Depression Health Article

Relapse and recurrences

Very few investigations of depression have addressed the prevention of relapses (reappearance of depression within two months of symptom resolution) and recurrences (a new episode of depression). After successful treatment with psychotherapy or medication, most patients have a relapse or recurrence. Therefore, to prevent relapses, it is recommended that psychotherapy and/or medication treatments continue. In adults, medication (with same dose that was used to cure the depression) may be continued for at least 16-20 weeks after achieving full remission of depressive symptom. In addition, various forms of psychotherapy can be used during the continuation period to help patients cope with the psychological and social difficulties produced by the depression and to manage the stress and conflicts that may trigger a depressive relapse or diminish medication compliance.

To prevent recurrences, the length of therapy depends on several factors, such as severity of the depression, number of depressive episodes, chronicity, presence of psychotic symptoms, other psychiatric disorders, family psychopathology, and presence of an adequate support system. In adults, three to five years of psychotherapy and/or medication can significantly reduce the occurrence of additional MDD episodes. Community studies of adolescents have shown that group cognitive-behavioral therapy combined with relaxation and group problem-solving therapy may prevent recurrences of depression for up to 9-24 months after treatment.

Education and primary prevention

Prevention of depression for children and adolescents at high risk to develop depression, such as the offspring of depressed parents and children with some depressive symptoms, may be of prime importance. Recent studies of high school adolescents and school children with some symptoms of depression, but not clinical depression, showed that cognitive interventions were effective in reducing depressive symptomatology and lowered the risk for developing depression for up to two years after the intervention. The prevalence and morbidity of depression in children and adolescents underscore the need for improved public awareness about depression, early detection and prompt treatment of depressed youths, and more research on the prevention and treatment of these disorders.

—Boris Birmaher, M.D. and David Axelson, M.D.
Department of Psychiatry
University of Pittsburgh School of Medicine
Western Psychiatric Institute and Clinic

Periodicals

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