I used to think depression was something you beat. Like a flu, or a bad year. You get through it, you come out the other side, chapter closed.
That isn't how it went for me. Depression has been in my life for a long time, tangled up with substance use, with the crashes after my big bursts of energy, with fifty years of not knowing I had ASD. It left. It came back. It left again. Every time it lifted I was sure it was gone for good, and every time I was wrong.
So here's the plain answer. For some people, one episode of depression ends and never comes back. For a lot of others it returns, and the more episodes you've had, the more likely another one gets. That's why the clinical guidelines spend so much time on relapse prevention and not just on getting better. Depression can go quiet for years. Nobody can promise you it's gone forever, and I won't either.
That sounds bleak. I don't think it is. Let me try to explain why.
Why does depression keep coming back?
Nobody fully knows. I'm not a doctor, so read this as what I've read plus what I've lived.
The UK's guideline on adult depression (NICE NG222) treats some people as being at higher risk of relapse once they recover, and says they should be offered specific help to stay well. Canada's CANMAT 2023 guideline has a whole section on preventing recurrence. You don't write a whole section about something rare.
In my case, it never came back out of nowhere. It came back through doors I'd left open. Not sleeping. Hiding at home. Pushing like a maniac on a project for months and then hitting the wall. Using, back then. And the old thinking habits, the voice that says I'm a fraud and that people only put up with me. That voice was there before the depression and it was still waiting after.
There's another layer for me. Finding out at 50 that I have ASD explained a lot of the exhaustion. Years of masking, of performing "normal" in rooms that drained me, wore me down in a way that looked a lot like depression. Some of it was. Some of it was burnout. I wrote about telling them apart in burnout or depression.
So what does "better" actually look like?
Better, for me, works more like a dial than a finish line.
Some stretches the dial sits low and I barely think about it. Other times it creeps up and I notice it in small ways first. I stop answering messages. The house gets very quiet. I stop taking photos. The anger comes faster, which surprised me until I read about anger as a face of depression. I've learned, slowly and badly at first, that those are signals and not proof I'm a bad person.
Two things I believe now, and you're allowed to disagree.
- If depression leaves for five years, that's five years of life. I'm not going to call that a failure because it came back.
- Catching it early changes everything. A low patch you notice in week two is a whole other problem from one you notice in month six.
Does anything actually lower the odds?
Yes. This is the part that gave me some hope.
Mindfulness-based cognitive therapy (MBCT) was built for people who keep relapsing. In the first big trial (Teasdale and colleagues, 2000), people who had already had three or more episodes and got MBCT on top of their usual care had a significantly lower risk of relapse over 60 weeks. For people with only two past episodes, it didn't make a difference. NICE lists it as a relapse-prevention option, and CANMAT includes it too.
I'll be honest. The first time someone told me to "be mindful" I wanted to throw something. It sounded like a fridge magnet. MBCT turned out to be something else: practice at noticing the slide early, the "here we go again" thoughts, and not following them all the way down the stairs. The book by the people who designed it is the one I'd hand someone first.
The Mindful Way Through Depression
Williams, Teasdale, Segal, Kabat-Zinn
My take. Mindfulness from the people who built MBCT, the approach with evidence for keeping depression from coming back.
Good to know. Only works if you actually practise. Daily.
It only works if you practise. Every day. I'm not good at every day. I'm working on it.
The guidelines also talk about staying on treatment long enough after you feel better, therapy, sleep, movement, and people. If you're on medication, don't stop it on your own because you feel fine; talk to your doctor or pharmacist first. People are my weak spot. I can run a room, but the people I'm closest to are far from here, which I wrote about in close friends, just none close by.
What I'd tell someone who just came out of a depression
Enjoy it. Really. Don't spend your good months bracing for the next bad one.
But while your head is clear, write down what your early signs look like. Give a copy to someone at home if you can. Mine would say something like: stops answering, sleeps at weird hours, gets snappy, stops making things. Sandra, my partner, usually sees it before I do. Not always.
And if it comes back, you didn't fail. Depression sometimes does that. Go back to what helped. In Québec that can start with your family doctor, your CLSC, or 811 option 2 (Info-Social). Relief, the organization that used to be called Revivre, has plain information on depression in French and English, plus support groups.
If it ever gets to thinking about dying, that's the moment to call, not to wait it out. In Canada and the US that's 988. In Québec, 1 866 APPELLE (1-866-277-3553), or text 535353.