Many patients with major depressive disorder (MDD) respond well to initial treatments with antidepressant medication. However, less than one-third of patients with MDD will actually reach remission (no symptoms) with that first treatment. Residual, or lingering, symptoms are very common. These residual symptoms put patients at an increased risk for functional and interpersonal impairments, and the likelihood their depression will recur increases as well.
Defining “Getting Better”
When a doctor and patient create a treatment plan for MDD, the two of them should come to an understanding of what is likely to happen with the initial treatment: most patients experience fewer symptoms, but few are completely “cured.” In other words, the likelihood all of your symptoms will go away is low. So when you begin treatment, the first goal should be a reduction in symptoms. This reduction in symptoms is the standard measurement most doctors and researchers use when they classify a patient as “responding” to medication, or “getting better.” This means, of course, that many patients will still suffer from some symptoms of MDD.
For each person, the definition of “getting better” will be different. While you may still have lingering symptoms, such as anxiety or fatigue, you may feel better because your treatment plan has increased your sense of optimism or your feeling of self-worth—both important results of MDD treatment.
Remission is the ultimate goal—the complete absence of both depressive symptoms and any residual symptoms or impairments—and 12 to 18 percent of patients with MDD will reach a state of remission as a result of treatment. However, it’s not uncommon for even the most well treated MDD patient to experience residual symptoms during remission.
Most Common Residual Symptoms
The most common residual symptoms of MDD include:
- Loss of interest
- Lowered libido
- Ongoing lack of interest or depressed mood
Common residual physical symptoms include:
- Muscle ache
- Joint pain
- Stomach ache
Common symptoms of cognitive impairment include:
- Difficulty remembering or incorrectly remembering people, places, or events
- Increased negative thought patterns
If you have one or more of these residual symptoms of MDD, even while being treated for it, you should not ignore them. In fact, these residual symptoms could be a predictor of relapse.
Most Common Residual Symptoms
Patients who experience insomnia as a residual symptom often have poor treatment response, too. That may be because insomnia causes many secondary effects on your health, which complicate treatment for MDD. Insomnia also increases a person’s risk of suicide. You may not be able to diagnose your insomnia by yourself. While self-report is effective, of course, some doctors may request patients undergo an EEG sleep test to discover unrecognized insomnia.
Patients with unresolved anxiety are at an increased risk of MDD relapse. In fact, anxiety can be a predictor of a more rapid recurrence of MDD, and patients with anxiety also take a longer time to respond to treatment. If anxiety remains unresolved, despite treatment, it is possible your anxiety is not a symptom of your depression, but is instead an anxiety disorder.
Lack of Interest
Many patients with residual symptoms of MDD experience a lack of interest in their work, relationships, and self-interests. In particular, this lack of interest can have devastating effects at work, where patients with unresolved symptoms experience lower productivity, higher rates of absenteeism, lower job satisfaction, and great difficulty getting along with co-workers.
The Risks of Residual Symptoms
Untreated or undertreated MDD increases a person’s risk for heart attack and stroke. Also, patients with residual symptoms are more likely to have additional health problems that increase their dependency on health services, medicines, and medical treatments.
Who Will Have Residual Symptoms?
It’s not entirely understood why some people continue to experience residual symptoms despite MDD treatment while others do not. However, research suggests a few common denominators may help doctors predict which of their patients are most likely to have a recurrence or residual symptoms. These risk factors include:
- Severity of initial symptoms
- The presence of dysthymia
- Ongoing stressors
- Additional medical illness
- Lower socioeconomic status
- Poor social support
Talk to Your Doctor
Open and honest communication with your doctor is vital to getting better. Only when you are willing and able to discuss all aspects of your treatment, recovery, and mental health will you be able to find a treatment plan that best suits your symptoms, lifestyle, and needs.
Record your symptoms. Vague descriptions of “not feeling well” or “not being able to sleep” do not help your doctor very much. Record what you’re experiencing. Keep a journal, and write down when you have difficulties or don’t feel well. Be sure to include everything you’re experiencing—you may think your symptoms are unrelated to your MDD, but your doctor may be able to identify another problem.
Be honest. One of the biggest problems with depression treatment is noncompliance. Whether it’s because the prescription is too expensive, you keep forgetting, and you don’t like the side effects, if you’re not taking your medicine, you need to tell your doctor. He assumes you’re following his instructions, so if you’re still experiencing residual symptoms, he will assume it’s because his treatment plan isn’t working—not because you’re not following it.