Clinical management
Supporting people with depression to prevent relapse
After an episode of depression, a significant number of people relapse, most within six months, contributing to increased morbidity and burden.
Risk of relapse is increased if: previous depression, particularly if severe; incomplete treatment response; older age of onset; unhelpful coping styles/behaviours (eg avoidance or rumination); other chronic health conditions; and ongoing personal, social, or environmental factors.
Treatments for preventing relapse include antidepressants and psychological treatments (CBT/ mindfulness-based approaches). Relapse prevention interventions are not widely available to all patients who need them in practice.
A quantitative study found that it is difficult to predict individual risk of relapse using information on predictors routinely available in primary care. Qualitative research involving GPs and people with lived experience of depression, found relapse was not consistently discussed in GP consultations. Some patients described feeling forgotten about or uncertain how to seek help, when their GP recommended patient-initiated follow-up. Communication and continuity of care were seen as key to good long-term care.
WiseGP actions:
After a patient has recovered from an episode of depression, explore whether they would like to understand their risk of relapse. Review relapse risk predictors (see above) and use this information to advise patients whether they are at a higher risk of relapse and what they can do about this (eg relapse prevention planning, looking out for early warning signs of relapse).
Review your processes for following up people with depression after they have improved.
a. Where possible, ensure continuity of care with a trusted GP and enable simple routes back in to your surgery for patients when needed.
b. Consider proactive follow-up for vulnerable patients or where patients express a clear preference for this.
c. Where you plan to use patient-initiated follow-up, ensure it clearly communicated when and how to get back in touch.
Give patients with a history of depression an opportunity to review their mood/ discuss their mental health during medication reviews.
Read more about research informing these recommendations here:
https://doi.org/10.3399/BJGP.2024.0384
https://doi.org/10.1136/bmjment-2024-301226
