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, 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.

Aggressive treatment pays off

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.

Keeping up with medication

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.

Is it a relapse or not?

When you stop taking an antidepressant, you may experience uncomfortable symptoms as your body readjusts. These might include stomach upset, loss of appetite, or diarrhea; flulike symptoms such as a runny nose, sweating, muscle aches, or fever; and a variety of other symptoms such as tingling, restlessness, trouble sleeping, vivid dreams, fatigue, dizziness, or lightheadedness.

Sometimes people also experience mood changes, such as irritability, sadness, anxiety, agitation, or crying spells. It can be difficult to know whether this is a result of stopping the medication or if the original depression is returning. The best way to tell is to wait a short time. Symptoms linked to coming off an antidepressant almost always disappear within several days or weeks. If symptoms of depression continue, however, see your doctor about restarting the antidepressant.

Tapering off your medicine slowly can help you avoid this problem. The medications most likely to cause these symptoms are the ones that leave the body rapidly — so your doctor may switch you to one that stays in your system longer and then gradually ease you off that one.

Review Date: 2008-04-01

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