Vulnerabilitätsfaktoren depressiver Rezidive und Rückfälle

BACKGROUND: Depressive episodes are associated with a high risk of relapse and recurrence. A precise understanding of the risk factors for recurrence and relapse can prevent poor disease courses through the implementation of early and targeted interventions. OBJECTIVE: Description of the factors that increase the risk of recurrence and relapse in major depression. MATERIAL AND METHODS: Narrative literature review. RESULTS: Risk factors for depressive recurrence and relapse are primarily clinical factors, including the number of previous depressive episodes, a young age at first onset and existing residual symptoms. Environmental factors include childhood maltreatment and current stressors. Intrapsychic factors such as increased neuroticism or dysfunctional cognition also promote relapses and recurrences. Biological factors include functional and structural brain changes, immunological dysregulation and genetic predispositions. CONCLUSION: In clinical practice the previous course of illness is the key predictor for individual risk prognosis. Therapeutic interventions should focus on achieving full remission of residual symptoms through combined pharmacological and psychotherapeutic treatment. The vulnerability to recurrence of depressive episodes is multifactorial and the indications for recurrence prevention should reflect this.