Can depression be cured?

Can you ever fully recover from depression?

Depression can affect people in different ways, sometimes causing very different symptoms in people who share the same diagnosis. There are also different types of depression, that can cause a range of symptoms. These differing types may have different underlying causes or symptom duration ^[1].

As such, different types and severities of depression may have different recovery processes. For example, some people might be able to recover from an episode of depression with no professional assistance, while others might require life-long treatment to manage their symptoms ^[2][3].

Different types of depression include ^[1][4][5]:

• Major depressive disorder (MDD): MDD can cause episodes of very low mood that tend to last at least 2 weeks. These episodes may vary in severity. Often, people with MDD will experience episodes of depression throughout their life and may require ongoing treatment to manage their symptoms.
• Persistent depressive disorder (PDD): PDD is usually characterized by an ongoing low mood. Although it may be less severe than symptoms of MDD, it is more persistent and may not improve with time. Sometimes people with PDD also experience episodes of major depression and can be diagnosed with both PDD and MDD. PDD typically requires ongoing treatment to manage symptoms and improve daily functioning.
• Seasonal affective disorder (SAD): SAD usually occurs during winter when there are fewer hours of sunlight. As such, many people with SAD require treatment for this period of time but may experience no symptoms of depression in the spring and summer months.
• Perinatal depression: It is common to experience symptoms of depression during or after pregnancy, known as prenatal and postpartum depression, respectively. These symptoms can be very severe and may require treatment. Often, the symptoms will alleviate within the weeks or months following childbirth with professional intervention.
• Premenstrual dysphoric disorder (PMDD): Hormonal changes that occur during the menstrual cycle can cause some to experience PMDD prior to menstruation, causing symptoms of depression. The symptoms usually then subside but may reoccur every month and can cause a significant impact on mood and functioning, so may require treatment.
• Depression with psychosis: For some people with very severe depression, symptoms of psychosis can occur. This typically requires professional treatment to manage, which may be necessary to continue long-term to prevent relapse.

As there is no cure for depression, it can require life-long treatment and there is often a risk of relapse, meaning that symptoms of depression can return. The risk of relapse may be higher for those who have experienced very severe episodes of depression or if treatment has been unsuccessful in the past ^[3].

However, many people with depression can manage their symptoms with professional treatment and self-care, so that they can continue to function well in personal, professional, and social aspects ^[1][4].

How is depression treated?

Depression is often treated with a combination of therapy and medication, which may vary from person to person. Treatment approaches depend on the severity of the individual’s condition, their current symptoms, their response to various treatments, and the duration of their illness ^[1].

The goal of depression treatment is to manage symptoms so that the individual can function well, have a good quality of life, and avoid severe relapses ^[2].

Therapy

Several different types of therapy can be utilized to help treat depression, including ^[2][6][7]:

• Cognitive behavioral therapy (CBT): CBT is often a very effective treatment for depression. It can help with recognizing and challenging unhealthy and negative thought patterns and their associated behaviors. CBT also provides problem-solving skills and techniques to manage distressing emotions.
• Interpersonal therapy (IPT): IPT provides an opportunity to discuss underlying emotional and interpersonal issues that may contribute to symptoms of depression. IPT also helps individuals to understand triggers, regulate emotional distress, and learn interpersonal skills that can help to improve relationships.
• Group therapy: Although group therapy may not be helpful during acute and severe episodes of depression, it can be useful as part of maintenance therapy. Group therapy provides an opportunity to share with and support others who have experienced similar symptoms, thereby helping to prevent social isolation and a worsening of symptoms.
• Family therapy: Family therapy can be utilized to help improve dynamics within the home, whether between children and parents or between couples. Family therapy provides skills for better communication and conflict resolution.

Medication

Often for the treatment of depression, one antidepressant medication will be prescribed. Although some individuals may need additional medications to help improve their symptoms.

Medications can cause different responses in people, so what is effective at treating one person’s symptoms may not be as effective for another’s. Therefore, it can sometimes be necessary to change medications or doses to find the most effective treatment ^[1].

Antidepressants include ^[2][6][7]:

• Selective serotonin reuptake inhibitors (SSRIs): This is usually the first choice of medication for depression, as it is typically effective and causes the fewest side effects. Common SSRIs include citalopram, sertraline, and fluoxetine.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): SNRIs are usually prescribed if SSRIs are ineffective. Common SNRIs include duloxetine and venlafaxine.
• Tricyclic antidepressants (TCAs): TCAs are not as commonly prescribed as SSRIs and SNRIs as they may be more likely to cause side effects, so will typically only be prescribed if other medications are not successful. Common TCAs include amitriptyline and imipramine.
• Other antidepressants: Some antidepressants do not fall under the above categories but work in a similar way and may still be utilized to treat depression. This includes bupropion and mirtazapine.

