improvement of the condition, unfortunately, it is not even customary to speak of cure, they speak only of remission, which can be more or less prolonged.

When depression can return

Remission can last 2 months or 20 years, but if depression develops as a disease, it is more likely to recur.

What does it mean - "develops as a disease"? This means that the onset of depression is not associated with any external reasons - life dramas, failures, disappointments, grief, loss, conflicts, emotional or physical exhaustion, and others. Depression occurs, as they say, “out of the blue,” “in broad daylight,” and a person begins to feel depressed and incapacitated, as if he were physically ill, but medical research at the same time fixes the absolute norm.

Endogenous versus reactive depression: important differences

Such depression is called endogenous, it should not be confused with reactive depression, which develops as a reaction (hence the name) to long-term or temporary, but by force capable of "breaking through" the protective psychological mechanisms of emotional stress.

Reactive depression is similar to endogenous depression only in external manifestations, while the internal content of these states and, accordingly, the therapeutic approach to them is completely different.

How does reactive depression develop?

Reactive depression, in fact, is a neurosis, a neurotic reaction to stress, so it can also be referred to as neurotic depression or depressive neurosis.

Reactive, or neurotic, depression sometimes go well without treatment, when the stressful situation is resolved

Also, with mild neurotic depression, psychotherapy, carried out without the use of medications, may well be effective. Reactive depression does not recur, if there is no reason for this, if life circumstances do not develop in an unbearable way for the psychic resources of the individual. Also, over time, a person can form in himself skills that prevent the occurrence of neurotic depressive reactions by mastering special psychotherapeutic techniques, as well as as a result of the formation of natural psychological maturity and emotional stability in the process of growing up and acquiring life experience.

Medication (use of antidepressants) for reactive neurotic depression is usually short-lived and not always necessary

How does endogenous depression develop?

With endogenous depression, things are completely different. Fine cerebral biochemistry (features of the functioning of the neurotransmitters serotonin, norepinephrine, dopamine) is genetically arranged in such a way that depressive symptoms develop without external factors "shaking" the psyche. There is no question of any neurosis or reaction to stress.

External traumatic circumstances sometimes precede a depressive episode and look like "triggering" its stimuli, but this is only an appearance - external (however, like internal, for example, hormonal) stress in endogenous depression can only be provoking its onset, but not causal. Accordingly, the basic therapy for endogenous depression is exclusively medication, aimed at restoring disorders of neurotransmitter metabolism. In such cases, psychotherapy, if used, plays only an auxiliary role.

Could Depression Change to Bipolar Disorder?

Sometimes endogenous depressions do not just proceed cyclically, monopolarly - remission-exacerbation-remission, but can be replaced by their mirror opposite, the other pole - mania or hypomania. In this case, bipolar affective disorder (BAD) is diagnosed, according to the old terminology - manic-depressive psychosis (MDP).

In this case, drug therapy is lifelong and is carried out with the use of not only and not so much antidepressants as drugs with a normotimal effect, preventing the transition from one affective phase to another. With a well-designed treatment, patients with bipolar disorder / MDP live a full life without any clinical emotional disturbances, sometimes even without signs of neurosis.

Should you treat recurrent depression yourself?

As you can see, the correct diagnosis of depressive conditions, about which very little has been said so far, is of great importance. This question is very serious. Depression, especially endogenous depression, is associated with high death rates from suicide.

At the first manifestation of depression, not only self-medication, but even referring to a psychologist without medical education is inappropriate

A psychotherapist or psychiatrist, who has sufficient experience in practical work with psychoemotional disorders, should conduct the initial diagnosis and draw up a treatment plan.

Special pathopsychological studies and consultations carried out by a clinical (medical) psychologist are very important in the diagnostic process.

Be careful not to try to treat depression yourself. Only a psychotherapist or psychiatrist can be trusted with the question of the relationship between psychotherapeutic and drug approaches in therapy