How long does it take people to recover from months or years of serious depression, if they do recover at all? And what extra problems should you be aware of when recovering from depression?
There is no general answer to the first question because individuals can differ widely when it comes to recovery. Jan Spijker, chronic depression expert at Nijmegen University in the Netherlands, paints the following global image of depression recovery today:
Many depression patients can indeed (often helped by medication) recover successfully, but not always in a way that can be said to be definitive. About 50% of all depression patients will recover in a non-definitive way: at some point in the future, they will suffer from a second depression episode. And about 10% to 20% of all depression patients will develop truly chronic depression, lasting longer than two years. According to Spijker, some patients “should accept that depression has become a part of their life”, in one way or another.
Based on my own experience (I belong to those 10-20% myself, and have also have seen depression recurring in others) I think this is a fairly realistic assessment. In a way, serious depression will always remain a part of your life simply because it remains a part of your life history.
Regardless of what group you belong to, for most of us comes a day when for the first time we are strong and lucid enough again to take a proper analytical look at our lives – at the smoldering ruin that remains of the life we had before depression struck us down.
This is the moment when we notice not just that we are recovering, but also that we will have some rebuilding to do.
Basically, speaking in general, recovering from serious depression also entails (1) acknowledging some losses, evaluating whether what you lost can be restored or not; and then (2) either fighting to rebuild whatever you lost, or accepting some losses and compensating for them in a different way.
Your losses can range from physical ones to social ones, in all terrains of life. For example, you may have less energy because you sleep less well than you used to; you may have lost your former self-assurance or even self-respect; medication side effects may keep slowing down your reaction times; after a lengthy period of depression you may have lost many of your friends; as a consequence of depression you may have lost your job or even your partner in love.
For some parts of the smoldering ruin of our former life there may be no other option than to write them off, to replace them with something different. Other parts may and should be rebuilt. Let me give you a brief (and of course too-schematic) overview.
One basic loss that in most cases can and should be recovered, is the self-discipline and energy to pick up normal daily chores again. Shopping, cooking, eating (yes that can feel like a chore), cleaning, walking or exercising, showering, taking care of your cat, all things like that. Even if your depression didn’t involve hospitalization, chances are that for an extended period your illness did make you lose your proper routine.
My tip for reclaiming it: in the early phase of your recovery process, write down a daily list of tasks on a piece of paper. All of them, including those that seem self-evident or those that still a little too daunting. Tick off each one you’re done with. Don’t feel guilty for what you didn’t do yet; feel relieved for what you already managed to do.
Both your depression and the depression therapy can have resulted in collateral damage, physically and mentally. Your physical condition may have deteriorated by lack of exercise, or by some depression-related addiction: drinking? smoking? As for therapy effects, your medication may have left you sexually near-impotent. Or (this happens to many) hospitalization may have eroded your subconscious mental image of yourself as an independent, goal-oriented person, making you too passive. Or (this is what happened to me) electroshock treatments may have permanently wiped out parts of your long-term memory.
It’s hard to give some kind of general tip here because it can greatly differ, from to one person to another, exactly what damage is repairable and what is not. Try to discuss things with your doctor and your psychiatrist. For example, if your recovery process allows for experimenting with less strong antidepressant medication, this may (though not for everyone) help solve sexual problems.
My basic tip here would be: above all, be realistic. Don’t try to achieve what you’re not up to yet, don’t force yourself. If trying to jog again somehow makes you feel like a sad failure, begin with simple walks instead. Try to accept irreparable losses and temporary setbacks. In such cases, it’s safer to go for compensation by some other activity than to end up with an inevitable defeat: because ongoing “failures” might result in a return of your depression.
As a consequence of years of serious depression and the inability to work when ill, many of us have lost their jobs. This happened to me, too: I lost the university job I’d had for over twenty years. And along with your job you may have lost other things. A large chunk of your income. Your home. And quite possibly, some of your identity and self-respect. I know about all of that.
Again, there is no easy one-size-fits-all solution here. Some of us may be capable of restoring the situation that existed before illness set in. But for many of us, that won’t be possible, or only in part. Meaning that you’ll have to look honestly at yourself and your options, and then to some extent redefine yourself. You may have to give up your former ambitions.
