Little is known about life after depression

A generation ago, depression was viewed as an unwanted guest: a gloomy 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 little depressed since my father died” — without worrying that they had become chronically ill.

Today, the condition has been recast in the medical literature as a darker, more permanent figure, a monster in the basement poised to overtake the psyche. For decades, researchers have debated the various types of depression, from mild to severe to “endogenous,” a rare, near-paralyzing despair. Hundreds of studies have been conducted, looking for markers that might 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 do not respond at all.

“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 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 in the current issue of Perspectives on Psychological Science, Rottenberg and his colleagues argue that, in effect, the field has been looking for answers in the wrong place. In trying to understand how people with depression might escape their condition, scientists have focused almost entirely on the afflicted, overlooking a potentially informative group: people who once suffered from some form of depression but have more or less recovered.

Indeed, while this group 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, even how many individuals it contains.

“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,” 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, Rottenberg and his coauthors, Todd Kashdan and David Disabato of George Mason University, and Andrew Devendorf of the University of South Florida, argue that the effort to understand how people recover from depression is stunted by a lack of evidence to study. 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, a psychiatrist at Rush University Medical Center in Chicago. “But we might simply find that they’re the people who were doing better in the first place.”

In an analysis to be published in Clinical Psychological Science, the same team of psychologists make a rough estimate of the number 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 25 and 75 and more than 500 who met criteria for depression. About half of the people who had received a diagnosis had recovered, meaning they had been symptom-free for at least a year, the researchers found. One in 5 of those were thriving a decade later. The research team based that judgment on measures of how people feel, how well their relationships are going, and their work.

To gain more evidence, the ideal approach would be to follow a large cohort of people who had recovered from depression, over many years, to tease apart the differences between the 10 percent or so who thrived and those who did not.

For now, said Stotland, the Chicago psychiatrist, the fact that depression can be chronic and recurrent hardly means that people are doomed by the diagnosis. “I’ve never told patients that,” she said.

“I tell them they’re likely to get better, and I suspect that most of my colleagues do the same.”