The notion of recovery from depression as opposed to symptom management is a relatively new idea and is open to debate (Stotland, 2012). Many individuals prior to experiencing a major depressive episode have throughout their lives experienced some degree of depression, with symptoms persisting post a depressive episode for as many as 20 to 30 % of people (Stotland, 2012; Valdivia and Rossy, 2004). In addition the chances of a recurrence of a depressive episode is high, with one study reporting that 85% of its subjects (n=380) experienced a relapse within 15 years post treatment (Mueller, Leon, Keller, Solomon, Endicott, Coryell, Warshaw and Maser, 1999). The American Psychiatric Association reports that at least 50% of people who have had a depressive episode will have a second episode, with some 80% of people who have experienced two episodes experiencing a third. Based on the above statistics what is meant by recovery is in and of itself unclear and while some sufferers of depression may experience a full recovery, for many depression sufferers simply keeping symptoms at a manageable level or preventing relapse for as long as possible is a reasonable expectation.
So how can the depression sufferer optimize their chances of getting well and staying well? Let’s explore some of the factors that bolster and support as full a recovery as possible. While there is a paucity of long term or rigorous studies that clearly indicate factors that assist in recovery, there are a number of variables that are widely recognized by mental health professionals and have some evidence behind them.
The statistics mentioned above are somewhat sobering but they also communicate very clearly to the depression sufferer a reality that demands the need for ongoing vigilance, self-monitoring and a solid commitment to sustained recovery. Thus awareness is a key factor in ensuring sustained recovery from depression. It is essential that individuals recovering from depression remain alert to the signs and symptoms of depression and self-monitor for the recurrence of any such signs and symptoms. People who have experienced depression also need to be aware of any triggering events or experiences that might impact on recovery or make them vulnerable to a relapse.
An additional major factor in recovery is to ensure appropriate treatment of depression. In order to maintain as sustained a recovery as possible, it is highly recommended that patient treatment includes a combination of medication and CBT (Cognitive Behavioral Therapy) (Sudak, 2012). This improves the response rate to treatment and also the sustainability of any gains made. CBT for depression includes strategies that modify beliefs, thoughts and behaviors and hence can reduce the likelihood of relapse (Sudak 2012). It is essential that these strategies are maintained well after the primary impact of the depressive episode has been felt, which may include sustaining a maintenance relationship with a supportive therapist. If healthy thought patterns and behaviors can be implemented and sustained the likelihood of as full a recovery as possible is increased and the risk of relapse greatly reduced.
Many professionals point to the role of exercise in recovery from depression. In a Cochrane review of exercise for depression a number of studies pointing to the benefits of exercise in depression recovery are cited. The use of exercise is shown to be as effective as antidepressants or psychotherapy with some studies linking exercise in particular to reduced risk of relapse (Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, et al., 2000). While inclusion of exercise is indicated in recovery from depression, the frequency and type of exercise is unclear from these studies. Some basic guidelines include building up slowly, choosing an exercise that is enjoyable and sustainable and generally increasing physical activity.
There is also some indication that social support plays an important role in depression recovery. The relationships and connections a person sustains help to bolster and support recovery. Social support reduces the experience of social isolation, ensures more of an outward focus and connection to life and provides a greater range of possibilities in terms of generating solutions for managing depression (Krull, 2016).
While a great deal more investigation is required to truly understand the factors essential to recovery, approaching it with an awareness of the some of the key factors that can optimize it will assist in ensuring a higher likelihood of sustained recovery from depression.
Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 2000;62(5):633–8.
Krull, E. (2016). Social Support Is Critical for Depression Recovery. Psych Central. Retrieved on December 29, 2016, from http://psychcentral.com/lib/social-support-is-critical-for-depression-recovery/
Cochrane review: Exercise for depression Retrieved on December 29, 2016
Mueller TI1, Leon AC, Keller MB, Solomon DA, Endicott J, Coryell W, Warshaw M, Maser JD. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry. 1999 Jul;156(7):1000-6.
An Overview of Depression Recovery. Retrieved on December 29, 2016, from WebMD
Stotland, N.L. Recovery from Depression. The Psychiatric clinics of North America 35(1):37-49 · March 2012 with 15 Reads
Valdivia, Ivan; Rossy, Nadine (2004). Brief Treatment Strategies for Major Depressive Disorder: Advice for the Primary Care Clinician. Topics in Advanced Practice Nursing eJournal. 4 (1) – via Medscape. (registration required (help)).