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Recurring or persistent depression: what to tell your doctor

Fahad AlmalikMedical review: Tatmeen team14 min read
خط متموج فوق تلال مرسومة، تتناوب عند قممه شموس صغيرة وعند انخفاضاته سحب رمادية.
Article contents
  1. Did symptoms return after improvement, or did some remain?
  2. What was changing in your life at the time?
  3. If it began during pregnancy or after childbirth
  4. If the low periods seem to follow a season
  5. What were the periods you called “good” actually like?
  6. Experiences that change your sense of reality
  7. When do you need urgent help?
  8. A short note you can take to an appointment
  9. Frequently Asked Questions
  10. Sources and references
  11. Writer and reviewer

You may feel better for months, then find sleep, enjoyment and everyday tasks difficult again. Or you may improve partly: some weeks feel easier, but you do not feel like your usual self. Perhaps you have noticed the difficulty returning in a particular season, or beginning during pregnancy or after childbirth.

If you need help now, go to the urgent-help guidance. If you are preparing for an appointment, you can start with the short note, then read the sections that fit your experience.

When you speak with your doctor, describe what is happening now and what came before, including periods when you felt better. How long symptoms lasted, their severity2, their effect on your day and what happened between periods help your doctor understand the problem1 and plan care. You do not need to diagnose yourself or remember exact dates. Start with what you know.

Did symptoms return after improvement, or did some remain?

“I got better” can mean different things. Did your usual interests and activities return? Or did life become less difficult while exhaustion, poor concentration or loss of enjoyment remained? Describe what came back, what stayed difficult, and how long that period lasted.

These two examples illustrate the difference; neither is a diagnosis:

“For several weeks, work was extremely difficult. Then I returned to my usual activities for months, before the low mood started again.”

“I keep working, but I haven’t felt like myself for a long time. Some weeks are better, although most days still feel heavy.”

In the first example, tell your doctor what life was like during the months you felt better. In the second, explain what improved and what remained difficult. Describe the effort it takes to keep up with responsibilities, too. Do you finish work, then cancel other activities because you have no energy left? Managing some tasks does not tell your doctor how hard life has become2.

A clinician may consider recurring depressive episodes3, symptoms remaining from an earlier episode, or depression that has continued for a long time. One diagnosis, persistent depressive disorder, usually involves symptoms lasting two years or more1. Do not wait that long to seek care. Continuing difficulties or their effect on your life are reasons to ask for help now.

If you have had treatment before, explain what helped, what difficulties remained, and when improvement or deterioration occurred3. Your response matters more than the treatment name alone.

If symptoms remain despite treatment

Describe what you tried and for roughly how long, any partial improvement, and adverse effects or difficulties attending appointments, accessing treatment or following the prescription. Explain what happened without blaming yourself. Barriers may need addressing, or the diagnosis or treatment may need review8. Ask: “What should we reassess now, what options can we discuss, and when will we review the result?” Do not change medicine yourself to test your response.

If you have improved and worry about symptoms returning

Discuss early warning signs8 from your own experience, what helped before and stresses you anticipate. Agree what to do when those signs appear, whom to contact and when, rather than waiting until difficulties become severe. Discuss continuing or changing treatment with your clinician according to your circumstances and preferences. Do not change medicine yourself.

What was changing in your life at the time?

Tell your doctor what else was happening at the time: a loss or continuing stress, changes at work or in relationships, a physical illness, a new medicine or dose change, or alcohol or other substance use. Mention the support available to you, too. These details help identify factors that may contribute to continuing difficulties2 or need attention alongside them.

Timing alone does not establish a cause. You can say, “This started after that event,” without deciding that the event explains everything. Some illnesses and medicines can cause symptoms resembling depression1, so assessment may include a physical examination or tests chosen for your situation. Do not stop a medicine or change its dose yourself to test an explanation.

Several patterns can appear in the same history. Low periods might recur, one might have started after childbirth4, and you might also notice seasonal timing5. If the current period began after birth, also describe any periods before pregnancy and what happened between them. If low mood seems seasonal, mention difficulties outside that season, too. Describing the starting point alone can leave an important part of the history untold2.

If it began during pregnancy or after childbirth

Depression can start during pregnancy or after birth4. Explain when the difficulties began in relation to pregnancy and childbirth, whether anything similar happened before, and what has become difficult in caring for yourself or your baby. Mention a current pregnancy or breastfeeding when discussing treatment.

