What Is Recurrent Major Depressive Disorder?

Summary: Recurrent major depressive disorder (MDD) is a clinical condition characterized by two or more episodes of major depression separated by periods of partial or full remission. Each recurrence tends to be more severe and harder to treat than the last, making early and sustained intervention critical. Recurrent MDD is classified under ICD-10 code F33 and is distinct from a single depressive episode (F32) in both its clinical trajectory and treatment implications. Symptoms include persistent sadness, loss of interest, fatigue, sleep disruption, difficulty concentrating, and feelings of worthlessness or hopelessness lasting two weeks or more per episode. At Overland IOP in Los Angeles, we treat recurrent major depressive disorder through structured outpatient programs — IOP and PHP — using evidence-based therapies including CBT, DBT, medication management, and relapse prevention strategies designed to reduce the frequency and severity of future episodes.

According to the World Health Organization, major depressive disorder is the world’s leading cause of disability. If clinical remission is not attained and sustained, episodes tend to recur with greater severity and with lessening responsivity to conventional treatments. This is called a recurrent major depressive disorder.

What Is Major Depressive Disorder?

You may hear this type of depression is referred to as “major depressive disorder”, “clinical depression”, “classic depression” or “MDD”. You might have this type if you feel depressed most of the time for most days of the week.

Like many mental health conditions, it is not always about what’s happening around the person. You can have a loving family, friends, and a dream job. You can have the kind of life that others envy and…. still have a major depressive disorder. Major depression is a severe form of depression that causes symptoms such as:

• sadness, gloom, or grief
• difficulty sleeping or sleeping too much
• lack of energy and fatigue
• changes in appetite
• unexplained aches and pains
• loss of interest in formerly pleasurable activities
• lack of concentration, memory problems, and inability to make decisions
• feelings of worthlessness or hopelessness
• constant worry and anxiety
• thoughts of death, self-harm, or suicide

These symptoms can last weeks or months.

Major Depressive Disorder Vs Depression?

All of us feel sad sometimes. While we may casually use the term “depressed” to describe the moment when they are sad, there is a difference between sadness and depression. Someone with depression may feel sad, guilty, or hopeless, but not really understand why—and the feeling can linger for weeks or even months. If you are struggling with constant sadness or hopelessness, it’s important to understand what depression is, what causes it, and what you can do to manage it. Major Depressive Disorder (MDD) or Clinical depression is the more severe form of depression. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.

Recurrent Major Depressive Disorder ICD-10

According to ICD-10: “A recurrent major depressive disorder characterized by repeated episodes of depression as described for the depressive episode, without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression, and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with the recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder.”

Recurrent Major Depressive Disorder ICD-10: Mild, Moderate, Severe, Psychotic.
According to ICD-10:

Recurrent depressive disorder

A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression, and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with the recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to bipolar affective disorder (F31.-).Incl.:recurrent episodes of:

• depressive reaction
• psychogenic depression
• reactive depression

seasonal depressive disorderExcl.:recurrent brief depressive episodes (F38.1)

F33.0 Recurrent depressive disorder, current episode mild

A disorder characterized by repeated episodes of depression, the current episode is mild, as in F32.0, and without any history of mania.

F33.1 Recurrent depressive disorder, current episode moderate

A disorder characterized by repeated episodes of depression, the current episode being of moderate severity, as in F32.1, and without any history of mania.

F33.2 Recurrent depressive disorder, current episode severe without psychotic symptoms

A disorder characterized by repeated episodes of depression, the current episode being severe without psychotic symptoms, as in F32.2, and without any history of mania. Endogenous depression without psychotic symptoms. Major depression, recurrent without psychotic symptomsManic-depressive psychosis, depressed type without psychotic symptoms viral depression, recurrent without psychotic symptoms

F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms

A disorder characterized by repeated episodes of depression, the current episode being severe with psychotic symptoms, as in F32.3, and with no previous episodes of mania. Endogenous depression with psychotic symptomsManic-depressive psychosis, depressed type with psychotic symptoms recurrent severe episodes of:

• major depression with psychotic symptoms
• psychogenic depressive psychosis
• psychotic depression
• reactive depressive psychosis

F33.4 Recurrent depressive disorder, currently in remission

The patient has had two or more depressive episodes as described in F33.0-F33.3, in the past, but has been free from depressive symptoms for several months.

F33.8 Other recurrent depressive disorders

F33.9 Recurrent depressive disorder, unspecified

FAQs About Recurrent major depressive disorder (MDD)

Q1: What is recurrent major depressive disorder?

