A relapse into depression means that after a period of feeling better or even nearly recovered, depressive symptoms return. Professionals speak of a relapse if symptoms reappear within six months of recovery, and of a recurrence if a new episode begins at a later time.

A relapse often develops gradually. At first, you might only notice minor changes. Take these signals seriously and take action early to prevent the depression from spreading again. Typical warning signs closely resemble your previous symptoms, though they often start out milder and tend to come in waves.

• Altered sleep patterns: You sleep poorly, wake up too early, or find yourself wanting to do nothing but sleep.
• Social withdrawal: You increasingly pull back from others and begin canceling plans or social gatherings.
• Increased rumination: You find yourself overthinking more, and it becomes difficult to break free from negative thought loops.
• Loss of interest: You lose interest in activities and hobbies that brought you joy just a short time ago.
• Persistent exhaustion: You feel constantly tired, drained, and depleted of energy.
• Irritability: You notice that you become frustrated or irritated much more quickly than usual.
• Self-doubt and guilt: You experience intense self-criticism, severe self-doubt, or heightened feelings of guilt.

You can feel that the symptoms are significantly holding you back again. Managing your daily life becomes difficult, and your ability to function at work, during your studies, or within your family is increasingly restricted. Now you need clear, immediate steps: contact your family doctor, inform your psychotherapist, or call 116 117 for the medical on-call service.

To prevent a new depressive episode, the following steps have proven highly effective. It is best to start with the first three steps and then continuously expand your routine.

1. Your 3 Most Likely Early Warning Signs

Think about what your personal red flags are likely to be and write down a specific "if-then" action step for each one. For example:

Early Warning Sign 1: I cannot fall asleep before 4:00 AM.

• If-Then: If I sleep poorly for two nights, then I will call Dr. M., go for a 20-minute walk, and turn off all screens by 9:00 PM.

Early Warning Sign 2: I start canceling social plans.

• If-Then: If I cancel two social get-togethers, then I will text Tom: "Please come outside with me for half an hour tomorrow at 6:00 PM," and confirm it with an OK emoji.

Early Warning Sign 3: I ruminate for longer than 30 minutes.

• If-Then: If my overthinking persists, then I will set a 5-minute timer and write down my thoughts to get them out of my head.

2. Your Therapy

Continue your psychotherapy—such as Cognitive Behavioral Therapy (CBT)—at a lower frequency, even after you start feeling better. This maintains a direct line of communication with your therapist, allowing you to address early warning signs and increase the frequency of your sessions again if necessary.

3. A Digital Health Application (DiGA)

Have your family doctor prescribe a DiGA like deprexis. Your health insurance provider will typically cover the costs entirely. Set aside 10–15 minutes every day to work through the modules, starting with behavioral activation or sleep improvement. Discuss your progress and results during your regular therapy sessions.

4. Take Medication Correctly

Place a weekly pill organizer right next to your toothbrush and take your dosage at the exact same time every day. Never stop taking your medication on your own; always plan any changes or tapering off in close consultation with your doctor.

5. Plan Activities

Write down three specific items for tomorrow:

• One obligation/chore
• One physical activity
• One joyful activity
• Start each task by setting a 5-minute timer to get over the initial hurdle, and check it off your list once completed. Reward yourself with a small treat after every checkmark.

6. Protect Your Sleep

Maintain consistent sleep hours (e.g., 10:30 PM to 6:30 AM), even on weekends. Air out your bedroom before going to bed and put your phone away starting at 9:00 PM. Get out into natural daylight as early as possible in the morning.

7. Leverage Social Support

Schedule two interactions per week with a friend—whether via chat, a phone call, or meeting up in person.

8. Manage Stress

Schedule daily breaks into your routine—not just for lunch or coffee, but additional 10-minute breaks to simply catch your breath. Inhale for a count of 4 to 6, and exhale for a count of 6 to 8, while consciously feeling both feet flat on the floor. Another excellent strategy: get off public transit two stops early and walk the remaining distance.

9. Practice Self-Compassion

Affirmations help feed your subconscious mind with encouraging, positive messaging. Use this specific affirmation: "I am struggling right now. I am taking things step by step." Place a hand on your chest, breathe in and out slowly, and repeat the phrase three times. Use this mantra especially after experiencing setbacks.

10. Track Your Progress

Every evening, rate your overall mood on a scale from 1 to 10 in a notebook to plot your personal "mood curve" over time. This visual log helps you recognize positive progress, track setbacks, and spot downward trends before they fully develop.

Relapses are rarely caused by a single reason. Usually, several factors work together and gradually weaken you. Common triggers include prolonged stress, conflicts, and overload at work or within the family. Lack of sleep or highly fluctuating sleep times also disrupt your mood and drive. Physical illnesses such as pain or thyroid problems can further depress your mood. Alcohol and cannabis can worsen sleep, lower your mood, and interfere with the effects of medication. Seasons with little light or distressing anniversaries can intensify feelings of dejection. Social isolation or persistent rumination can also keep negative thoughts going and make you more vulnerable.

Another possible trigger is a gap in therapeutic treatment. Cancelled therapy sessions, excessively long intervals between appointments, or abruptly discontinuing antidepressants significantly increase the risk of a relapse. Sometimes, residual symptoms such as sleep disorders or rumination remain after an episode. These minor remnants also increase the risk. Shift work or stressful life events like a separation, grieving a loved one, losing a job, or hormonal changes can also favor relapses. The decisive factor is to perceive such elements and take counteraction early.

Exactly what helped during your first episode: A conversation with your doctor and your therapist. Following this, psychotherapy in the form of Cognitive Behavioral Therapy (CBT) should be resumed. It will help you once again to change your thoughts and behavior. You continuously practice planning activities, recognizing cognitive distortions, and addressing relapses early. A combination of therapy and antidepressants can also be considered.

Furthermore, you should support yourself in your daily life: plenty of physical activity, good sleep hygiene, a structured daily routine, and social contacts will strengthen you. Note down what makes you feel good and then consistently repeat those steps—motto: what makes you feel good is good for you.

deprexis is a Digital Health Application (DiGA) based on Cognitive Behavioral Therapy. The program offers structured modules, exercises, and daily aids designed to support you over the long term in managing depression. Speak with your doctor about obtaining a prescription for deprexis.