The public “deserve to know” that there is an overlooked subset of people who thrive after major depression

More research is needed into people who experience "high functioning after depression."

Depression is a chronic, recurrent, lifelong condition. Well, that's the current orthodox view – but it is overstated, argues a team of psychologists led by Jonathan Rottenberg at the University of South Florida. "A significant subset of people recover and thrive after depression, yet research on such individuals has been rare," they write in their recent paper in Perspectives on Psychological Science. They propose a definition for "high functioning after depression" (HFAD); argue that the advice given to people with depression need not be so gloomy; and lay out key areas for future research.


The "gloomy" view of depression is relatively recent, the researchers argue. Just a generation or two ago, conventional wisdom held that depression was the opposite – transient and self-limiting. "But what if neither the older orthodoxy nor the new view of depression fully captures the truth?", Rottenberg and his colleagues ask. "What if, instead, two variants of depression operate simultaneously – a grim chronically-recurring, lifelong variant, and a relatively benign, time-limited variant?"

Long-term studies certainly suggest that a substantial population of people are affected by a burdensome, recurrent form of the disorder. But Rottenberg's team cite three studies finding that an average of 40 to 50 per cent of people who suffer an episode of depression don't go on to experience another (for example, this study in Sweden) – but overall these individuals have been little studied. "This omission, and the field's lack of focus on good outcomes after depression more broadly, virtually guarantees an unduly pessimistic impression of depression's course", Rottenberg and co write – and this is an impression they would like to see changed.

HFAD has been overlooked in part, they argue, because researchers, influenced by the current view, have focused on finding factors associated with chronicity and recurrence. Also, people with recurrent depression are highly likely to be over-represented in depression studies simply because, when researchers put a call out for subjects with depression, these people are statistically more likely to be suffering at the time, and so to be recruited.

To be categorised as experiencing HFAD requires more than simply remitting or recovering from the symptoms of major depression for at least a year, Rottenberg and his colleagues add. An individual must also have achieved "high end-state functioning" – doing well at work and home and socially, and reporting "robust" wellbeing – feeling satisfied with life and enjoying high levels of self-acceptance, for instance.

With such powers of recovery, what leads people who exhibit HFAD to become depressed in the first place? "One hypothesis might be that HFAD represents a more psychosocial form of depression that is more likely to be precipitated by environmental adversity, such as death, a break up of a romantic relationship or a job loss," the team suggest.

Whether or not this is the case clearly needs exploring. And they point to other big questions. For instance: Are people who are HFAD more likely to have sought help while they were depressed? Does depression itself play a role in triggering the long-term improvement seen in HFAD? (Something similar has been proposed for trauma). Can we apply what is learnt about HFAD to enhance clinical interventions?

What does HFAD tell us about thriving after other mental disorders?

There are clearly a lot of questions. But here, at least, is a framework for finding potentially useful answers.

"One reason HFAD needs to be discussed," the researchers write, "is that it is part of the truth, which patients and the broader public are owed. It would be odd if an oncologist did not tell a cancer patient his or her chances of achieving lifetime remission. We submit that a depressed patient also deserves to know. The public deserves to know as well."

Emma Young (@EmmaELYoung) is Staff Writer at BPS Research Digest

This article was originally published on BPS Research Digest. Read the original article.

China’s artificial sun reaches fusion temperature: 100 million degrees

In a breakthrough for nuclear fusion research, scientists at China's Experimental Advanced Superconducting Tokamak (EAST) reactor have produced temperatures necessary for nuclear fusion on Earth.

Credit: EAST Team
Surprising Science
  • The EAST reactor was able to heat hydrogen to temperatures exceeding 100 million degrees Celsius.
  • Nuclear fusion could someday provide the planet with a virtually limitless supply of clean energy.
  • Still, scientists have many other obstacles to pass before fusion technology becomes a viable energy source.
Keep reading Show less

How to split the USA into two countries: Red and Blue

Progressive America would be half as big, but twice as populated as its conservative twin.

Image: Dicken Schrader
Strange Maps
  • America's two political tribes have consolidated into 'red' and 'blue' nations, with seemingly irreconcilable differences.
  • Perhaps the best way to stop the infighting is to go for a divorce and give the two nations a country each
  • Based on the UN's partition plan for Israel/Palestine, this proposal provides territorial contiguity and sea access to both 'red' and 'blue' America
Keep reading Show less

Why a federal judge ordered White House to restore Jim Acosta's press badge

A federal judge ruled that the Trump administration likely violated the reporter's Fifth Amendment rights when it stripped his press credentials earlier this month.

WASHINGTON, DC - NOVEMBER 16: CNN chief White House correspondent Jim Acosta (R) returns to the White House with CNN Washington bureau chief Sam Feist after Federal judge Timothy J. Kelly ordered the White House to reinstate his press pass November 16, 2018 in Washington, DC. CNN has filed a lawsuit against the White House after Acosta's press pass was revoked after a dispute involving a news conference last week. (Photo by Alex Wong/Getty Images)
Politics & Current Affairs
  • Acosta will be allowed to return to the White House on Friday.
  • The judge described the ruling as narrow, and didn't rule one way or the other on violations of the First Amendment.
  • The case is still open, and the administration may choose to appeal the ruling.
Keep reading Show less

Scientists just voted to change the definition of a kilogram

The definition of a kilogram will now be fixed to Planck's constant, a fundamental part of quantum physics.

Greg L via Wikipedia
Surprising Science
  • The new definition of a kilogram is based on a physical constant in quantum physics.
  • Unlike the current definition of a kilogram, this measurement will never change.
  • Scientists also voted to update the definitions of several other measurements in physics.
Keep reading Show less