Depression is a mental health condition and serious mood disorder that currently affects millions of people worldwide, yet very few of them receive the help they need. The effects of this mental illness can be difficult to live with as it causes depression symptoms such as sadness, emptiness, or hopelessness that persist for most of the day, nearly every day. Additionally, individuals with depression often find it difficult to experience pleasure or enjoyment and may lose interest in activities they once found fulfilling. Depression can also cause various physical symptoms, such as appetite and weight changes, sleep disruption (like difficulty sleeping or sleeping too much), and reduced energy levels or tiredness. Individuals who are experiencing depression may often ask themselves, “How long does depression last?”.
Despite advancements in antidepressant medications, effectively addressing depression remains challenging for some individuals. Severe symptoms of depression can persist and have a negative impact not only on a person’s physical and mental health but their emotional and social well-being as well. The effects of depression can be long-lasting, causing prolonged emotional distress and compromising overall well-being for weeks, months, or even years. In this article, we explore the complexities of depression and the importance of effective treatment strategies.
Depression: A Spectrum of Disorders
Depression is a collection of mood disorders categorized by the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) of the American Psychiatric Association. These disorders include Major depressive disorder (MDD), persistent depressive disorder (dysthymia), disruptive mood dysregulation disorder, premenstrual dysphoric disorder, postpartum depression, and depressive disorder due to another medical condition. [2-3] Despite the differences in terminology, they all share common features: persistent sadness, emotional emptiness, or irritability, often accompanied by somatic and cognitive changes that significantly impair an individual’s ability to function effectively. [2-3]
Understanding Depressive Episodes
The term depressive episode refers to times when an individual experiences symptoms associated with depression, such as intense sadness, hopelessness, negative thinking, emptiness, fatigue, reduced energy, disrupted sleep patterns, anxiety, irritability, restlessness, and other indicators that go on for at least two weeks [9]. The overall severity and length of symptoms will indicate a minor or major depressive episode.
For some, depression may only pop up once throughout their entire life, however, it is not uncommon for individuals to experience multiple major depressive episodes or minor depressive episodes throughout their lifetime. In these cases, individuals may find themselves in a series of recurrent depressive episodes.
Progression of Untreated Depression
Research has shown that almost 60% of people experiencing depression avoid seeking professional help [2-3]. This reluctance primarily arises from the enduring stigma of mental health, making it challenging for individuals to access the support they require [2-3].
How the Brain is Affected by Depression
A 2018 study showed a potential link between untreated depression and lasting changes in the brain that might lead to future brain-related issues. The research, carried out by a team previously associating depression with brain inflammation, suggests that depression isn’t merely a short-term problem; it may gradually reshape the brain’s functioning [6].
The study involved 80 participants divided into three groups based on their depression status. The first group had untreated depression for more than ten years, the second group had untreated depression for less than ten years, and the third group did not have depression. All the participants underwent brain scans to identify a specific protein linked to brain inflammation. While some inflammation is beneficial to our health, excessive inflammation may lead to chronic diseases such as Alzheimer’s or Parkinson’s disease [6].
Effects of Untreated Depression
According to the researchers, people who suffer from untreated depression for a long time may have higher levels of inflammation-related protein in their brains. The study found increased protein levels in different areas of the brain, such as the prefrontal cortex, which is crucial for reasoning and decision-making and is often impaired by depression [6]. These findings suggest that depression may have similarities with degenerative diseases such as Alzheimer’s, potentially causing lasting damage to the brain. However, it’s important to note that the study had a relatively small sample size, highlighting the need for further research to confirm and expand on these findings [6]. Untreated depression can have significant consequences, including an increased risk of suicide, adverse effects on physical and mental health, and disruptions in both personal and professional life [2-3].
How Long Does Depression Last: With and Without Treatment
How long depression lasts varies based on several factors, such as the depression type, severity, lifestyle factors, and whether an individual is undergoing treatment. In some cases, the symptoms of depression may only persist for a short period, usually a few weeks. However, for those who do not receive treatment, depression could potentially last for months or even years [4].
Without treatment, clinical depression episodes can persist on average for six to twelve months [4]. However, with treatment, including medications, psychotherapy, and/or interventional psychiatry, individuals may notice some improvements in their symptoms within the first week or two of starting antidepressants. The full benefits of treatment may not be realized until two to three months of continued therapy [4].
Progress depends on many factors, such as the severity of symptoms, whether an individual is undergoing treatment or is untreated, and if they have other mental health problems. Seeking treatment is crucial, as approximately 80% to 90% of people with clinical depression who seek treatment eventually respond well to it [4].
When it comes to treating depression, many different methods can be used based on how severe the symptoms are and the individual’s circumstances. Some people may benefit from watchful waiting, while others may need urgent treatment. Support and communication are also important factors to consider. Overall, treatment for depression is multifaceted and should be tailored to meet the needs of each individual. [7].
