In spite of good psychotherapy, some people have repeated depressions interspersed with periods, sometimes years, of ordinary mood. Marian Sandmaier (2018) wrote about her personal experiences with multiple depressions, and she also supplied some interesting information. She reported the results of a meta-analysis of 10 studies that found that 50% of those who fully recover from a first depressive episode will have another. With each subsequent episode, comes the increased chance for another. Two depressive episodes increases the risk for another to 80%. The average number for a lifetime is between five and nine. Recurrent depression increases the risk of suicide.
Many vulnerabilities are related to recurrent depression. Most are unchangeable because they are based in genetics and epigenetics, which are changes in gene expression caused by psychosocial factors. Some examples are the severity of the first depression, family members with depression, the coexistence with other psychological disorders, and past traumas. As Sandmaier 92018) said, " We know that the genetic roots of depression run deep" (p. 22).
But there is hope. Some vulnerabilities can be lessened. It can be helpful to continue to work through earlier psychological injuries in psychotherapy, even after the depression remits. After regular therapy sessions have been discontinued, an occasional tune-up session can be positive and make returning to therapy more seamless when there is relapse. The identification and anticipation of triggers that are met with improved coping can reduce vulnerability. Continuing antidepressant medication can also be considered.
Sandmaier (2018) emphasized three major mitigating factors. One was changing chronic negative thinking. She advocated mindfulness-based cognitive therapy that focuses on regarding negative thoughts as simply passing thoughts that come and go and do not need to be hung onto and magnified. Secondly, she recommended a strong social support system composed of caring intimates with whom there are constructive relationships. Lastly she spoke of the strength that comes from acknowledging the reality that, in spite of everyone's best efforts, there can be a re-occurrence and then, most importantly of all, recovery.
Sandmaier, M. In the shadow of depression: How can we manage to stay well? Psychotherapy Networker, 42(4),18-25 & 48.