Depression is one of the most commonly experienced challenges of the mind in the world. The World Health Organization reported that 264 million people around the world suffer with depression. The WHO’s statistics only include those who meet the diagnostic criteria for Depressive Disorders, and those who are reported. Imagine how many people suffer with depression who for one reason or another are not seeing a provider who can report their diagnosis or for one reason or another fall short of the diagnostic criteria, but still suffer with depression. Our bag of tools for treating depression is quite diverse and vast, from medications, to meditation, to Cognitive-Behavioral Therapy, Existential Therapy, Psychoanalysis, exercise, sunlight, and many more. While depression may not be easy to treat or recover from, in terms of mental illness it has some of the best statistics for recovery. Even for the roughly 20% of people with depression who suffer with it chronically, their symptoms often gradually reduce over time. The process of recovery from depression is not the easiest to understand as the sufferer though. Here we will look at how the recovery process from depression is filled with peaks and valleys and at times can be frustrating to handle.

A “Typical” Recovery
When we get injured, say a broken leg, recovery follows a fairly predictable course. As long we avoid reinjury, use self-care, and have proper medical care, it isn’t the most complex process to conceptualize. Injury recovery is often linear in nature. Linear meaning that it follows a consistent and unidirectional path from bad to better. Day 1 after a broken leg is very bad, day 5 is bad but a little better, day 21 is decent but still painful, day 40 is good but not quite back to normal, and by day 60 we should be just about fully healed. If you were to track your recovery of a broken leg on a graph where the X-axis represents time and the Y-axis represents how good your leg feels, it will generally look like this:

Time passes, you feel better. There is a direct positive relationship between how your leg feels and time. Depression recovery, however, is a bit more complex.

Am I Getting Better?
Whichever treatment or combination of treatments for depression works for an individual will take time, often on the scale of weeks to months, to fully take effect. Medications typically takes 4-6 weeks to reach their peak effects and counseling-based techniques can take time to show reductions in symptoms as well. But people do start to feel better. The frustration begins often after that first sign of improvement. A common example is a depression sufferer will have a day or two where they feel improvement in their mood, but then have a day that feels like they are right back where they started in the depths of depression. Let’s run through a hypothetical person’s early stages of recovery from depression:

• Days 1-4 after starting treatment, client does not see any improvement and wonders if they are doing the right treatment.

• Days 5-7 client notices subtle improvements in mood and functioning and feels there may be a light at the end of the dark tunnel.

• Days 8-9 client notices drastic improvement and reports to counselor and those around them that they are truly feeling better.

• Day 10-11 client has no major stressors or life events, but feels worse, almost as bad as when they started. Client is frustrated, feeling they had false hope.

• Day 12 client feels somewhere in between how they felt in days 10-11 and days 8-9, and while this is an improvement from the previous days it still is confusing as to what is causing these ups and downs.

So, is this client getting better? Yes! Unfortunately, in depression recovery we do not simply feel a little better each day until we are back to normal. We bounce up and down and follow a general trend upwards.

Follow the Trend
If you have ever followed the stock-market or listened to financial experts, there is an accepted fact that while stocks can peak and dip radically over short periods, the overall market trends upwards over the course of years. Depression recovery is similar to this except without necessarily taking years. Remember back to your High School math days (if it isn’t too stressful to think back to those days) and recall scatter plots. Those were the graphs where a bunch of dots where plotted, and one line was drawn through the average of the dots to find that trend. Depression recovery is a lot like a scatter plot with the general trend being upward toward feeling better.

Ignoring the Independent/Dependent variable labels, this graph illustrates the point well. Each of those dots is a day and their position on the vertical axis is a depressed person’s mood. We see that earlier in time towards the left of the graph, most dots are low but varying levels of low. Towards the right of the graph, the dots are higher but again not consistent. The trend is towards recovery but the day to day changes are not easy to track. This graph also shows as the “outlier” which occurs during depression recovery as well. Outliers are days where one may feel extremely up or extremely down compared to the days immediately before or after. This could be because while recovery from depression a person received really good news, or had a stressful incident, and this created a drastic mood shift for a short period. This is why I recommend clients with depression use a mood tracking app of their choice. It can help show the overall positive trend, but also can show outliers and allow the client in therapy to explore these bigger swings and what causes them. If you are looking to see if you are on the path to recovery from depression, focus on the overall trend and less on the day to day fluctuations.

Why Isn’t It Linear?
Why recovery from depression is so filled with peaks and valleys is not well understood. There likely is some blame to be found in the fact that our mood fluctuates up and down regardless of whether we suffer with depression or not. Biological reasons are probably involved with things like our Circadian Rhythms, hormones, stress, and even seasonal changes in our neurobiology. I tend to think that there is a “pushback” effect when it comes to depression recovery. Our brains and pathways inside our brains get used to reacting certain ways to certain things. While depression feels horrible and can be torturous, our brains get used to feeling that way and fight against the changes we make when we are trying to get better. Like a rubber band around our wrist that we pull tight, sometimes it snaps back and gives us a painful slap. The brain will push back against our changes and this can sometimes lead to painful days that challenge our belief that we are getting better. This is where it becomes important to trust the counselors, doctors, and support systems we have around us. Those people who see us improving overall can remind us during those pushback days that the overall trend is upwards and stop us from abandoning hope or the methods that are working because of a temporary setback.

Hopefully we are able to someday understand why depression recovery isn’t linear and can be so frustrating. The good news is that even though we don’t understand it yet, we have enough data to know that people do recover. It is often inconsistent, filled with potholes along the way, and demands we be resilient and trust the process.

If you are struggling with depression and the complex recovery process from this condition, please contact Life Enhancement Counseling Services today at 407-443-8862 to schedule an appointment with one of our experienced mental health counselors.