Depression is a chronic illness. This means that it lasts a long time and usually requires ongoing treatment. Depression is like cancer, in that it can go into remission and never come back. Depression can also go away for months or years before it comes back. It’s important to be able to recognize a recurrence, also known as a depression relapse, as early as possible.
Although mood and anxiety disorders are highly treatable, many people struggling with their mental health go a long time between developing symptoms and receiving appropriate treatment and support. Early intervention can make a big difference by saving a person and their loved ones from stress, developing more serious symptoms, and reducing the likelihood of problems with work, family, school, and disordered substance use.
What is Depression?
Depression (major depressive disorder or clinical depression) is a common but serious mood disorder, often characterized by a sense of sadness or loneliness. It can cause physical and emotional symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, these symptoms are usually present for at least two weeks.
People with depression may experience a loss of interest in work, family, and activities. They may also experience physical symptoms, like fatigue, chronic aches, and pains, or unexplained sleep or weight changes. Depressive symptoms can range from mild to severe and vary from person to person. Symptoms may include:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
What is Depression Relapse?
A depression relapse is when you start to re-experience symptoms of depression that occur after achieving remission from depression. The signs of a depression relapse may be the same as the ones you had during your last depressive period or there can be new symptoms that you did not experience previously.
Why Do People Experience Depression Relapse?
Depression relapses can occur for a number of reasons. For instance, certain situational triggers — events, locations, or people — can be a catalyst for emotional responses, which can cause a depression relapse.
Certain times of the year can also have an impact on how you feel. For some, seasonal changes can bring about the onset of a depression relapse. Additionally, important anniversaries, holidays, and other notable days can have a similar effect.
In addition to triggers and seasonal changes other factors can play a role, including:
- Discontinuing or changing your medication
- Treatment is no longer effective
- Changes in hormone levels
- Getting divorced
- Being fired or laid off from a job
- Buying or selling a home
- Children moving out
- Death of a loved one
- Poor sleep hygiene
What Are 6 Lesser Known Signs of Depression Relapse?
Depression symptoms can be physical or psychological, and may not always seem obvious. When experiencing a depression relapse, the severity of the relapse and intensity of the emotions and feelings can vary. In some cases, you may only have a very mild relapse. In other cases, it can be a full-blown relapse with the same intensity and severity of symptoms as initial onset depression. Often, the earliest signs of a depression relapse may be one or more of these lesser known signs:
1. Changing Sleep Patterns:
Many people in the early stages of depression experience sleep changes, either getting too little sleep (less than 6 hours) or too much sleep (more than 9 hours). In addition to impacting sleep quantity, depression may also impact sleep quality causing non-restorative sleep. Sleep changes can include:
- taking a long time to fall asleep
- waking up frequently during the night
- lying awake in bed for a long time during the night
- not feeling refreshed after sleep.
While the connection between sleep and depression can create a negative feedback loop — poor sleep worsens depression and worsening depression further interrupts sleep — it also opens an avenue for treatment and prevention. Improving sleep direction improves depression, anxiety, PTSD, attention deficit hyperactivity disorder (ADHD), and other mental health conditions.
2. Unexplained Appetite or Weight Changes:
Both eating too much and not eating enough can be signs of depression. Changes in appetite may be related to other symptoms of depression, such as fatigue and a lack of pleasure from activities. Many people with depression lose both energy and interest, which can include a loss of interest in eating. This may be especially true for older adults with depression, who may lose interest in cooking and don’t have the energy to prepare meals. For others, nausea may be a symptom of their depression and a cause for loss of appetite.
While loss of appetite is a common depression symptom, feelings of sadness or worthlessness can make some people overeat. Depression can also result in emotional eating, a common event in which the need to eat is not associated with physical hunger. Instead, emotional eating is eating in response to emotional hunger. When patients eat in response to their emotions, they are soothed by the food as it changes the chemical balance in the brain, produces a feeling of fullness that is more comfortable than an empty stomach, and improves mood through positive association with happier times.
Consequently, a sudden change in weight, either gaining or losing, can be a warning of depression, especially in someone who has other symptoms of depression or a history of depression.
