Depression: Do You Know All Your R's?
Understanding Response, Remission, Recovery, Relapse and Recurrence.
Posted Mar 24, 2011
Move over Reading, wRiting and aRithmetic. In this article, you're gonna be schooled about the 5R's known as Response, Remission, Recovery, Relapse and Recurrence. If you're living with depression, or any chronic illness for that matter, you will likely move through many, if not all of these clinical experiences. Understanding the particulars of each category will not only help you stay on track with your treatment plan, but will also aid in deepening your self-observational skills.
The first objective in the treatment of your depression is to get you to a response level. Response is clinically defined as an improvement from the initial onset of your illness. The goal herein would be to report less depressive symptoms. It doesn't matter if you're involved in psychotherapy and/or pharmacotherapy. What does matter is that you experience feeling better. Getting to a response level will be easy for some, moderate for others, and harder for those with treatment resistant depression. When it comes to a response, don't compare yourself with another person's experience. Instead, focus on your biology and biography to set realistic goals.
The second goal in treating your depression is to bring you to a full state of remission. Remissionis clinically defined as the experience of being symptom-free from illness. This differs from response in that you not only report an improvement from when you started treatment, but also describe the presence of well-being, optimism, self-confidence and a return to a healthy state of functioning. It is important to follow your treatment plan so you can achieve a full state of remission. Not doing so can lead to a partial remission - an experience of significant improvement where mild symptoms still exist. It is VERY IMPORTANT to know that if you're still experiencing depressive symptoms, you have not reached a full remission. Partial remission signals the need to continue with your treatment for depression. This is where most children and adults with unipolar or bipolar disorders lose their way. They stop taking their medication or interrupt psychotherapy because they "feel better"... but in actuality, they haven't achieved a full remission.
Recovery is clinically defined as the absence of symptoms for at least 4 months following the onset of remission. Recovery presents with periods of improvement and growth as well as with setbacks and stumbling blocks. So, essentially, you'll have good days and you'll have bad days. And yes, the human experience is one where you'll feel depressed, fatigued and hopeless from time to time. It's important to monitor yourself by assessing your physical and emotional experiences with the tools you've learned in psychotherapy. It is also imperative to keep up with your medication if that's part of your treatment plan. Research states that over 50% of children and adults who have a mood disorder will not achieve recovery because they don't tend to this stage of treatment, which is sometimes called the continuation phase of treatment.
Relapse and Recurrence
Relapse and Recurrence are terms commonly used to describe a return of depressive symptoms. In truth, though, they are distinctly different experiences. Relapse is defined as a full return of depressive symptoms once remission has occurred - but before recovery has taken hold. Recurrence refers to another depressive episode after recovery has been attained.
I know all these R words get a little tricky to follow, but practice makes perfect. Learn about these clinical experiences, educate yourself with further reading and incorporate the 5R's in your treatment plan.
Talk about the 5R's with your therapist or doctor - and make your final goal the setting up of a maintenance treatment plan for your depression.
McIntyre, R.S.; O'Donovan, C. (2004). The human cost of not achieving full remission in depression. Canadian Journal of Psychiatry, 49:10S-16S.
Vittengl, J.R.; Clark, L.A.; Dunn, T.W. & Jarrett, R.B. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy effects. Journal of Consulting Clinical Psychology, 75(3): 475-488.