I’ve been asked a question in my Facebook group about recurrent depression. The question is why does depression come back? And so I’m going to do a short series of videos to just kind of try to explain that in more detail, because of course as always the case the more you know about something, the better prepared you are and the more able you are to deal with it.
So, I’ve just done a little drawing here, which I’d like to just share with you, and this is a fairly technical drawing really, but it just kind of shows really what we’re talking about here. So, here we have normal mood and of course this is the threshold for depression and what happens is you proceed through what’s called the prodromal phase.
Your mood gets lower and lower until you bounce into the acute phase of depression, and this would be a first episode of depression. Now depression tends to be a recurring problem for between 40 to 60% of people.
So, the first episode of depression could last anything from 18 months to two years, if it’s untreated and even with some forms of treatment, it can last as long as that.
We come to remission. Now we’re in the continuation phase here and what that means is if you don’t do anything more, if you kind of come to remission from anxiety, sorry depression, so you don’t feel depressed anymore, but you don’t do anything.
You have up to a 60% chance of having another episode in two years. Now that brings us then to relapse and once you’ve relapsed into depression, you go through a period of depression and then you’ll come to recovery again.
But the more episodes of depression that you have, the more likely it is that you will have another one, and so then we move into maintenance, which is basically chronic depression, where you’ll have repeated episodes of depression for the rest of your life, really. And it’s typically the case that if you’re treated for depression, you’re treated with antidepressants.
Talking about Anti-depressants
Now anti-depressants I would suggest that there are a kind of a common treatment, but not necessarily as good a treatment as you might think they are. First of all they only manage the symptoms of depression and they give you no benefit when we’re talking about relapse. So, they will manage the symptoms of depression for some people, obviously with side effects etcetera, for as long as you’re on them, but as soon as you come off them, it’s like you’ve never been on them.
There’s no protective element of antidepressants. You get no benefit from them, and so if you come off an antidepressant, you are likely to relapse within two years.
Now because you get no additional benefit from them, you’d have to go back on antidepressants and what I’ve seen in my clinical practice is that we have people on antidepressants for 15, 20 years.
And for some people that’s okay. It’s not a problem but for other people if they have side effects, then that is a problem. Now the question is why is it that we relapse into depression? And I just want to show you that pictures to kind of understand what we’re talking about.
Depression as a relapsing problem
Depression is typically not always, but it’s typically a relapsing problem, and so the secret of not relapsing is to do something in the acute phase and to continue doing a little bit of something in the continuation phase, so that we’re just preventing depression coming back in and kind of kicking in again, and that’s what we do of course with active self-help CBT, but that’s another story for another film.
So, just to summarize in this first video, depression is a recurring problem for many people, and it can be a sort of an accelerating recurring problem. The more episodes of depression you’ve had, the more likely it is for you to have another one.
So, the secret really is to if you find yourself in depression is to not have another episode, and the secret of not having another episode is to do something during the acute phase, once you’re suffering from depression and then just carry on doing a little bit of something afterwards in the same way, that you might manage your diet a little bit.
You might do a little bit of exercise. You might take a walk up the stairs as opposed to taking the elevator. That kind of thing right, nothing onerous, nothing huge, but just enough to manage the processes, which drive you back into the depression and in another blog post, I’ll talk about those. Thanks for taking time to read this.
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