- Can mental disorders be cured?
That's what I'm talking about today.
I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
I've been asked this question several times,
and the answer is no.
Here's the explanation.
Most disorders, both mental and physical,
are managed, but not cured.
In medicine, we think of a cure
as a total reversal of an illness
to the point where there's no evidence of it,
and it does not return.
The closest we get to this scenario is fixing a broken limb,
or treating a vitamin deficiency
by giving a vitamin supplement,
but even things like high blood pressure are not cured.
Let's say you develop high blood pressure
because you're overweight.
Then you lose weight,
and your blood pressure returns to normal.
Did you cure the depression?
You resolved it at the moment,
but you're still at risk
for later developing high blood pressure
because not everyone who becomes overweight
gets an elevated blood pressure.
Some people are more susceptible
to elevations in blood pressure
as a response to weight gain or diet,
and if that's you, it could happen again at a later point.
Let's look at the main mental illnesses
that tend to come and go over the course of your life,
and then I'll talk about how they tend to look over time.
The main illnesses are major depression, bipolar disorder,
anxiety disorders, attention deficit hyperactivity disorder,
and schizophrenia.
The mood disorders,
like major depression and bipolar disorder,
are recurring illnesses
where you have episodes that last a while
and then they resolve.
Some people can have chronic symptoms,
but the classic picture is that you have discrete episodes
that resolve and then return.
You have periods in between
with either very few symptoms or no symptoms,
and when your symptoms go away we call it remission.
When your symptoms return, we call it a relapse,
so both depression and bipolar disorder
are relapsing and remitting illnesses.
The symptoms from these illnesses can remit on their own
even if you don't take medication,
but most times you need to take medication
to treat the symptoms.
When you take medication and the symptoms go away,
you're in remission.
If you stop taking the medication
you can remain in remission for weeks, months, or even years
until your symptoms return.
There are people with depression who have an episode
and never seem to have a return of their depression.
We still wouldn't say that that person is cured.
They've just remained in remission.
Why does this distinction matter?
In practice, an episode that's in lifetime remission
looks the same as one that's cured.
The difference, really, is in how you think about it.
If you think about it as being in remission,
you have some level of expectation
that there's a possibility that it could happen again,
so you could be prepared if there is a next time.
With the mood disorders, if you have future episodes,
they can become worse over time,
and we refer to this as the kindling effect.
We think of kindling, as in building a fire,
and the more material you put on the fire
the stronger the fire becomes,
so repeated episodes,
especially ones that go left untreated,
can return and become longer or harder to treat.
Now, this doesn't mean that you have to live in fear.
It just means to be aware
of when you start to have a return of your symptoms
so that you can jump on it quickly and extinguish the fire
to resolve the symptoms earlier rather than later.
Anxiety disorders tend to behave a little bit differently.
Rather than being episodic,
they tend to come and go in intensity over time.
It's kind of like a wave that crests and then recedes,
so there can be periods of your life
where your anxiety can feel unmanageable,
and you may seek treatment for it,
and then there can be periods of time
where it's not that bad.
The usual is that
you don't become completely free of anxiety.
It's just that your symptoms are manageable,
so you may have pops of feeling tense during the day
that go away for,
if you were to go on a walk or watch a movie with friends,
and you're able to bring yourself down from that anxiety,
and it's not causing much problems for you,
but then you might have some stressors that come along,
like moving, or changing jobs,
or some other life transition,
and your anxiety ramps up
and becomes more problematic for you.
You might start losing sleep or drinking more
to bring yourself down from the anxiety.
Attention deficit hyperactivity disorder
tends to look a little different from anxiety
over the course of your life.
Generally, symptoms can improve or nearly resolve
once you become an adult,
but not resolve to the point of being completely absent.
Residual ADHD symptoms
can look like being a slow reader,
or being disorganized and losing things a lot,
or not being a good listener.
There can be little things here and there
that don't really cause much dysfunction for you,
but if you become stressed because you're going through
a difficult period in your life,
your ADH symptoms may become more prominent.
It still may never get to the level
where you feel like you need to see a psychiatrist,
but you may just have trouble getting things done,
or struggling with dealing with whatever that stress is,
but then once the stress passes,
you're back to your usual functional self
with a few issues here and there.
That's one way that ADHD can progress over your lifetime,
but there are people whose ADHD symptoms
don't improve a lot as they become an adult.
They're just as symptomatic as an adult
as they were when they were a child,
but what can happen is that over time you learn to adapt,
and to recognize your weaknesses such that you avoid things
that you know that you're not good at,
and you spend more time doing things that you can do well,
and that's the ideal scenario in the adult with ADHD.
Schizophrenia tends to look more like a series of plateaus.
A person can start out with somewhat mild symptoms
that don't always look like schizophrenia,
and then at some point in their life
the symptoms fully manifest.
I did a video explaining schizophrenia,
and I'll put a link in the description
and in the corner of this video
so that you can watch that video after this one,
but the usual course with schizophrenia is that
once the symptoms fully manifest,
a person can remain at that level of illness severity
for a while,
and that can be years,
and then at some point there's a decline,
and the symptoms increase.
You may get more medication added,
but that seems to be your new baseline,
and this is especially the case for the cognitive symptoms,
so instead of having this gradual deterioration,
which some people can have,
there's this stepwise downward trend.
The good news about this pattern is that
the interval in between the steps
can be very long, like years,
so someone who develops the disorder at 25,
and then lives until they're 75,
may have three or four steps downward.
I hope this helps you understand
the outlook of mental disorders and how they're not cured,
but the symptoms are treated
in a way that they can be completely absent or minimal.
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I publish new videos every Wednesday.
See you next time.