Is My Depression Here to Stay?
People who have experienced more than one episode of depression ask, quite reasonably, whether they are ever likely to be well? The answer they receive is often ambivalent, but nearly always with a hint of optimism, reflecting the fact that no two people are alike. Still, as we learn more about the course of depression it becomes clearer who is most at risk from chronic depression, and what the most effective treatment and preventative methods are.
Depression affects people differently. There is a recognized genetic link to depression that seems to increase vulnerability, but it does not mean the person will inevitably become depressed or that they are immune to treatment if they do. With this in mind it becomes increasingly important to know whether and where the tipping point might be that says a person is less or more likely to develop depression as a chronic state.
Studies into this very issue suggest that anyone experiencing more than three episodes of depression falls within the chronic category. What does this mean for people beneath and within this category? For those who fall within the chronic category the message, for the moment at least, seems to be they are far more vulnerable to further depressive episodes. Their sensitivity to triggers is heightened both psychologically and physically. For those who fall under the threshold, the message is to try and stay well and there are different ways to achieve this.
Depression is a little like pain in the sense that once it passes it can be difficult to quite remember how it felt. For people that have experienced one or two episodes of depression it is important they focus on staying well during the times they aren't depressed and not dismiss their depression as a passing problem. Of relevance here is the role of antidepressants versus psychological therapy and lifestyle. If your experience was that antidepressants helped you get better, that's good, but be aware that antidepressants are for treating depression, not to keep you well. Staying well is a different mechanism and if you only rely on antidepressants to treat your illness, you are inviting further depressive episodes and increasing your risk of a chronic condition.
Over the past decade there has been quite a lot of interest in ways to stay well that overlap methods of treatment. We know, for example, there are ways to actively work with a low mood that grumbles on. Brain mechanisms can be boosted by purely psychological means and enhanced by exercise and a good diet. Moreover, these positive effects can actually be demonstrated with neuroimaging scans that reveal the areas of brain being affected. A good therapist will encourage new ways of thinking that discourage rumination and negative thinking and replace these with more mindful activities that focus on the hear and now.
Now, the tipping point I mentioned previously is really just a number and our lives aren't dictated in such ways. The fact that you may have experienced more than three episodes of depression certainly doesn't mean you are doomed to a life of depression so you may as well give up. In your case you need to focus just as much on the better times in order to keep your next episode (which may not be inevitable) at bay. The evidence to date also suggests that a good regime of diet, sleep, exercise, and no alcohol or drugs during the better times, may take the edge off both the depth and duration of a subsequent depressive episode, should it occur.