What are the signs of recovery from depression?

To be able to consider end signs of depression, it is important to determine what we mean by the term “cure”. According to the criteria of the World Health Organization (WHO), healing is a return to the previous state. So, when you go through a depression, is a return possible? Aren’t there residues that persist, alterations in the environment and/or at work… and which continue to “take the lead”? Isn’t the fear that it will start again too strong? Can depression really be cured? Answers.

How quickly can depression be cured?

The management of a major depressive state, of depression, goes through initiation of antidepressant treatment. It is generally necessary to count 3 weeks for this treatment to be properly applied and to judge its effectiveness. From the 3rd month, we can consider that the depressed person has come out of this symptomatic state. Treatment will continue between 3 and 6 monthsand all that along with psychotherapy to consolidate this “healing”. There are nuances between these data and the patients’ feelings about the healing time. “When we question the patients, they do not have the same notion of healing: there is always for them an “after-depression” which remains deeply rooted in their existence and which means that they will need to pursue psychotherapy at their own pace. The doctor-patient relationship is therefore very important. in this healing, emphasizes Dr. Chabannes, psychiatrist.

To know if the depression is over, it is important to determine the 9 characteristic criteria that define this major depressive state (according to the DSM-IV, 5 of these criteria are required for the diagnosis to be made) and thus to consider the improvement of the symptoms which make it possible to evoke a cure:

1. depressed mood, sadness or even a certain irritability, found more in men than in women, and in children or adolescents
2. the rather brutal drop in interest and pleasure in living
3. changes in appetite: loss of appetite or weight gain
4. sleep changes: morning insomnia (at 2 a.m.) which is accompanied by dark thoughts when the person has gone to bed exhausted; hypersomnia (sleep day and night) is less common but can be observed;
5. psychomotor slowing: difficulty performing even routine tasks
6. energy loss and permanent mental fatigue
7. feelings of guilt and worthlessness: “Very often, this feeling remains underlying despite the so-called medical cure of the patient, because he has the feeling of having turned everything upside down: family life, professional life, friendly relations…”
8. cognitive impairment, difficulty thinking, concentrating
9. recurrent thoughts of death and suicidal thoughts.

“If these symptoms improve, it means that the patient is facing an upward slope, which can give hope for recovery”, insists Dr. Chabannes. When any of these signs change, they are very good indicators of the improvement of the depression towards its cure:

► Improved sleep apart from the prescription of hypnotics or sleeping pills: “Today I manage to sleep until 6 a.m….”

► The resumption of a more invigorating activity : “I regain a little pleasure in reading or watching a film on television. I manage to do it when it was impossible for me…“

► A contract between doctor and patient during psychotherapy will make it possible to postpone certain ideas or impulses to allow little by little to find a certain stability.

Can we have sequelae after depression?

Sequelae are very often found after depression.

► Psychological sequelae:

• the fear that it will start again,
• uncertainty about why the depression happened. “The subject is questioning and envisages the future, the post-depression, not always in a positive way“, explains Dr. Chabannes.

► Sequels affective which can be very destabilizing:

• energy boost,
• return of pleasure
• renewed enthusiasm but partially
• fatigue may persist. “The subject feels good about returning to work, resuming family life, but still lacks, imperfections, a certain form of enthusiasm… An example: are we going on vacation this summer in Guernsey? Answer: oh, you think… you think… So this lack of enthusiasm can be a sequel”.

► Of the sequelae related to the alterations generated by the disease in the direct environment of the patient:

• being poorly received at work because of depression,
• being watched by his spouse to find out if the treatment is taken and if the depression does not recur,
• to no longer have the same intimate relationship with one’s spouse…

To avoid relapse, the patient should be informed about their disease to be able to monitor it and identify symptoms which could be indicative of a risk: for example, the seasons (spring and autumn bring depression), excessive consumption of alcohol or certain medications (cortisone)… A certain number of keys are transmitted to the patient to involve him in his healing and allows him to react quickly in case. “There are patients I used to see every month and now see twice a year. The latter know their illness very well, their symptoms and the side effects of their medication… As the psychotherapy progresses, we will be able to space out the consultations”.

Can we never recover from depression?

30 to 40% of people who have had a single bout of depression recover

“You should know that only 30 to 40% of people who have had a single bout of depression recover. For more than 50%, there is a risk of relapse“, notes Dr. Chabannes. Two types of cure for depression exist: the final cure And intercyclic healing. Intercyclic healing is a state of healing between two depressions. The space between two depressions decreases between the 2nd and 3rd and decreases further between the 3rd and 4th. “The more bouts of depression you have, the closer the next one is“. Depression is an upheaval of existence that leaves traces, which even digested can resurface. “Medicine does not cure, it heals to maximize healing“, concludes Dr. Chabannes.

Thanks to Dr Jean-Pierre Chabannes, psychiatrist, lecturer at the Faculty of Medicine of Grenoble