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How to Deal with Recurrent Major Depression

written by: N Nayab • edited by: Daniel P. McGoldrick • updated: 5/23/2011

Recurrent Major Depression can cause many emotional and physical problems, leading to impairment of performing normal day-to-day activities, and giving the patient a feeling that life is not worth living. Read on to find out how to cope with recurrent major depression.

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    Recurrent Major Depression 

    What is recurrent major depression?

    Major depression or major depressive disorder is a mental disorder where the person suffers from a combination of low mood, self-esteem, and loss of interest or pleasure in normally enjoyable activities. This occurs either due to a single traumatic event or it develops slowly owing to many disappointments and problems over time.

    Major depression occurs only once, and when treated and cured, never occurs again. Some people, however, have episodes of major depression that goes away when treated, and then the same condition recurs, usually with more intensity after some time, again responding to treatment, and the same process repeating for life. Such a condition is recurrent major depression.

    Image Credit: flickr.com/Bashar al-Ba'noon

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    Symptoms

    People suffering from major depression always feel sad, unhappy, irritated, agitated, restless, tired, and frustrated at the same time. They experience loss of interest or pleasure in normal activities that they once enjoyed doing, experience sleeplessness, usually have a reduced sex drive, and develop changes in appetite. They also suffer from slow thinking and indecisiveness, feeling of worthlessness or guilt, and may even think of committing suicide. All such mental conditions may also manifest as unexplained physical problems such as back pain or headaches.

    When people experience such symptoms after having experienced depression before, these symptoms probably indicate the onset of an episode of recurrent major depression.

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    Treatment Through Medications

    Consumption of antidepressant medication is one proven approach of curing recurrent major depression. Research indicates that depression occurs owing to alteration of neuronal functions in the brain caused by stress. Antidepressants reverse this neuronal degeneration by increasing the availability of neurotransmitters.

    Consumption of antidepressants can however cause side effects such as decreased sexual desire, delayed orgasm, digestive problems, jitteriness, restlessness, headache, and insomnia. Since most of such side effects are already symptoms of major depression, such symptoms increase before the depression subsides. For this reason, the best type of antidepressant medication are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro), which cause fewer such side effects compared to other types of antidepressants.

    A study at Virginia Commonwealth University reveals that long-term maintenance treatment with the SSRI escitalopram may reduce the risk of recurrent depression in patients with major depressive disorder.

    At times, however, SSRIs may remain inadequate, and treatment of recurrent major depression may require other categories of antidepressants, such as

    • Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta), desvenlafaxine (Pristiq), and venlafaxine (Effexor).
    • Norepinephrine and dopamine reuptake inhibitors (NDRIs) such as bupropion. These antidepressants do not cause sexual side effects but may instead cause seizures.
    • Atypical antidepressants such as trazodone (Desyrel) and mirtazapine (Remeron), which do not fit into any other antidepressant category. These have sedative property.
    • Monoamine oxidase inhibitors (MAOIs) such as tranylcypromine (Parnate) and phenelzine (Nardil). These have severe side effects and need a strict diet regimen, and as such are prescribed as a last resort.

    Other stimulants, mood-stabilizing medications, anti-anxiety medications, or antipsychotic medications may also find use to treat recurrent major depression, as appropriate.

    Finding the right medication may require some trial and error as individual constitutions vary, and most medications would require about eight weeks or longer to take full effect and for side effects to ease. Patient and perseverance through this time is of critical importance for successful treatment

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    Treatment Through Phychotheraphy

    Psychotheraphy or psychological counseling is another key approach to deal with recurrent major depression, and many practitioners recommend a combination of medication and psychotherapy to cure recurrent major depression.

    Psychotherapy involves the patient and the mental health provider discussing the patient’s condition and related issues, with the mental health provider making patients identify underlying causes of depression, and enabling them to identify and make changes to such behavior or thoughts.

    Cognitive behavioral therapy helps the patient identify negative beliefs and behaviors and replace them with healthy, positive ones, and ranks as the most effective form of psychotherapy for recurrent major depression.

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    Electroconvulsive Therapy (ECT)

    Recurrent Major Depression Another treatment option to cure recurrent major depression is Electroconvulsive therapy (ECT), which entails passing electrical currents through the brain, in a bid to induce more neurotransmitters in the brain. This can cause side effects such as confusion and memory loss for some hours, but provides immediate relief.

    A variant of ECT is transcranial magnetic stimulation, or placing a large electromagnetic coil against the scalp near the forehead to produce an electrical current in the brain.

    ECT is generally applied as a treatment option for those who do not respond to medication, those with pregnancy and other conditions that make taking medications inappropriate, and those at high risk of suicide.

    Image Cerdit: flickr.com/James Cridland

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    Alternative Medications

    Herbal remedies and supplements such as John's wort (Hypericum perforatum), SAMe, and a diet rich in Omega-3 fatty acids may help ease depression. Such treatment methods are however not approved or monitored by FDA, and their effectiveness remains unproven by scientific research.

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    Early Identification and Treatment

    The key to overcoming recurrent major depression lies in identifying the disorder early and making prompt intervention. This requires paying attention to the symptoms abnd signs of major depression and taking help if the symptoms get worse. Recurrent major depression, if left unchecked can cause severe conditions such as diabetes and or cardiovascular complications, besides disrupting the individual’s physical and social life.

    Since each episode of recurrent depression poses a new risk that the depression may not respond to treatment, the best approach is to consider recurrent major depression as a lifetime disorder with a complex multidimensional character, and undergo lifelong treatment aimed at prevention.

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    Lifestyle

    Apart from undergoing treatment, coping with recurrent major depression requires some lifestyle changes and determination. Some initiatives to help overcome the cloud of depression include:

    • simplifying life by cutting back on obligations when possible, setting reasonable and achievable goals, learning to relax, ensuring sound sleep, and opting for a job change if required
    • eating a healthy diet. Herbal supplements such as John's wort (Hypericum perforatum), and a diet rich in Omega-3 fatty acids may help ease depression, but such treatment methods are not approved or monitored by FDA
    • undertaking regular physical activity such as walking, jogging, swimming, and or gardening
    • reading reputable self-help books, or joining support groups to help cope.
    • participating in social activities, and getting together with family or friends regularly to overcome feeling of isolation
    • undertaking acupuncture, meditation, yoga, and or tai chi to manage stress.
    • avoiding alcohol and illicit drugs

    While it is not possible to prevent depression, such initiatives help control stress and increase resilience, lessening the risk of depression in a big way.

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    Caution

    Talk to your doctor and other health care providers before taking any medications, herbal or dietary supplements. Do not try to cure recurrent major depression by yourselves. This article does not constitute medical advice.

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    References

    1. Greden, John, F. "The Burden of Recurrent Depression: Causes, Consequences, and Future Prospects." Retrieved from http://www.psychiatry.wustl.edu/Resources/LiteratureList/2001/November/Greden.pdf on 18 December 2010.
    2. Abraham, Sathya Achia. “New Treatment Strategy for the Prevention of Recurrent Depression.” Retrieved from http://www.news.vcu.edu/news/New_Treatment_Strategy_for_the_Prevention_of_Recurrent_Depression on 18 December 2010.
    3. MayoClinic. “Depression (major depression)” Retrieved from http://www.mayoclinic.com/health/depression/DS00175/DSECTION=prevention on 18 December 2010.
    4. Psychology Information Online. “Major Depression.” Retrieved from http://www.psychologyinfo.com/depression/major.htm on 18 December 2010