Depression: The problem of recurrence

When depression isn’t treated, there’s a high likelihood that it will recur. Roughly half of those who have a single untreated episode of major depression will go on to have another. The second untreated episode boosts the odds of a third. Once that occurs, the chances of having a fourth episode are 90%. Over a lifetime, people with untreated major depression will have an average of five to seven episodes, and episodes often accelerate, becoming more frequent and more severe.

Bipolar disorder, dysthymia (a low-level, long-term depression), and all other mood disorders are also more likely to persist or recur if they go untreated. As with depression, episodes occur more frequently and become more intense over time. This suggests that it’s best to treat major depression, bipolar disorder, and dysthymia as early as possible.

Recurrences also occur more frequently if treatment has not wholly eradicated depressive symptoms. Therefore, treatment should aim for maximum relief.

It’s best to gradually increase the dose of an antidepressant until no further improvement is seen. Preliminary research also supports continuing with the full, therapeutic dose even after you start to feel better, rather than risk taking a lower dose that may be only partially effective. Yet inadequate dosages are a common problem. Primary care doctors who are less experienced with psychopharmacology are often reluctant to increase doses, and people who are uneasy about taking medication may be reluctant to try a higher dose.

Here are some other strategies worth considering in search of a lasting, full recovery:

·         switching to a different antidepressant if the first one is not adequately effective

·         combining two antidepressants that have different mechanisms of action

·         adding a second drug (not primarily an antidepressant) that may augment the effect of the antidepressant you’re taking

·         combining medications and therapy.

To prevent a relapse, it’s important to continue taking your medication even after you feel better. A study from the Journal of the American Medical Association divided into two groups 150 people with dysthymia or double depression who had responded to treatment with sertraline (Zoloft). Some of these people continued to take the drug, while the rest took a placebo. After 18 months, only 6% of the group taking sertraline had relapsed, compared with 23% of the placebo group.

Most psychiatrists will recommend that you stay on your medication for about a year after a first episode of depression. If you have had several episodes, your doctor will probably recommend maintenance treatment indefinitely.

On your road to treatment, your primary care doctor may be your first stop. A good primary care doctor can assess your symptoms with an eye to whether you have any underlying medical problems. If your doctor believes that depression is the main problem, he or she may suggest an antidepressant. Sometimes the initial response to the medication is good. If so, you may not need to go further.

However, if you don’t respond well to the first medication, your doctor may refer you to a mental health professional, such as a psychiatrist, psychologist, social worker, or psychiatric nurse. Most primary care doctors aren’t equipped to do a more detailed review of the mood problem or to take treatment further with psychotherapy or different medications.

You can also find a mental health professional through a local clinic or hospital or through recommendations from family members or friends. While some insurance plans leave the choice of therapist up to you, others limit you to professionals enrolled in their networks. Therefore, it’s worthwhile to check with your insurer before choosing a doctor.

Since states have different requirements about who may hang out a shingle as a therapist, inquire about the therapist’s training, and opt only for one who has been formally trained and certified (see “Ten questions to ask when choosing a therapist”). Some people like to meet with a few therapists before making the commitment to work with one. Even the most highly recommended person may not be the right match for you. Beginning therapy can be uncomfortable, but if a therapist’s demeanor or office set-up puts you off, you needn’t waste your time trying to make the situation work.

Understanding Depression, a report from Harvard Medical School, includes information about medications, therapy, and other treatments that can help people overcome depression and boost the likelihood of a full remission. Reading it and sharing it with loved ones might help improve your life—or the life of someone close to you. And, because depression remains a leading cause of suicide, the information might even be lifesaving.

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