Is Depression a Chronic Illness?

Some people with depression may be reluctant to pursue new treatment options because they believe that nothing will work for them or that their persistent low mood is just part of who they are. But it is possible to find relief from depression symptoms, even if first-line therapies have been ineffective. Is depression treatable? Yes. However, persistent or "chronic" depression is a distinct form of depression that often requires specific treatment. The key is finding a treatment option that works for you.

Is Depression a Chronic Illness? 

Though definitions vary, the Centers for Disease Control and Prevention characterizes chronic illness as a condition that lasts at least one year and demands ongoing medical attention or restricts activities of daily living. Examples of common chronic conditions include asthma, heart disease, and diabetes. Treatment options for chronic diseases tend to involve lifelong symptom management rather than curative courses of treatment.

In most cases, major depressive disorder will not meet this definition of "chronic," as the average length of an episode of depression is three months. However, many people experience chronic symptoms because they have not received the right treatment. For instance, about two-thirds of patients with chronic depression do not receive a medication of adequate dose and duration.

For people who experience depression that lasts longer than the average episode, depression can have a greater impact on daily life than other chronic conditions—whether at work, at home or socially. In a national depression survey, 96.9% of respondents reported at least some form of impairment in their day-to-day lives, most commonly in their social life. They had 35 days "out of role" in total, which means they were unable to perform their normal activities for over a month. This contrasts with most other chronic conditions, such as heart disease and high blood pressure, for which patients reported 15 days "out of role" on average.

What about Persistent Depressive Disorder? 

Also known as dysthymia, persistent depressive disorder (PDD) is a specific form of chronic depression that causes people to experience symptoms for at least two years. Of individuals diagnosed with depression, around 30% report PDD, and the National Institute of Mental Health estimated that 1.3% of all US adults had experienced persistent depressive disorder at some point in their lives.

If you have PDD, you may feel depressed more days than not. You might also experience other symptoms of depression, such as a change in your appetite, disrupted sleep, or diminished energy levels. You are more likely to develop PDD if you experienced early life adversity, such as childhood neglect or emotional trauma, or if you have a family history of mood disorders.

It is possible to find relief from long-lasting depression. A major 2019 review found that chronic depression responds well to several treatments, including psychological therapy and medications. Here are some options you may wish to explore:

• Changing medications: If you are already on medications, you could speak to your doctor about optimizing the dose of your current medication or trying a different one.
• Targeted therapy: Since PDD is more associated with childhood adversity than non-chronic depression, attending therapy sessions can be an important part of addressing the condition. Specific therapy techniques that address childhood maltreatment have been shown to be more effective in treating chronic depression than standard (non-specific) psychotherapy.
• Transcranial magnetic stimulation: If you are still experiencing symptoms after trying medications and therapy, there are other options available. Transcranial magnetic stimulation (TMS) is a non-invasive and non-drug treatment that has been cleared by the FDA when at least two medications have not been effective for depression. TMS uses gentle magnetic pulses to stimulate brain regions involved in mood regulation; these regions are underactive in people diagnosed with depression. TMS can help to relieve some, or even all, symptoms of depression in many patients. Sixty-two percent of patients report a reduction in depression symptoms at the completion of the acute phase of TMS therapy, which lasts six to nine weeks.

What If I Experience a Recurrence of Depression? 

If your symptoms have improved, could they return? Yes, but recurrences generally respond to treatment.

Taking antidepressants over an extended period of time may reduce the severity of your symptoms. Continuing psychological therapy may also decrease the chance of depression returning, and TMS in particular may help patients who have not found relief from medications. To learn more about whether TMS might be right for you, consider scheduling a no-cost consultation.

Reaching out for treatment is a meaningful and empowering step toward improving your long-term well-being. Remain hopeful as you pursue a treatment option that works for you. You don't need to settle for anything less.