Will I get depressed again after I have recovered?

Many people who have a major depressive episode go for many years without another episode of depression. Remission^[1] is defined as the absence of or presence of only minimal symptoms with normal functionality. Once remission has lasted for more than 6 months, it is considered recovery^[2]. If full recovery has been achieved, a subsequent episode of depression is considered a recurrence. The risk of recurrence drops with increasing time since the index episode. The risk for recurrence is highest within the first year after recovery. The risk for recurrence is also affected by the number of episodes of depression that you have had. The greater the number of episodes that you have had, the greater is your risk for becoming depressed again. You can modify your risk for recurrence using the methods described previously in Question 32.

Response to a treatment is defined as a significant improvement of symptoms but without being completely free of symptoms. Another term for this is partial remission^[3]. It is important to remember that although many effective treatments for depression are available, response and recovery may not occur with the first treatment intervention. Less than half of depressed persons achieve remission with a trial of a single antidepressant. Keeping this in mind, it is very possible that another medication will need to be tried or that your physician will recommend other strategies. Current research efforts are geared toward facilitating complete remission of depression in most persons. The potential consequences of failing to achieve remission include an increased risk for relapse and later treatment resistance, impaired work functioning, and an increased cost of health care.

Many people who have a major depressive episode go for many years without another episode of depression.

What can I do if I have failed several forms of medication and therapy?

Anne's comment:

Both my spouse and my son have been fortunate in responding well to medication. My daughter's experience has been much more difficult. It took patience and perseverance on her part and diligence on the part of her doctor to achieve a mix of medications that finally stabilized the illness. It is important to resist feelings of hopelessness during this period of discovery.

Unfortunately, situations come about when depression does not respond to conventional treatments available. This can be frustrating and certainly contributes to the morbidity of depression. If you have been with the same clinician, sometimes it can be helpful to obtain a consultation by another clinician who will examine the treatment history and perhaps make some other suggestions. Sometimes lack of response to treatment is due to inadequate dosing or duration of medication trials or due to a missed diagnosis. Comorbid conditions can make a depressive illness more refractory to treatment. Conditions that may co-occur with depression include anxiety disorders (panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder), posttraumatic stress disorder (also an anxiety condition), attention deficit disorder, and substance abuse disorders. Further evaluation and treatment of other conditions may be necessary. Substance abuse treatment, for example, may need to be obtained for the depression to be adequately treated. Sometimes a refractory depression is a missed bipolar depression, which may require the use of additional medications. Psychiatrists use guidelines in the treatment of refractory depression. Often, older antidepressants such as TCAs or MAOIs have yet to be tried, and also ECT may need to be considered. Although all psychiatrists are trained in psychopharmacologic treatments, some individuals have a specific expertise in the field of psychopharmacology for depression. These individuals are typically associated with an academic institution. In addition, research protocols are usually conducted in association with academic institutions investigating newer medications. Participation in a research protocol usually involves a comprehensive evaluation during which other diagnostic possibilities are investigated as well.

• [1] complete cessation of all symptoms associated with a specific mental illness. This occurs within the first 6 months of treatment, after which the term used is recovery.
• [2] achievement of baseline, premorbid functioning after successful treatment for a mental illness. Recovery is the term used after a time period of 6 months symptom free. Up to that point, the term is referred to as remission.
• [3] symptoms of an illness have resolved by 50%. An impairment of functioning continues to be present.