Recurrent Depressive Disorder

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While rates of mental illness create increasing concern for mental health professionals globally, as our understanding grows and treatment guidelines develop, approaches to supporting people with mood disorders such as depression continues to improve. Co-occurring anxiety and depression is the most common mental health condition in the UK, and 1 in 6 people in the UK will experience depression at some time in their life.

There are different types of depression, and they can present a variety of symptoms. It is important to be aware of the risk factors, the wide range of signs, and the treatment approaches for depression.

Although recurrent depressive disorder is often viewed as a milder, more moderate form of depression than major depressive disorder, it can cause a range of adverse effects and increase the risk of a major depressive episode.

Understanding Depressive Disorders

Depressive disorders encompass a range of mood disorders, including major depressive disorder, seasonal affective disorder (SAD), recurrent depression, postpartum depression, and more.

Major Depressive Disorder

Major depressive disorder, known more commonly as unipolar depression or major depression, is the most well-known type of depression and is characterised by an all-consuming feeling of sadness, lethargy and hopelessness. Major depressive disorder is severe depression and is generally diagnosed using the Diagnostic Statistical Manual-5 (DSM-5), which lists symptoms such as fatigue, low mood, and loss of interest in pleasurable activities.

In the case that these symptoms persist for at least two weeks, and – most significantly – the symptoms impact the patient’s normal level of functioning, then a diagnosis of clinical depression will be made. Diagnostic criteria states that at least five of these symptoms of severe depression must be present for diagnosis:

  • Change in appetite, weight loss, or weight gain
  • Trouble getting to sleep or feeling sleepy during the day
  • Experiencing fatigue, sluggishness or low energy most days
  • Experiencing intense and lasting feelings of worthlessness, guilt, and hopelessness
  • Having trouble concentrating or making decisions in such a way that interferes with daily tasks at home, work, or school
  • Moving in a slow or agitated manner (a change that is often noticeable to others)
  • Thinking about death or having suicidal thoughts

Although it is relatively rare, some people with major depression experience psychotic episodes, which as often referred to as psychotic depression.

Recurrent Depressive Disorder

Recurrent depressive disorder, also known as recurrent depression, dysthymic disorder, and high-functioning depression, is listed in the DSM-5 as persistent depressive disorder. It causes consistent feelings of hopelessness, hollowness, and low self-esteem. Many people refer to this as having a depressed mood, although it is important to know that chronic depression is a disorder and not a personality trait.

It is often thought of as more mild depression, yet a more enduring disorder than major depressive disorder. Recurrent depressive disorder is generally diagnosed when a person has experienced depressive symptoms for most of the day, for more days than not over two years, without experiencing mania or hypomania.

The diagnostic criteria in the DSM-5 states that a person should experience two or more of the following:

  • Poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness

Unlike major depressive disorder, the symptoms of persistent depression don’t always cause significant distress or impairment to a person’s daily life, although they might. Unfortunately, the fact that symptoms are experienced over a long period of time but may not be debilitating makes it particularly difficult for people, loved ones, and doctors to identify persistent depression. Although it is widely described as milder than major depression, research suggests that long-term depression may be associated with a higher suicide risk than major depression. Individuals with recurrent depression can also experience severe depression and major depressive episodes. A major depressive episode will generally last for at least two weeks.

Bipolar Disorder

Recurrent depressive disorder is sometimes confused with bipolar disorder, which is a mood disorder that causes periods of depression as well as periods of extreme highs. These are known medically as mania/hypomania and depressive episodes.

Manic or hypomanic episodes can cause people to:

  • Feel extremely happy, excited, and joyful
  • Feel like they cannot get their words out fast enough
  • Experience psychotic symptoms such as delusions or even hallucinations
  • Be irritable, agitated, or easily distracted
  • Be extremely confident, as if they are untouchable and can’t be harmed by anything
  • Feel like they need less sleep than normal

A depressive episode lasts at least two weeks but can continue for much longer, sometimes for months. The symptoms of a depressive episode are very similar to major depression symptoms but often also include rumination – spending a great deal of time thinking about upsetting or painful things.

Recurrent depression differs from bipolar disorder quite significantly. Those with recurrent depressive disorder do not experience mania or hypomania, although they may notice a lightening of their mood and an increase in energy during certain periods.

Risk Factors for Major Depression and Recurrent Depression

Although mental health conditions can affect anyone, there are certain risk factors that make recurrent depressive disorder and major depression more likely to occur.

Genetics

It is understood that having a family history of depression can increase the likelihood that you will also experience depression, although researchers are yet to fully understand why.

Trauma

Living through a traumatic experience, such as an accident, assault, or conflict, can lead to a range of mental health conditions, such as anxiety disorders, depression and post-traumatic stress disorder (PTSD). Trauma can have a profound effect on a person’s health as well as their physical well-being. The effects of trauma can cause cardiovascular disease, sexual dysfunction and other general medical illnesses.

Significant Life Events

Stressful life events, such as losing a job or moving house, can cause recurrent episodes of depression. Other significant events that cause life stress, such as divorce, can cause a higher risk of a depressive illness. The process of trying to conceive a child and childbirth can cause postnatal depression.

Death or loss

Grief is an entirely natural reaction to loss; however, for some people, it can cause an increased risk of serious symptoms of depression, such as suicidal thoughts or feelings of worthlessness. This can manifest as both recurrent depressive episodes or a severe episode of depression.

Treatment for Recurrent Depressive Disorder

There is a wide range of treatments available for depression generally and recurrent depressive disorder specifically. The best option for you often depends on your personal circumstances, what the root causes of the depression symptoms are, and the symptoms you are experiencing. The two main forms of treatment for depression are medication and therapy.

Medication

In many cases, antidepressant treatment is the first approach to treatment. Antidepressant medications vary in effectiveness and in the way that they work. The most widely prescribed antidepressant medications are selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

Both SSRIs and SNRIs work in similar ways to correct chemical imbalances of neurotransmitters in the brain. As well as being used in antidepressant therapy, they are also prescribed for the relief of anxiety symptoms, Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive-compulsive Disorder (OCD).

Both of these forms of medication are seen as effective treatments for depression. Long-term antidepressant treatment is often part of maintenance treatment, also called maintenance therapy. Clinical trials have shown that antidepressant maintenance therapy is effective in preventing recurrent depression.

Therapy

There is a wide range of effective therapeutic interventions for depression, including interpersonal therapies, cognitive behavioural therapy (CBT), dialectical-behavioural therapy (DBT), integrative therapy, somatic therapy, and electroconvulsive therapy.

Emerging research suggests that after recovery from the acute phase, preventative cognitive therapy, in addition to the gradual tapering down of antidepressant maintenance therapies, may be a more effective treatment approach for recurrently depressed individuals, especially those who wish to stop taking medication.

Therapy can be used as a short or long-term treatment, depending on the requirements of the individual. Preventing recurrent depression often requires supporting an individual to build tools and competencies to prevent relapse. Controlled trials show that talking therapies, such as interpersonal psychotherapy, CBT, DBT, and somatic therapy, constitute successful treatment of depression. Initial treatment may include a process of the therapist seeking to understand your current state of mind, and if you are in a current depressive episode, they may even suggest you try medication as well.

Contact Us

If you are ready to seek treatment for recurrent depression, contact The Wave Clinic today. We offer individualised programmes, tailed to the needs of each young person that we support on their journey to regain their self-confidence and self-esteem. With carefully designed psychosocial interventions, The Wave Clinic creates a safe place for your teenager to get the help that they need and ensure that they achieve their goals in treatment. 

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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