Treatment and Management of Depressive Disorders
Effective treatment for depression often involves a combination of various therapies, medication, and other strategies. The ideal approach may vary depending on the severity of the condition and individual circumstances, so it’s important to seek the guidance of a mental health professional.
Medications
Effective depression treatment often involves the use of psychiatric medication, particularly in cases of moderate to severe depression or when there is a risk of self-harm or suicide. There are several different classes of antidepressants available. [1].
Antidepressants:
Antidepressants are medications used to treat depression, bipolar disorder, anxiety, and other mental health conditions. They can also be used off-label for other conditions such as pain, insomnia, and migraine.
Here are some key classes of antidepressant medications and their mechanisms of action [8]:
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRI medications like sertraline, fluvoxamine, fluoxetine, paroxetine, citalopram, and escitalopram work by increasing serotonin levels in the brain, which improves mood.
- Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs): Medications such as venlafaxine, desvenlafaxine, duloxetine, milnacipran, and levomilnacipran affect two neurotransmitters (chemicals in the brain) serotonin and norepinephrine which can help regulate mood.
- Atypical Antidepressants: Drugs like bupropion, mirtazapine, and agomelatine have different ways of working. For example, bupropion increases dopamine and norepinephrine levels, while agomelatine interacts with melatonin and serotonin receptors.
- Serotonin Modulators: Vilazodone, trazodone, and nefazodone are serotonin modulators that change serotonin levels in the brain and affect serotonin receptors differently.
- Tricyclic Antidepressants (TCAs): TCAs, including amitriptyline, clomipramine, and imipramine, increase both norepinephrine and serotonin levels in the brain but can also affect other receptors, leading to various side effects.
- Monoamine Oxidase Inhibitors (MAOIs): MAOIs like selegiline, moclobemide, tranylcypromine, isocarboxazid, and phenelzine block monoamine oxidase. This enzyme can break down serotonin, norepinephrine, as well as dopamine.
- NMDA Antagonists: Esketamine and dextromethorphan are used to treat severe depression that doesn’t respond to other treatments. They work by changing how glutamate, a brain chemical, is used.
Different antidepressants work in unique ways by targeting various neurotransmitters and receptors in the brain. The choice of medication depends on the patient’s specific condition and how they respond to the treatment.
While antidepressants can effectively treat depression, they can also come with side effects. Common SSRI side effects include sexual problems, drowsiness, weight gain, trouble sleeping, anxiety, dizziness, headaches, dry mouth, blurred vision, nausea, rashes, and trembling. Some patients might also experience other adverse effects, such as increased prolactin levels, inappropriate antidiuretic hormone (SIADH) syndrome, and low levels of sodium in the blood (hyponatremia).
Psychotherapy
Cognitive-behavioral therapy (CBT): CBT is the cornerstone of psychological treatment for depression. It involves a structured approach to identifying and challenging negative thought patterns contributing to depressive feelings. This therapy helps individuals with depression identify detrimental beliefs and challenge them, gradually improving their self-perception and overall emotional well-being. It is often recommended in combination with medication, particularly for acute depressive episodes. [7] CBT has shown to be effective in treating depression, both alone and in combination with antidepressant medication, and remission from depression can often be achieved through CBT, mainly when used in conjunction with medication for chronic depression. [3]
Holistic Treatment Options
Implementing these holistic practices can play a vital role in relieving depression symptoms alongside proven treatment methods.
- Relaxation Techniques and Yoga: Relaxation techniques encompass practices like progressive muscle relaxation, autogenic training, music therapy, and yoga. While these techniques can relieve mild to moderate depression, they are generally less effective than cognitive behavioral therapy (CBT). Some psychotherapists may incorporate relaxation techniques as part of a broader treatment plan. [7]
- Sports and Exercise: Physical activity, such as Nordic walking, jogging, cycling, swimming, or hiking, can improve mood and energy levels and is recommended for alleviating or preventing depression symptoms. [7]
- Light Therapy: Light therapy, also known as phototherapy, is presented as a treatment for seasonal affective disorder (SAD), a form of depression occurring during darker months. This therapy involves exposure to a special bright light device for about half an hour each morning, simulating the effects of natural daylight. [7]
- Sleep Deprivation Therapy: Sleep deprivation therapy is a method that temporarily deprives individuals of sleep to alter brain metabolism and potentially improve mood. This treatment offers temporary relief and may be used alongside other depression treatments. [7]
Alternative Treatment Options
Alternative treatments for depression offer another avenue for healing for individuals who have already tried medications or prefer not to take medications. In addition, many of these treatments provide faster symptom relief compared to antidepressants.
Electroconvulsive Therapy (ECT): ECT is considered a last-resort option for severe depression when other treatments prove ineffective. Administered under general anesthesia in a hospital setting, ECT induces controlled seizures through electrical currents. It is reserved for individuals grappling with severe and treatment-resistant depression [7].
Transcranial Magnetic Stimulation (TMS): TMS therapy has emerged as a promising therapeutic option for individuals battling depression [10]. Using magnetic fields, this non-invasive procedure stimulates specific brain regions, primarily the dorsolateral prefrontal cortex (DLPFC) [10]. TMS is often considered when other treatments, such as medication or psychotherapy, have not yielded the desired results or have caused undesirable side effects [10].
