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It Is Possible to Thrive After Depression

Psychologists are beginning to study depressed people who go on to flourish.

People who suffer from depression can recover more fully than most people think.
Source: spukkato/iStock

What are the chances of full recovery from major depression? Most people assume they’re not good. The message from clinicians and researchers has generally been that depression is a destructive disease that lingers and/or recurs. And, of course, depression often is exactly that. But it does not have to be that way—at least not for everyone.

When a group of researchers went looking—for the first time—for really good outcomes in people who had previously suffered from depression, they were surprised by what they found. Over 10 years, 10 percent of those who had previously had an episode of major depression were not only managing their symptoms but could be said to be thriving in life. In various measurements of psychological well-being, they were doing as well as the top 25 percent of people who had never suffered an episode of depression at all. (More on what that means in a moment.)

Ten percent may not seem like a lot, but what’s important is that until now, we didn’t know that anyone with depression managed to get into what psychologist Jonathan Rottenberg of the University of South Florida, who led the research, has called “the rarified air of people going along in life and flourishing.” If you don’t look for something, he points out, you won’t find it.

The study, which was published in Clinical Psychological Science in 2018, used a nationally representative sample from the long-running Midlife Development in the United States study, which includes adults aged 25 to 74. Out of more than 3000 participants surveyed two times, 10 years apart, 239 qualified as having had a major depressive episode at the start of the study and also completed all the necessary questionnaires on well-being.

Rottenberg and his colleagues looked at nine measures of psychological well-being: autonomy, personal growth, positive relationships with others, expressing positive feelings to a high degree, expressing negative feelings to a low degree, environmental mastery, having a purpose in life (“an overarching life aim”), self-acceptance, and overall life-satisfaction.

“Who’s doing well in life?” the researchers asked themselves. They set the bar high for what qualified as a good outcome and looked for measures of good mental health, not just the absence of mental ill health. They found that among non-depressed people, the top 25 percent of the population scored above the 50th percentile on eight out of the nine measures, and above the 84th percentile on three of them.

So they held those who had suffered from depression at the start of the study to the same standard. The researchers found that roughly 10 percent of the depressed group (23 of the 239 participants) had high levels of psychological well-being 10 years later. Among non-depressed adults it was 20 percent. That meant that depression reduced one’s chances of flourishing by half, but it didn’t do away with those chances entirely. Having a higher level of psychological well-being at the start of the study predicted who would be flourishing a decade on.

It might seem unlikely that anyone could have high levels of any of those well-being measurements while also being depressed. “The assumption would be that depression would destroy various manifestations of well-being,” Rottenberg told host Eric Zimmer on the podcast The One You Feed. On average that was the case, but not for every individual. As an example, a young woman who has recently had a baby might suffer from an episode of depression, but also feel that the baby gives her purpose in life and she might have strong relationships with her spouse and parents as they all join in taking care of the baby. “It’s important to know that happens,” Rottenberg said.

Just knowing that these people are out there ought to force clinicians to think differently about what’s possible for those with depression. “Viewing well-being rather than symptomatic relief as an achievable goal represents a paradigm shift in thinking about psychopathology outcomes,” Rottenberg and his colleagues wrote. “Such a perspective can spark new questions regarding the ordinary magic of resilience.”

Facebook/LinkedIn image: Gorodenkoff/Shutterstock

Copyright: Lydia Denworth, 2019

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Rottenberg, Jonathan, et al. "Optimal Well-Being After Major Depression." Clinical Psychological Science 7.3 (2019): 621-627.

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