Monday, 22 October 2018

What’s Life Like After Depression?

What’s Life

What’s Life Like After Depression? Surprisingly, Little Is Known

A generation ago, depression was viewed as an unwanted guest: a dark presence that might appear in the wake of a loss or a grave disappointment and was slow to find the door.
The people it haunted could acknowledge the poor company — I’ve been a touch depressed since my father died — without fear that they had become chronically ill.
Today, the condition has been recast within the medical literature as a darker, more permanent figure, a monster within the basement poised to overtake the psyche. For decades, researchers have debated the varied sorts of depression, from mild to severe to “endogenous,” rare, near-paralyzing despair. Hundreds of studies have been conducted, trying to find markers that may predict the course of depression and identify the best paths to recovery. But treatment largely remains a process of trial and error.

A drug that helps one person can make another worse. The same goes for talk therapies:
some patients do very well, others don’t respond at all.

“If you bought a depression diagnosis, one among the foremost basic items you would like to understand is, what are the probabilities of my life returning to normal or becoming optimal afterward?” said Jonathan Rottenberg, a professor of psychology at The University of South Florida.
“You’d assume we’d have an answer to that question. I think it’s embarrassing that we don’t.” In a paper within the current issue of Perspectives on psychology, Dr. Rottenberg and his colleagues argue that, in effect, the field has been looking for answers in the wrong place. In trying to know how people with depression might escape their condition, scientists have focused almost entirely on the afflicted, overlooking a potentially informative group: people that once suffered from some sort of depression but have more or less recovered.

Indeed, while this cohort almost certainly exists — every psychiatrist and psychologist
knows someone in it — it is so neglected that virtually nothing is known about its
demographics, how well its members are faring and, fundamentally, how many
individuals it contains.

“We know that a lot of people with manic depression, as an example — a significant, lifetime
condition — do alright after treatment, and find yourself in creative jobs,” said Sheri
Johnson, director of the mania program at the University of California, Berkeley. “But we
can’t predict who. So it would be very important to have this kind of information, to know
more about that group.

Imagine if doctors could give you some sense of what’s possible.”In the new paper, Dr. Rottenberg and his co-authors, Todd Kashdan and David Disabato of George Mason University, and Andrew Devendorf of The University of South Florida, argue that the trouble to know how people get over depression is stunted by the kind of evidence available.

Treatment trials typically last six to eight weeks and they focus on reducing negative symptoms, such as feelings of worthlessness, fatigue, and thoughts of suicide. What happens in the subsequent months and years — and which positive developments occur, and for whom — is largely unknown.
“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,” said Dr. Nada Stotland, the psychiatrist at RushUniversity Medical Center in Chicago. “But we'd simply find that they’re the people who were doing better in the first place.”
In a forthcoming analysis, to be published in Clinical Psychological Science, the same
team of psychologists makes a rough estimate of the amount of post-depression“flourishers,” using data from a periodic national survey called the Midlife Development in the United States. The survey includes more than 6,000 people between the ages of 25and 75 and quite 500 who met the criteria for depression. About half of the people who had received a diagnosis recovered afterward, meaning that they had been symptom-free for at least a year, the researchers found. One in five of those — 10 percent of the total —were thriving a decade later. The research team based that judgment on an assessment that includes measures of how people feel, how well their relationships are going, and
their work.

That 10 percent number might look disappointingly low, or encouragingly high,
depending on one’s perspective. The best comparison is that the portion of individuals who were
rated as thriving who never had depression: 20 percent.

“That is, having depression cuts in half your chances of ending up during this group” at the
the high end of the well-being scale, Dr. Rottenberg said. He added: “But we really don’t know
for sure, until we have better evidence.”
To gain that evidence, the perfect approach would be to follow an outsized cohort of individuals
who had recovered from depression, over a few years, to tease the differences
between the 10 percent or so who thrived and those who did not. Such studies would be
costly, the authors acknowledge, and certainly would require collaboration among many
large clinical centers.

Still, individuals who’ve routed what Churchill called his “black dog” and built a full life has a collective knowledge that others don't. And researchers can only speculate about what that vanquishing entailed until they ask, systematically and empirically.

The answers won’t necessarily fall into a straightforward pattern. Whereas some people
who thrive after depression might swear by daily pills, others may depend upon weekly talk
therapy. Good friends, good opportunities, and good genes are likely to play a role.

And they're very well may be many people who have developed idiosyncratic methods of their
own, a sort of daily self-therapy or routine not found in any manual, textbook or study.
“If so, it might be exciting to seek out out what those are,” Dr. Rottenberg said. “You’d not
only be giving people with depression some hope, by studying this group. You might also
be able to give them something they could use.” For now, said Dr. Stotland, the Chicago psychiatrist, the very fact that depression is often chronic, and recurrent,

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