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Depression is an illness which affects over 120 million people around the world in one form or another. Major depressive disorder is a lifelong illness that is characterized by severe episodes of depression separated by extended periods of time.

Some medical experts suggest that 80 percent of those who experience one severe episode of depression will go on to experience repeated episodes in the future. No one can say with certainty precisely what causes depression, but experience shows that when it strikes, it often tries to make repeated appearances in a person’s life.

Although there is no single determining factor which predicts depression, genetics and environment seem to play a significant role. When there is a family history of depression, the chances of depression rise. Those with difficult childhoods seem also to be more prone to depression throughout life. Genetics and environment are not the only clues, but they are common enough to serve as warning signals of possible danger ahead. Since not everyone with major depressive disorder experiences relapses at the same rate, some have tried to learn what may trigger or predict those episodes.

In the Netherlands, one such study followed 687 individuals with major depression for whom six months or more had passed since their last episode. The researchers gathered baseline information and then tracked the subjects for the next three years to see when episodes reappeared and what commonalities might be present. Baseline information included the age at which major depression was first noted, the number and intensity of depressive episodes, childhood difficulties, adult environment and evidence of neuroticism.

The Dutch study revealed that a younger age of depression onset and a younger initial relapse contribute dramatically to a person’s relapse risk. Neuroticism and problematic childhoods also were common factors in relapse risk. The study showed that if a person had lived five years without an episode they had a greater than 13 percent risk of relapsing. At 10 years the risk was over 23 percent and after 10 years the risk of relapse was greater than 40 percent. When there have been three or more episodes, the risk of another episode is between 80 and 90 percent.

This does not mean that a person with major depressive disorder is helpless to prevent these relapses. Talk therapy and antidepressant treatment can help a person avoid future episodes and mitigate their severity if/when they do occur. Talk therapy such as cognitive behavioral therapy teaches patients how to combat the negative thinking patterns which may have formed during childhood and which can cause depression to spiral. Talk therapy can also help the person to confront and work through feelings which may be part of the sub-surface environment that contributes to relapses.

In addition to medication and learned coping skills, people with major depressive disorder can reduce their chances of relapse by avoiding alcohol, getting regular exercise, maintaining a steady sleep schedule and taking an active interest in others. The risk of recurrence with major depressive disorder is high, but there are positive steps to be taken which can restore a measure of control.

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