In this video,
I'm going to talk about whether or not it's possible
to fully recover from depression
and what you can do to increase the chances of recovery.
I'm Dr. Tracey Marks, a psychiatrist
and I make mental health education videos.
This video is based on a viewer request from X,
that's a shortened version of the name
to talk about euthymia and what it means to be euthymic.
I expanded the topic to include recovery,
which is not the same as being euthymic.
Euthymia means having a normal mood state.
In depression, you have recurring episodes of dysthymia,
which is a low mood state.
And that state of dysthymia includes your mood
and other symptoms that come with a depressive episode.
Then when the episode resolves,
you return to a euthymic state,
which is your baseline state.
Some people think of euthymia as being symptom free,
but that's usually not the case.
Most people have some lingering symptoms,
even at their baseline state.
And here's what I mean by that.
Depression is a chronic illness that can come and go,
over the course of your life.
About 40% of people recover from their depressive episode,
within three months and 80% will recover within a year.
And this is spontaneous recovery if you do nothing about it.
Then the remaining 20%
of people can develop chronic symptoms
that can become what we call persistent depressive disorder.
By the way,
this pattern refers unipolar depression
and not bipolar depression,
which behaves a little differently
as you can have alternating episodes of depression
or mania as part of the illness.
There are factors that lessen the chance
that you will have the quicker recovery within three months
or even complete recovery without medication.
These factors are having severe symptoms
that include psychosis,
having a lot of anxiety with your depression
and having a personality disorder underneath the depression.
If those factors are present,
you have a greater chance of having a longer episode
or having chronic symptoms.
Although depression is a recurring illness
that comes and goes,
if you have a first episode,
the longer you stay in remission,
the greater the chance you may not have another episode.
So, let's say you suffer a loss of someone
that you're close to and you grieve,
but you also fall into a depression on top of that grieve.
You recover after several months
and a few years go by without another episode,
it's reasonable to assume that you may be someone
who has the one off episode of depression
that does not recur.
Things that increase the chance
of your depression coming back are,
having a very severe previous episode,
being very young when you had your first episode
and having multiple episodes.
Once you start having a recurring episodes,
it's very likely that that will be the pattern.
Now, keep in mind,
what I'm talking about with these risks of having a return
of your symptoms is if you let the illness come
and go naturally and do nothing to intervene.
Some people can have their symptoms resolved
with medication treatment and remain stable for years,
without any significant symptoms.
And that brings me to what we consider recovery.
Another word for recovery is remission.
The "Psychiatric Diagnostic Manual,"
defines depression remission as having at least two months
with no significant symptoms.
Partial remission is when you have some symptoms,
but not enough to meet criteria
for still being in a major depressive episode.
Notice the definition for full remission
is not zero symptoms,
but that symptoms that are not significant.
I think it's more often than not
that people have some leftover symptoms that are manageable,
but not completely gone.
And the Star D Trial supports this conclusion.
It was a huge landmark study,
funded by the National Institutes of Health from 2006
that looked at how many people achieved remission
from some of the common antidepressants.
Sadly, that study showed
that the highest responding group
that achieved remission was only 33%
and that's pretty low.
33% is still a minority.
And to make matters worse,
the study defined remission as scoring a seven or less
on the Hamilton Depression Scale.
Here's what that scale looks like.
It has 17 items on it that represent symptoms of depression
and the items can get a score of zero to four
with zero meaning it's not a problem at all
and four meaning it's pretty bad.
So, here's what a score of seven can look like.
You can score zero for having a depressed mood
if you feel like your mood is back to normal,
but you can get one point
for having mild indigestion or diarrhea.
And one point for waking up in the middle of the night,
you can get two points for being tired all the time.
And another two for having no sex drive,
then another point for being fidgety because you're tense.
That's still a lot of things going on,
yet you're considered to be in remission
from your depression,
according to this big authoritative study.
So, even though it's still a lot of stuff,
none of the symptoms are severe enough to hold you back
in major areas of your life.
Having no sex drive may impact your relationship
or it may not if you've got other positive things going on
and you're still able to be active,
even though you're not the initiator.
Also some of these things,
like waking up in the middle of the night,
may be long standing issues or influenced by other factors,
like having a pain problem
that wakes you up in the middle of the night
or a snoring spouse or barking dog.
So, at the end of the day,
what does all this mean when it comes to depression?
It means that
when you are determining your level of recovery,
you have to consider
that you will likely not be symptom free,
but still have some mild symptoms
that you may or may not have had before you had the episode.
And some of these symptoms,
may be affected by your life situation.
Also, you have to accept
that you can have wellness within the illness.
And this is where the silver lining is here.
On the one hand,
the results of the Star D Study show
or at least make depression treatment look pretty grim.
To say that at best only a third of people reach remission,
where remission
is defined by still having a lot of symptoms,
sounds pretty discouraging.
However, these results reflect the heavy focus on pathology
and illness management that is traditional psychiatry.
But over the past 20 years,
there has been some shift toward what some call,
positive psychiatry.
It started with positive psychology
and psychiatry is falling in line.
What's the difference between traditional
and positive psychiatry?
The positive psychiatry framework,
takes a more holistic approach to address overall wellness.
Instead of mostly managing pathology
with a positive psychiatry view,
we look more at prevention of symptoms
by reducing risk factors and identifying protective factors,
which are the things that can help prevent future episodes,
like being a part of a supportive community,
prioritizing self-care and using adaptive coping mechanisms.
If you do develop symptoms,
the treatment focus
is on achieving your best level of recovery,
increasing overall wellbeing and building resilience.
So, in the case of someone who gets depressed
and then gets into remission with medication or therapy
or let's say it goes away spontaneously,
the next step is to work on lifestyle maintenance
to keep the illness away or minimize residual symptoms.
What would some of those things be?
Prioritizing your sleep
to get seven to nine hours each night.
And that is more than saying to yourself,
"Yeah, I'm going to work on that."
It's a whole process of sleep hygiene behaviors
that you have to attend to.
The Mediterranean diet continues to be shown in studies
to treat depression symptoms,
independent of other treatment methods.
Food is not something
that's just going to snap you out of depression.
The effect of changing your diet takes time.
But when you add these natural things,
like sleep, food, exercise, self-care, meditation
or some other kind of mental strengthening,
these things produce accumulative effect,
like compounding interest.
You get more benefit over time
and that's how you can break through
this dismal 33% recovery prognosis.
Medication isn't the only answer in neither is therapy.
Taking a whole body and mind approach
is the way to maximize your mental and physical wellness.
Watch this video for more on what exercise does
for your brain.
And then I have a nutritional psychiatry playlist
that dives deep into how food treats your mood.
Thanks for watching,
see you next time.