The main thing here, I think, is to find a new and realistic balance between (a) what you need to do to survive, (b) what you can do best with your knowledge and skills from the past, and (c) what you would really like to do again. And then, accept the new balance. Ending up with a less stressful job might be much more important than being able to afford a seaside vacation every year, don’t you think?
In many cases, when you emerge from years of deep depression, you’ll discover that you have lost many of your former friends. There are several reasons for this, one of them being that for a long time you as a depression patient had not much to offer to others. Another reason can be that during your depression, they changed – or that the depression period did change you. Personally I also think one huge problem is that some people, even good friends, can deep down be very afraid of depression – as if it’s some contagious kind of leprosy. Many other things can also play a role (like in my own case, my lack of memory caused by ECT proved a complicating factor: I didn’t even recognize some of my old friends).
I think that often one or two meetings will be enough to judge if an old friendship is restorable or not. Sorry, but here you’ll have to be realistic again. Mourning what was in the past will not help you any further. If you end up with nearly no friends at all, then you’ll have to find some new ones, maybe in the context of your new job or new activities.
My basic tip here: above all, be honest to others. Whether you like it or not, your having a psychiatric past is now one part of your identity. It really is best to be open about this to all potential new friends. This honesty will help you to easily separate the understanding ones from the ones with prejudices, right away. Say good riddance to the latter category.
In some cases, the love relation with your partner may not have survived your years of depression. If this is the case, it’s the most sad and difficult complication that can happen to both of you. But you should not blame the other one for it, nor feel guilty about it yourself. Often, it is a very understandable consequence of years of unbalance, of relational disequilibrium: the other one had to care for you and carry an extra burden while your illness prevented you to give something back.
It’s not unusual for the healthy partner to break down right at the point when finally, after years of illness, the depressed partner arrives at the brink of recovery. This is a sign that for the other one, the burden had in fact already become unbearable since quite some time. Let me say again that guilt and blame are completely irrelevant terms here. This can be a quite natural and understandable situation.
In some cases like this, when you both are still motivated, it obviously is worth the trouble and energy and time (this can cost years) to restore the relationship and find some sound mutual balance again. In other cases (let me be blunt) it can be simply too late for that. Your partner can have become too worn out, or he/she can already have fallen in love with someone else: compensating for what amounted to his/her own loss over the past years.
I have no easy solution here. Evidently, the intense sadness over a lost, ruined, not-restorable relationship can seriously hamper one’s recovery from depression itself. It can easily throw you back. Maybe you should seek extra psychotherapeutic support in a situation like this.
At the same time, please remember that one of the essential elements of your own recovery is becoming an independent, self-supporting person again instead of a patient who is mostly dependent from the care of others. The better you manage your over-all recovery in this sense, the more chance there is that you and your former partner will at least repair part of the relationship, to remain warm and close friends.
I wrote all the above for those among us who are taking their first steps on the long and difficult road towards full recovery from depression. I’m sorry if to you this reads like a daunting list of dangers and difficulties, or like a heap of too moralistic advice. I can understand if it does. Sorry.
But still I hope (that’s why I wrote it all down) that this overview may help you a little to view and tackle the problems of your recovery in a systematic and successful manner. I hope you will restore some parts of your smoldering ruin, and perhaps replace some other parts of the same ruin.
Things will never become exactly like they were before mental illness struck us down. For many of us, depression will never completely go away.
But may I say something here that (if you are still depressed) may sound stupid? In the end, years of battling depression and of recovering may leave you not just a as different person, with a different life, a different job. Unexpectedly, this whole long depression struggle can also have made you into a better, wiser, more human person – even if it didn’t make you more happy, rich or successful.
• footnote: This post was inspired by an article Recovery and Accepting in the Dutch newspaper Trouw (printed version, April 18, 2014) that centered on the example of Nathalie Kelderman.
She once worked in the Dutch Foreign Office aspiring a diplomatic career. After seven years of depression and recovery (for the second time in her life) she now works as manager for the Dutch Depressievereniging, a national association of depression patients (website Dutch language only).
Kelderman, by the way, succeeded with much effort in salvaging her marriage that after her years of depression was on the brink of falling apart: she herself calls it “a miracle” that she and her husband are still together.