Recurrent major depressive disorder is a form of clinical depression in which a person experiences two or more major depressive episodes, each lasting at least two weeks, separated by a period of at least two consecutive months without meeting full criteria for a depressive episode. It is classified in the ICD-10 under code F33 and in the DSM-5 as major depressive disorder, recurrent. Unlike a single episode of depression, recurrent MDD indicates a pattern of relapse that typically requires longer-term treatment strategies including maintenance therapy and relapse prevention planning. Research shows that after a first depressive episode, the risk of recurrence is approximately 50 percent; after a second episode, the risk rises to 70–80 percent.

Q2: What is the difference between major depressive disorder and recurrent major depressive disorder?

Major depressive disorder (MDD) can present as either a single episode or as a recurrent condition. A single episode of MDD (ICD-10 code F32) means the person has experienced one qualifying depressive episode — at least two weeks of depressed mood or loss of interest plus additional symptoms such as sleep changes, fatigue, and difficulty concentrating. Recurrent MDD (ICD-10 code F33) is diagnosed when a person has experienced two or more such episodes with a period of remission between them. The distinction is clinically significant because recurrent MDD typically requires more intensive and longer-duration treatment, often including maintenance medication and structured relapse prevention, to reduce the likelihood of additional episodes.

Q3: What are the symptoms of recurrent major depressive disorder?

The symptoms of each depressive episode in recurrent MDD are the same as those for a single major depressive episode. They include persistent depressed mood or sadness most of the day and nearly every day, markedly diminished interest or pleasure in activities, significant weight or appetite changes, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating or making decisions, and recurrent thoughts of death or suicide. To qualify as a major depressive episode, at least five of these symptoms must be present for a minimum of two weeks and must represent a change from previous functioning. With recurrent MDD, these episodes return after periods of partial or full remission.

Q4: What causes depression to keep coming back?

Several factors contribute to the recurrent nature of major depressive disorder. Biological factors include genetic predisposition, neurochemical imbalances involving serotonin, norepinephrine, and dopamine, and structural changes in the brain that may worsen with each untreated episode — a process sometimes described as “kindling,” in which the brain becomes increasingly sensitized to depressive episodes over time. Psychological factors include unresolved trauma, chronic stress, negative cognitive patterns, and co-occurring conditions such as anxiety disorders or substance use disorders. Environmental triggers such as major life changes, relationship conflict, isolation, and loss can also precipitate new episodes. Inadequate initial treatment — stopping medication too early or not receiving sufficient therapy — is one of the most significant modifiable risk factors for recurrence.

Q5: How is recurrent major depressive disorder treated?

Treatment for recurrent MDD typically involves a combination of psychotherapy, medication management, and structured relapse prevention. Evidence-based therapies with strong support for treating recurrent depression include Cognitive Behavioral Therapy (CBT), which targets the negative thought patterns that sustain depressive episodes; Dialectical Behavior Therapy (DBT), which builds emotional regulation and distress tolerance skills; and Mindfulness-Based Cognitive Therapy (MBCT), which was specifically developed to prevent depressive relapse. Medication management often includes antidepressant maintenance therapy extending well beyond symptom resolution — current guidelines recommend continuing medication for at least one to three years after remission for recurrent episodes. Outpatient programs like IOP and PHP provide the structure and clinical intensity needed to stabilize acute episodes while building long-term coping strategies.

Q6: Can outpatient treatment help with recurrent depression, or do I need inpatient care?

Most individuals with recurrent major depressive disorder can be effectively treated in outpatient settings, including Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP). Inpatient care is generally reserved for situations involving active suicidal ideation with a plan, inability to perform basic self-care, or psychotic features. IOP provides 9 or more hours per week of structured therapy while allowing patients to live at home and maintain work or family responsibilities. PHP provides more intensive daily treatment (5–6 hours per day, 5 days per week) for individuals who need closer clinical monitoring without overnight hospitalization. Research consistently shows that structured outpatient programs produce outcomes comparable to inpatient treatment for moderate to severe depression. At Overland IOP in Los Angeles, both IOP and PHP are available with morning, afternoon, and evening tracks, in-person and virtual. SAMHSA — IOP Evidence Review (PMC)

Q7: Does Overland IOP treat recurrent major depressive disorder in Los Angeles?

Yes. Overland IOP in Los Angeles provides specialized outpatient treatment for recurrent major depressive disorder through our IOP (3 hours per day, 3–5 days per week) and PHP (6 hours per day, 5 days per week) programs. Our clinical team designs individualized treatment plans that address the recurrent nature of MDD using CBT, DBT, ACT, psychodynamic therapy, medication management, and structured relapse prevention. We treat depression alongside co-occurring conditions including anxiety disorders, PTSD, substance use disorders, and personality disorders. Programs are available in-person at our Los Angeles location and virtually, with flexible scheduling. Most major insurance plans are accepted, including Aetna, Cigna, UnitedHealthcare, Blue Shield of California, Kaiser, TRICARE, and SAG-AFTRA. Call (800) 530-3100 for a free consultation.