Depression is a condition that prompts so many questions.
What is happening to me?
How can I cope?
How long will this last?
One deceptively difficult, but no less urgent question for many people who struggle is, “How will I know I’m better?”
As someone who has struggled with depression, I have lived through the challenges of trying to provide an intelligent answer to that question.
On its face, an answer should be easy. After all, if you’ve been in the depths of depression, it’s not difficult to tell if you’ve improved. The pain is less excruciating. You’re off the floor, able to get out of bed and take a shower; you’re more functional at work. If you’re in doubt, you can even score yourself on a depression questionnaire from Psych Central to discern improvement.
But when can you say that you’re “better”? The word better means so much more than just improved. For me, it meant that I was in possession of some vital sign that the nightmare may be ending, that I was getting back to normal, finally.
What does “better” mean?
From my perspective as both a psychologist and someone who has experienced depression — and been able to recover from it — it’s challenging to talk about “better” for three main reasons.
The first reason is that depression can last a long time, and during this time it strongly colours how we think and behave. Depression disturbs our points of reference for “better.” People who have a protracted struggle in depression can lose their memories of what normal is. After experiencing long periods of a sustained low mood, the very concept of a normal mood becomes alien.
When depression lasts years, people may have difficulty remembering times when they did not feel depressed. This was true for me. During my chronic depression, I remember losing touch with my non-depressed self. How could I say I was back to normal when I was not totally confident about how Jon “normally” thought or behaved?
The second reason this question is difficult is that we have not established a firm boundary where depression ends and normality begins. How much fatigue is normal for a person to have? How much concentration difficulty is normal? How long can a normal person work without tiring? When exactly do the feelings of clinical depression blend into to the everyday frustrations and disappointments that beset nearly every person on Earth? This is what Sigmund Freud called “everyday unhappiness.”
Not only does research fail to set a clear boundary where normality begins, our common language blurs this boundary, as the word depression is used indiscriminately both to refer to a profound clinical syndrome, and to our reactions to the most minor of slights and setbacks.
The third challenge to saying when you’re better from depression is that depression is so tightly bound to the changing circumstances of life. Depression may happen because of a major life transition (your spouse has passed away), or it may cause such a transition (you lose your job, or change careers). In my own case, by the time my depression had improved, I had a new career and had started a family. Each new role made powerful demands on my time and energy. When I felt inadequate as a psychologist or as a dad, I could never be quite sure if this was my depression lingering on, or my lack of mastery of the new roles.
Even when depression doesn’t change your circumstances outright, it can colour your important relationships. For me, depression felt like a third person tagging along for the ride in my relationship with my then-girlfriend, Laura (who is now my wife). When I didn’t take the trash out, or didn’t feel like doing something fun on the weekend, Laura and I were never quite sure if this meant that I was still struggling with depression, or just that our relationship was struggling. It’s harder to score your recovery from depression when you can’t separate depression from other changes in your life.
Recognizing signs of improvement
So, “How do I know that I’m better?” is a tough question to answer definitively. But let’s also grant that people do get better, and that there are concrete signs this has occurred. So what are these signs? I offer an idiosyncratic list.
This list of fifteen signs is assembled from my own careful observations of my recovery process, and from speaking to many others who have become well after a struggle with depression:
- You catch yourself humming or singing.
- You aren’t annoyed by people who usually bother you.
- You erupt in spontaneous laughter.
- You briefly forget about the depression.
- You find yourself so immersed in an activity (a movie, a conversation) that you lose track of time for several hours.
- You have a desire to put on upbeat music — and listen to it.
- You notice a slight swagger in your step when you walk.
- You look at yourself in the mirror and feel OK about what you see.
- You are looking forward to exercise.
- You are thinking about sex, and are interested in being intimate.
- You start to be able to plan for the future, without feeling like this is an idle exercise.
- You feel a sense of calm in your mind.
- You want to go out with friends.
- You find pleasures in small things, like the smell of blooming flowers or a good cup of coffee.
- You notice that you are talking more and more, and at a louder volume.
If you’re still curious about whether your depression is improving, you might try keeping a symptom journal or talking with your healthcare provider about ways to chart (and encourage) your personal progress.
Keep in mind that the list above is in no way definitive, but just a collection of signs from people who have been there and come out the other side. If you want more first hand-stories about the depression recovery process, read The Recovery Letters, written by people who have recovered from depression and those who are still struggling.
Job Code: UK/MED/18/0234
Date of Preparation: September 2018