Most medications cause side effects at the start of treatment, such as headaches, stomach upset, and drowsiness. These side effects will typically only last a few weeks as your body adjusts to the medication. However, if you experience any persistent or concerning side effects it is important to consult with your doctor, as you may require a change of medication ^[2].

Hospitalization

In some cases, someone with depression may need to receive treatment in hospital. Hospitalization is usually required for depression if the individual is at a very high risk of suicide or has made several attempts. Hospitalization may also be required if the individual is a risk of harm to others or is experiencing severe symptoms that cannot be managed at home.

While in hospital, a team of professionals will provide treatment, with the aim to stabilize the individual’s mental state by administering medication and therapeutic interventions. The individual will then return home when their condition is stable with a plan around their continuing treatment ^[8].

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is a treatment that can be used to treat severe depression that has not responded to other treatment. ECT involves the use of electrical pulses that stimulate the brain. The procedure is very brief and occurs while the individual is under general anesthesia ^[2][9].

ECT is typically performed up to 12 times over several weeks. The aim of ECT is to provide a rapid improvement in symptoms, which can be particularly beneficial for those who experience catatonia or are a very high risk of suicide ^[9].

If ECT or other types of brain stimulation therapy are deemed an appropriate treatment, a doctor will discuss the risks and benefits with the individual and their family or carer. Following ECT, treatment will typically continue with the use of medication and therapy ^[1].

How else can you manage depression?

While therapy and medication are often crucial to successfully treating depression, it is also very important to ensure that you engage in healthy behaviors and habits to maintain your physical and mental wellbeing. This includes ^[1][2][4][7]:

• Diet and exercise: Eating healthy foods and engaging in regular exercise have been shown to have a significant effect on mental health, such as improving sleep, reducing symptoms of anxiety and depression, and increasing self-esteem.
• Sleep routine: Getting a good night’s sleep is very important when recovering from depression and helps to prevent a worsening in symptoms. Sticking to a routine of going to bed and getting up at the same time every day, as well as avoiding caffeine and screens before bed, can be very beneficial in improving symptoms of depression.
• Relaxation exercises: Engaging in relaxation exercises, such as breathing exercises, meditation, yoga, and mindfulness techniques, can help to reduce stress and symptoms of depression.
• Talking to others: It is important to have a support system when recovering from depression, whether this is a family member, friend, or support group. Talking to others and sharing your experiences can improve symptoms of depression and reduce social isolation and loneliness.
• Continue treatment: Ensure that you attend all appointments with your doctor or therapist, take medications exactly as they are prescribed, and continue with your self-care techniques. Sticking with your treatment plan is the best way to aid the recovery process, as well as helping to prevent a worsening of symptoms or relapse.
• Avoid alcohol and substance use: Reducing or avoiding the use of drugs and alcohol can significantly improve the recovery process. Substances can have a negative impact on mental health and can prevent treatment from being effective.

Will there ever be a cure for depression?

There is ongoing research into the treatment of depression and new medications and treatments are regularly being developed and tested. It is unlikely that there will ever be a cure for depression, as it often has several underlying causes and contributing factors, thus presenting differently from person to person, but new treatments may increase the likelihood of successful recovery ^[1][6].

New medications for depression include:

• Dextromethorphan/Bupropion: This new medication, sold under the brand name Auvelity, combines dextromethorphan hydrobromide and bupropion hydrochloride and has very recently been approved by the FDA for use in the treatment of major depressive disorder ^[10].
• Esketamine: Esketamine is approved by the FDA for the treatment of depression under professional supervision. It is administered as a nasal spray and has been found to be an effective treatment, that begins working much quicker than antidepressant medications such as SSRIs ^[11].
• Brexanolone: Brexanolone is a new medication and the first FDA-approved medication that can be prescribed to treat postpartum depression ^[12].
• Psilocybin: Psilocybin is found in what is often referred to as ‘magic mushrooms’ and is currently being tested and trialed as a medication for treatment-resistant depression, with positive results so far ^[13].

New treatments that are being developed include variations of ECT, including transcranial magnetic stimulation, which uses brain stimulation to treat depression.

A treatment developed at Stanford University called Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), which uses transcranial magnetic stimulation, has been found to be very effective in trials at improving severe and treatment-resistant depression ^[14].

In 2022, the FDA approved the further development of the SAINT protocol for the treatment of MDD, so it may be available to the public in the near future ^[15].