Depression

"If you got a depression diagnosis, one of the most basic things you want to know is, what are the chances of my life returning to normal?"
"You'd assume we'd have an answer to that question. I think it's embarrassing that we don't."
"You'd not only be giving people with depression some hope, by studying this [research] group. You might also be able to give them something they could use."
Jonathan Rottenberg, professor, University of South Florida

"We know that many people with bipolar disorder, for instance -- a serious, lifetime condition -- do very well after treatment, and end up in creative jobs."
"But we can't predict who [will do well after treatment]. So it would be very important to have this kind of information."
Sheri Johnson, director of mania program, University of California, Berkeley

"I think it's fine -- it's a good idea -- to look at people who do well after a period of depression, over the longer term."
"But we might simply find that they're the people who were doing better in the first place."
"I've never told patients that [they're doomed to be depressed forever throughout their lives]. I tell them they're likely to get better, and I suspect that most of my colleagues do the same."
Dr. Nada Stotland, psychiatrist, Rush University Medical Center, Chicago

Jim Goldberg, Magnum Photos

Transitory depression at one time was expected when people were exposed to life-changing episodes in their lives. Others noted the state that was induced and deduced that it was temporary -- the depressed person had lost a family member, lost employment, been in an accident and is recovering -- and in due time the depression would lift, with a return to normalcy and acceptance.

Psychiatry itself now has taken to wondering about the types of depression, from mild and transitory to chronic. And though clinicians may be able to diagnose the depth of depression and hope to be able to prescribe adequate therapy, there remains much that is unknown about the condition.

Generally depression is described as not always characterized by a dark mood soon to be lifted given enough time and distance from depressive events. It is viewed as a condition of greater permanence. One capable of storming the fragile psyche of the depressed. And so the debate revolves around mild depression, to severe, to "endogenous", the latter rare, a near-paralyzing condition of despair.

Studies have gone forward in search of identifiable markers to predict depression and to identify paths to recovery.

Despite which, treatment remains an intransigent process of trial and error, with various types of drugs tried in the hope that it will pave the path toward if not complete recovery then at least the capacity to live with the condition. Even so, a drug that works for one person will not necessarily be useful for another, in fact can make someone else's condition even more seriously engrained.

Dr. Rottenberg and his colleagues produced a paper published in the current issue of Perspectives on Psychological Science where the argument is made that while attempting to understand how people with depression could improve their condition, scientists remained focused on those in dire straits; failing to follow those who have managed to recover from their once-debilitating condition.

The focus on understanding how people recover from depression is limited by available evidence, the new paper points out. Typically, treatment trials take six to eight weeks to completion, focusing on reducing negative symptoms such as worthlessness feelings. It is what occurs in years subsequent and in the process in which positive developments occur and for whom, that is missing.

The same team of psychologists arrived at a rough estimate of the number of post-depression "flourishers" in a forthcoming analysis by the same team of psychologists, to be published in Clinical Psychological Science. They made use of data from a periodic national survey in the United States, one that includes over 6,000 people between the ages of 25 and 75, more than 500 of whom met criteria for depression.

Half of those who received a depression diagnosis recovered. That meant they had been symptom-free for at least a year -- and one in five of that group, representing ten percent of the total, were thriving, a decade on. The researchers realize that recovery may not be a simple process to quantify since some people who thrive afterward might claim that daily pills led to their recovery, while others may depend on weekly talk therapy. Generally, it is agreed that friends and good genes play a role.

About 1 in 10 Canadians will experience an episode of major depressive disorder (the diagnosis given to those suffering from depression) during their lifetime.
Depression is, in fact, a widespread medical condition:

• Depression is among the leading causes of disability worldwide
• Women are more likely than men to experience depression
• People with a family history of depression may be more likely to develop the disease
• People with chronic illnesses may also be susceptible to the disease

• According to worldwide projections from the World Health Organization (WHO), by 2030, the amount of disability and life lost from depression will surpass that from war, accidents, cancer, stroke, and heart disease. In fact, WHO reports that for youth aged 10 to 19, depression is already the number-one cause of illness and disability.
• The National Comorbidity study reported two decades ago that 18-to-29-year-olds in America were likelier to experience depression than those 60 and older, even though they’d been alive for less than half as long.
• According to a 2012 survey by the Association for University and College Counseling Center Directors, 95 percent of college counseling-center directors in America reported an increase in the number of students with significant psychological problems. A 2012 survey of college students by the American College Health Association found that 33 percent of women and 27 percent of men identified a period in the previous year of feeling so depressed that they had difficulty functioning.
• According to the Centers for Disease Control, antidepressant use has increased 400 percent since 1988 in America. In fact, 11 percent of Americans over the age of 12 take an antidepressant. A recent BBC news story reported that so many people are taking Prozac in the United Kingdom that scientists are concerned that active metabolites in human urine are running off into water and affecting the behavior of wildlife.

Dr. Jonathan Rottenberg, Psychotherapy Networker