3. Loss of Interest or Maladaptive Response to Music:
People across cultures often use music to evoke positive emotions and moods. Yet, many people with major depressive disorder (MDD) experience anhedonia. It is the loss of interest in previously rewarding or enjoyable activities. So, people suffering from clinical depression often lose interest in things they once enjoyed or appreciated. For many people, losing interest in music, especially if they previously enjoyed music, is an early sign of depression relapse.
For others with depression, they may adopt maladaptive strategies when they listen to music. These maladaptive strategies may include rumination, avoidant coping, or social isolation. The relationship between depression and maladaptive music engagement is bidirectional. Maladaptive music engagement increases the odds of experiencing depressive symptoms and depression increases the likelihood of having a maladaptive response to music.
4. Disengagement from Hobbies:
Withdrawing is often an early sign of depression relapse. If you stop going out, doing things you used to enjoy, or reaching out to others, it could be a sign that your mood is dipping. For many people, depression feels like slowing way down and it can be hard to find the energy to do anything, whether that be gardening, playing sports, crafting, walking the dog, or doing anything else ‘extra’ beyond sitting on the couch watching TV.
If you’ve lost interest in hobbies you once enjoyed, especially if you’re also experiencing social isolation, disengagement from friends and family, apathy, or feelings of hopelessness, it could be a sign of depression relapse.
5. Increased Irritability:
Everyone feels irritable sometimes. But, changes in the frequency or severity of your irritability — a reduced control over one’s temper that results in angry outbursts — could signal a depression relapse. Signs of irritability can include feeling like you ‘woke up on the wrong side of the bed’, saying things you don’t mean, using sarcastic humor to put people down, struggling to stay productive at work because you’re annoyed by people around you, or experiencing road rage.
Research has also linked emotional exhaustion to noise sensitivity, particularly in women, which may contribute to the link between irritability and depression. Specifically, studies found that women with a high level of emotional exhaustion were more sensitive to sound after artificially induced stress than those who were not exhausted. Some women experienced hearing sound at 60 decibels — the level of a normal conversation — as a noise so loud that it was uncomfortable to them. Men in the study experienced a similar reaction, but it was not statistically significant.
6. Brain Fog:
Depression can cause a range of cognitive symptoms, most of which interfere with memory, processing speed, attention, and executive functioning, that people commonly refer to as brain fog. Depression may also make people more likely to think and interpret information negatively, which can result in low-self esteem, harmful self-talk, frustration, and a negative perspective.
Early signs of depression relapse may include losing focus when giving or receiving directions, experiencing more misunderstandings at home, work, or school, missing information from written instructions or a lack of enjoyment when reading for pleasure, losing your way when driving because of distractive thoughts, or forgetting details and new information. Other symptoms of brain fog can include:
- Changes in attention span
- Being unable to concentrate or focus
- Difficulty remembering or recalling information
- Disorganized thinking or task handling
If you’ve noticed changes in your thinking, or if you feel forgetful, slowed, or inattentive, it may be an early sign of depression relapse. The good news is these cognitive symptoms tend to improve with treatment.
Why Seek Help for Depression Relapse?
Getting timely and appropriate help for a depression relapse can make a big difference. Psychiatrists and psychiatric nurse practitioners can help you understand your symptoms and choose the best treatment option for your health goals, whether that’s a referral for therapy and/or a medication or non-drug treatment like TMS.
What Treatments Help Relapse Depression?
Depression is highly treatable and remission is possible. A psychiatrist can help you determine what combination of medication management and alternative treatment can best help you stave off a depression relapse. TMS, MeRT, PBM, IV ketamine therapy, and Spravato are safe and highly effective treatments for depression and they can be used as stand-alone therapies or in conjunction with medication and talk therapy. These alternative treatment options are particularly effective in people with treatment-refractory depression or when prescription medications are causing unwanted side effects or are no longer effective at managing depressive symptoms.
When Should I Seek Treatment for Depression or a Depression Relapse?
It’s time to schedule a mental health check-up if you have a history of depression and have started to notice one or more of the relapse signs listed above or if you’re having thoughts, emotions, or behaviors that are affecting your relationships, your work, or your sense of well-being. It can be helpful to treat yourself like your own best friend. If someone you care about asked you what they should do about your symptoms, how would you guide them?