For many adults, depression is not a single episode. It lifts, life moves on, and then the heavy weeks return. Many women describe that second or third return as the hardest part, because it can feel like the treatment that once helped has stopped working. That feeling is common, and it is a reason to go back to your doctor, not a reason to stop asking for help.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.
One point comes first. The questions in this article are for planning care with a doctor over days and weeks. They happen alongside crisis care, never instead of it. If thoughts of suicide feel urgent, reaching the 988 Lifeline or emergency services comes before any appointment.
When depression comes back, say so plainly
A return of depression is useful medical information. It tells your doctor something about how your current plan is working, and it opens the door to adjusting it. You do not need to wait until things feel unbearable to make that call.
It helps to be direct. Tell your doctor how long the symptoms have been back, which treatments you have tried before, how each one went, and whether you have had thoughts of suicide. Saying that last part out loud can feel frightening, but doctors ask about it because it changes what kind of care fits right now. Being honest about it is a step toward safety, and it helps your doctor match the plan to what you are actually going through.
If you have had thoughts of ending your life, your doctor may talk with you about a safety plan: the warning signs you notice, the people you can reach, and the steps to take if things get worse. Many people keep that plan written down and share it with someone they trust.
An FDA-approved option to ask about
Some adults hear about esketamine nasal spray, sold under the brand name Spravato. According to its FDA prescribing information, it is approved for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior, used together with an oral antidepressant. It is also approved for treatment-resistant depression in adults.
It is important to be clear about what the label says. The prescribing information states that esketamine has not been shown to prevent suicide or to reduce suicidal ideation or behavior. It also states that standard care still applies, including hospitalization when a doctor judges it is clinically needed. In other words, this medicine is not a replacement for crisis care or for close follow-up. It is one possible part of a larger treatment plan.
The way it is given is different from a pill you pick up at the pharmacy. Under the label, esketamine is given only in a certified healthcare setting that takes part in a federal safety program. Patients are monitored for at least two hours after each dose. Patients must not drive or operate machinery until the next day, after a restful night of sleep, so getting a ride home is part of planning each visit.
The label lists common side effects that include dissociation, which can feel like being disconnected from yourself or your surroundings, as well as dizziness, nausea, sleepiness and a rise in blood pressure. Those effects are part of the reason for the monitored setting.
Whether esketamine fits your situation is a decision for you and your doctor. Your doctor will weigh your health history, other medicines and other conditions before recommending it or suggesting a different path.
Questions to bring to your doctor
Writing questions down before an appointment can make a hard conversation easier. Consider bringing a list like this one:
- What is changing? Why do you think my depression has come back, and what does that tell us about my current plan?
- What are my options? Should we adjust my medicine, add therapy, or consider other treatments?
- Is esketamine nasal spray something to consider for me? Why or why not, given my history?
- What would treatment involve? How often would I visit, how long would I stay, and how would I get home afterward?
- What side effects should I watch for? Who do I call if something feels wrong?
- What is my safety plan? What should I do, and who should I contact, if thoughts of suicide get stronger?
- When should we check in again? How will we know whether the new plan is helping?
Bringing support with you
You do not have to carry these conversations alone. Some people bring a partner, friend or family member to appointments to take notes or simply to sit with them. Others ask a trusted person to help them keep track of symptoms between visits.
It can also help to keep a short record of how you are sleeping, eating and feeling each day. That kind of record gives your doctor a clearer picture than memory alone, especially when depression makes the days blur together.
Recovery from recurring depression often takes more than one attempt at finding the right plan. Needing to try something new is not a personal failure. Help is available, and many people find a way forward with the right support and steady care.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day. If someone is in immediate danger, call 911 or go to the nearest emergency room.