The “baby blues” are usually mild, brief mood changes in the first two weeks after birth. Severe or continuing difficulties need assessment. Do not wait for two weeks to pass if symptoms are severe or interfere with basic care. Describing sleep can also help: was there no opportunity to sleep, or were you unable to sleep even when the opportunity arose4?

New hallucinations, firmly held beliefs that are not based in reality, a marked, unusual rise in mood and activity, or confusion after childbirth may indicate postpartum psychosis and require emergency help immediately. In Saudi Arabia, call the Saudi Red Crescent on 99711 or go to the nearest emergency department4. Outside Saudi Arabia, use your local emergency number or emergency department. Do not wait for a routine appointment or a completed set of notes.

If the low periods seem to follow a season

Describe the months when difficulties begin and improve, and what you remember from previous years. A seasonal pattern involves recurrence associated with the seasons5; it can happen in summer, too. Stress that returns with a work or school schedule or an annual occasion also belongs in the account. Feeling worse around the same date does not, by itself, establish seasonal depression.

Instead of saying only “Winter affects me,” you might say, “I remember two low periods beginning around these months, followed by improvement. In one of those years I also struggled at other times.” Be clear about the limits of your memory. You do not need to wait another year to collect evidence before seeking assessment.

Recognising the timing may help a clinician discuss care and when to provide it. The rest of the year still matters, including any unusually elevated mood or activity: seasonal patterns can also occur in people with bipolar disorder5.

What were the periods you called “good” actually like?

A period of unusually high activity may have felt enjoyable or productive, so you leave it out when seeking help for low mood. Mention any period when you were clearly different from your usual self: needing much less sleep6 while still having considerable energy, unusual activity or irritability, racing thoughts and unusually fast speech, or impulsive, high-risk behaviour. Needing less sleep differs from insomnia that leaves you exhausted.

Describe how long the change lasted, what happened, and what others noticed, even if it was years ago. This history may lead a clinician to assess for bipolar disorder, because its depressive episodes can resemble depression6 at the time you seek care. A good day or a passing mood change does not establish that diagnosis. Mention any known family diagnosis of depression or bipolar disorder, if you know of one.

If a marked, unusual change that could indicate mania is happening now, such as a major increase in activity, very little need for sleep with unusual energy, or risky impulsivity, seek an urgent mental health assessment today. These are examples; they do not all need to occur together, and you do not need a previous diagnosis or immediate danger to seek assessment. If you cannot obtain a suitable assessment promptly7, go to an emergency department. If there is current danger to you or someone else, seek emergency help immediately as described below. Do not wait for a particular number of days to pass6 or change your treatment yourself.

Experiences that change your sense of reality

Severe depression can involve psychosis1, such as hearing voices others do not hear or firmly held beliefs that do not reflect reality. These experiences can have other causes9, too. Tell the clinician what happened, when it began, and whether it occurred only during low periods or at other times. This can affect assessment and the need for specialist care8.

If these experiences are happening now, seek an urgent medical assessment today8. If you cannot obtain a suitable assessment promptly, go to an emergency department. Voices telling you to harm yourself9 or someone else, rapidly worsening hallucinations, severe agitation, or sudden confusion require emergency help immediately.

When do you need urgent help?

Seek emergency help now for any of the following:

In Saudi Arabia, call the Saudi Red Crescent on 997 or go to the nearest emergency department. Outside Saudi Arabia, use your local emergency number or emergency department. Do not delay help10 to book an appointment, find someone to accompany you, or contact 937.

Do not drive yourself to emergency care. Ask someone else to take you13 if they can do so safely. If nobody can take you safely, or safe travel is unavailable, call an ambulance10. Do not delay seeking help while waiting for someone to accompany you. A previous assessment does not remove the need for urgent help9 if danger continues or new danger develops, or if urgent medical care is still needed or becomes necessary again.

If you can no longer eat or drink enough, or your ability to provide basic care for yourself or your baby has seriously deteriorated, seek an urgent medical assessment today. Also seek urgent assessment for severe deterioration, current psychotic experiences9, or marked, unusual changes that could indicate mania7, such as the examples above. If you cannot obtain a suitable assessment promptly, go to an emergency department; do not wait for a later routine appointment. If there is immediate danger, use the emergency route directly.

Thoughts of death or suicide call for professional contact today, even without immediate danger. Contact your treating team10 if you have one. If you do not, or cannot reach them, contact an available doctor or seek an urgent assessment. If you cannot obtain suitable professional help promptly, go to an emergency department14. Someone you trust12 who can help you safely can stay with you or help you make contact, but you can seek help without them.