Spravato (esketamine) Treatment: Spravato is a relatively new and innovative depression treatment that is FDA-Approved for treatment-resistant depression. The treatment is performed in a clinical setting via a self-administered nasal ketamine spray that is supervised by a trained mental health professional. Individuals who have tried more than one medication and failed to see any positive results may be good candidates for Spravato.
Phases of Treatment
Treating depression involves distinct phases with unique objectives and timeframes. It is helpful to understand these phases to understand the path towards remission.
- Acute Treatment: During the first six to eight weeks of treatment, the goal is to reduce the severity of symptoms and help individuals resume their normal daily activities. This phase is focused on providing relief and stopping the progression of depression. The ultimate aim is to achieve remission for a period of at least six to eight weeks. [7,11]
- Continuation Treatment: Following the acute phase, continuation treatment lasts four to nine months. Its primary focus is further alleviating symptoms and preserving the progress achieved during the acute phase. Preventing relapse is a crucial objective during this stage [7].
- Relapse Prevention: For those at a heightened risk of recurrent depression, a long-term treatment phase, often referred to as “relapse prevention,” may endure for several years, particularly if symptoms persist or personal circumstances remain challenging [7].
In addition to these treatment phases, achieving remission is a pivotal milestone in the journey to recovery. While complete remission from depression is not common, many individuals experience partial remission within 12 months, offering substantial improvements in their quality of life and emotional well-being [2-3].
Recovering from depression involves cycles of remission and relapse, making continuous management and support crucial. Healthcare professionals and a strong social network are vital in providing the necessary assistance [2-3].
What is Remission?
Remission is when a patient’s depressive symptoms have significantly improved or completely disappeared, leading to a full recovery from depression. It is often measured using standardized depression severity scales and criteria. [10]
Does Depression Ever Go Away?
Although depression can often be effectively treated and managed, achieving complete elimination of all its symptoms may not be attainable for everyone. It’s important to understand that even after reaching a state of remission, it’s not uncommon for relapses to occur [2]. To minimize the risk of symptom recurrence, it’s advisable to consider long-term maintenance treatment [5]. Recognizing the early signs of depression and seeking treatment promptly is vital to prevent the condition from worsening [5].
Finding Hope and Help for Depression
While the duration of depression varies from person to person, early intervention, appropriate treatment, and a strong support network are crucial in managing its impact. Understanding the phases of treatment, from acute intervention to relapse prevention, can provide individuals with a roadmap to recovery. Whether through medications, psychotherapy, holistic approaches, or alternative treatments, various effective treatment options are available.
It’s important to remember that depression is a treatable illness, and many people experience significant improvements in their quality of life and emotional well-being with proper mental health care. Seeking help is a sign of strength and a crucial step towards a brighter future. Depression may not always go away completely, but with the proper treatment and support, it can be managed, allowing individuals to lead fulfilling lives.
If you or someone you know suffers from depression, don’t hesitate to seek professional help. You don’t have to face it alone; there is hope for a better tomorrow. At Neuro Wellness Spa, our dedicated team specializes in innovative mental health treatments and compassionate care to help you on your journey to wellness. Contact us today to learn more about our in-person and online psychiatry services offering medication management, as well as alternative treatments like TMS therapy.
References:
- Bains, N., & Abdijadid, S. (2023). Major Depressive Disorder. In StatPearls. StatPearls Publishing.
- Chand SP, Arif H. Depression. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430847/
- Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/
- Cleveland Clinic (2022, November 30). Clinical Depression (Major Depressive Disorder). https://my.clevelandclinic.org/health/diseases/24481-clinical-depression-major-depressive-disorder
- (n.d.). Depression (major depressive disorder). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
- DiSalvo, D. (2018, April 6). How Untreated Depression Changes the Brain Over Time. Psychology Today. https://www.psychologytoday.com/us/blog/neuronarrative/201804/how-untreated-depression-changes-the-brain-over-time
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Treatments for Depression. [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279282/
- Sheffler ZM, Patel P, Abdijadid S. Antidepressants. [Updated 2023 May 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538182/
- Substance Abuse and Mental Health Services Administration (SAMHSA) (2023, April 24). Depression. https://www.samhsa.gov/mental-health/depression
- Sonmez, A. I., Camsari, D. D., Nandakumar, A. L., Voort, J. L. V., Kung, S., Lewis, C. P., & Croarkin, P. E. (2019). Accelerated TMS for Depression: A systematic review and meta-analysis. Psychiatry Research, 273, 770–781. https://doi.org/10.1016/j.psychres.2018.12.041
- (n.d.). Three Phases of Treatment of Major Depression. PCORE Primary Care Online Resources and Education. https://edblogs.columbia.edu/pcore/depression-treatment-recommendations-for-major-depressive-disorder/depression-three-phases-of-treatment-of-major-depression/