If you are thinking about killing yourself right now, seek an immediate professional assessment, even without a plan. Go to an emergency department if an immediate assessment is unavailable or you cannot wait safely.

If you are unsure whether a substance you swallowed, breathed in or touched, or a dose you took, is harmful, obtain medical advice immediately13. The poisoning advice here concerns medicines and toxic or harmful substances; it does not mean that every ordinary case of food poisoning requires an ambulance.

In Saudi Arabia, the Ministry of Health’s 937 service provides medical consultations15 around the clock and guidance about services and poisoning. You can use it for guidance, while going directly to emergency help for the emergency situations above.

A short note you can take to an appointment

If you do not need urgent help, you can copy these lines and fill in only what you know. “Roughly” and “I don’t remember” are useful answers. The note is optional; do not delay care to complete it.

Current period: The change began roughly… The hardest thing to manage now is… Earlier periods: I remember something similar around… It lasted roughly… Then… Between periods: I returned to… I still struggled with… for… Or I do not remember clearly. Timing and circumstances: The change coincided with pregnancy, childbirth, a season, an event, an illness, a medicine change, or substance use… Other important changes: Unusual activity, reduced need for sleep, impulsivity, or experiences affecting my sense of reality happened around… Or I am not sure. Previous care: I tried… It helped with… What remained was… The medicines I take now are…

If you agree, you can include what someone who knows you noticed during a period you find hard to remember. You do not need to agree about what happened. Tell the clinician what each of you observed.

Useful questions for the clinician include: “What does this history suggest, and what still needs clarifying?”, “Do the earlier periods affect treatment or follow-up?”, and “What changes should prompt me to contact you sooner?”

Start with a primary care doctor1 or mental health professional if low mood persists or affects your life. You can ask for an assessment2 before you know what to call the problem.

This article is educational and does not provide a diagnosis or an individual treatment plan.

Frequently Asked Questions

What should I tell my doctor if depression keeps coming back?

Describe what is happening now and what came before, including periods when you felt better: how long symptoms lasted, their severity, their effect on your day and what happened between periods. You do not need exact dates. Mention what was happening in your life at the time and any previous treatment. Also mention any period when you were clearly different from your usual self, such as needing much less sleep while still having considerable energy.

Do I have to wait two years before seeing a doctor about long-lasting depression?

No. One diagnosis a clinician may consider, persistent depressive disorder, usually involves symptoms lasting two years or more, but do not wait that long to seek care: continuing difficulties or their effect on your life are reasons to ask for help now. A clinician may also consider recurring depressive episodes or symptoms remaining from an earlier episode. Explain what improved and what remained difficult; managing some tasks does not show how hard life has become.

What is the difference between the baby blues and depression after birth?

The “baby blues” are usually mild, brief mood changes in the first two weeks after birth. Severe or continuing difficulties need assessment; do not wait two weeks if symptoms are severe or interfere with basic care.

New hallucinations, firmly held beliefs not based in reality, a marked, unusual rise in mood and activity, or confusion after childbirth may indicate postpartum psychosis and require emergency help immediately: in Saudi Arabia, call the Saudi Red Crescent on 997 or go to the nearest emergency department; outside Saudi Arabia, use your local emergency number or emergency department. Do not wait for a routine appointment or a completed set of notes. Do not drive yourself: ask someone to take you if they can do so safely, or else call an ambulance.

Can depression come back in a particular season?

Yes. A seasonal pattern involves recurrence associated with the seasons, and it can happen in summer, too. Feeling worse around the same date does not, by itself, establish seasonal depression. Tell your doctor the months when difficulties begin and improve, any difficulties outside that season and any unusually elevated mood or activity. You do not need to wait another year to collect evidence before seeking assessment.

What should I do if I am thinking about killing myself right now?

Seek emergency help now if there is current danger to yourself or someone else, you cannot keep yourself safe, or you have a current intention or plan to die by suicide. In Saudi Arabia, call 997 or go to the nearest emergency department; elsewhere, use your local emergency number or emergency department. Do not delay help to book an appointment, find someone to accompany you or contact 937. Do not drive yourself: ask someone to take you if they can do so safely, or else call an ambulance. A previous assessment does not remove the need for urgent help if danger continues or returns.

Even without a plan, seek an immediate professional assessment; go to an emergency department if one is unavailable or you cannot wait safely.

Writing and article review

Fahad AlmalikWritten byFahad Almalik

Content writer and researcher at Tatmeen, writing in Arabic and English about mental health and everyday life, from relationships and stress to work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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