Defining Success
Particularly with Depression
Here’s the sitch:
You’re not going to wake up bright-eyed and bushy-tailed every morning. You’re not going to attack every day’s problems with zeal and joy. “Carpe Diem” will never drive your every decision.
These things are true for anyone. There are ups and downs in every life. It’s difficult, though, for a depressed person to understand what success might look like for their efforts in therapy, medications, and other treatments. Having the wrong definition of success can make depressive symptoms even worse, as it exacerbates the perceived distance from mental wellbeing.
When I went through TMS therapy, the providers defined “success” as cutting depressive symptoms in half. They said most people don’t achieve full remission. Let’s look at how depressive symptoms are measured.
The PHQ-9
You’ve probably seen it before (I talked about it in my post on TMS, too). The PHQ-9 is extremely common in the medical world. Ever since reaching adolescence, I’ve filled out a PHQ-9 as part of the pre-appointment paperwork for my yearly checkup with a primary care physician.
It’s great because it takes deeply subjective, nebulous symptoms and makes them measurable. Fill it out multiple times over a course of weeks, months, or years, and you’ll begin to see trends in the data. Woohoo! How does the PHQ-9 do this?
I’ll list the survey below. For each item, think of how often you have experienced the symptom in the last two weeks. There are four options for this (associated “score” in parentheses): Not at all (0); several days (1); more than half the days (2); nearly every day (3).
Take some time to go through and reflect on your answers for this. Rate your symptoms using the four options mentioned, and add your scores up at the end.
The questions are as follows:1
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself… or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead, or of hurting yourself
Total your score now, then do the additional question below:
If you have checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Interpreting Your Score
This final question probably gives you a good idea, but let’s break down the scores.
Total score:
1-4: Minimal depression
5-9: Mild depression
10-14: Moderate depression
15-19: Moderately severe depression
20-27: Severe depression
If you have never been diagnosed with depression but scored above zero, do not fret! As life’s seasons change, it is common to experience a bit of depression every once in a while. The issues arise when you start scoring a little higher, a little more often.
Think about our earlier definition of success: cutting scores in half. So, for a severely depressed person with a score of 24, success is decreasing that to moderate depression (a score of 12). That’s interesting to me.
Of course, that is just the definition of success for one round of TMS. While a good starting point, I think it’s fair to say this definition isn’t enough for life as a whole. Even moderate depression is shitty.
A Different Take
And so the question still stands: how do we define success for coping with depression on the whole?
“Leading a happy life” is too ambiguous.
“Seizing the day, every day” is unrealistic.
What about “being okay”?
When you’re okay, you’re doing the things you need to, working, maintaining relationships with family and friends, and taking care of yourself. You’re not always happy, seizing every day, or excelling to the highest degree, but you’re okay. There are bad times and good, just like for normal people, and you’re okay.
Can that be a reasonable definition?
In a recent session with my therapist, we went over progress I’ve made as well as my goals moving forward. I’ve done a lot of work on the “acceptance” part of ACT; I’ve done a lot of thinking for the “commitment” part, but but less actual work on it. It’s time to start the work for the latter. But what does that look like?
In our session, my therapist and I defined a clear goal: To live a life uninhibited. At first glance, it seems just as broad and unclear as the definitions of success we’re debunking today. I can assure you it’s not. Let me explain: to lead a life uninhibited is to pursue values, not letting depression or anxiety deter you from doing so. We’ve talked about finding values and trying to live in accordance with them before, and how that is beneficial for mental wellbeing. This is the next step of that process.
A few months ago, in the midst of unemployment and winter (I can’t handle being stuck inside), depression wrapped its gnarled fingers around my social life. I was experiencing depressive episode after depressive episode, and when they coincided with social plans, I simply stayed home. Often, I wouldn’t even let my friends know I was bailing on them until right when I should have been showing up. I was not being a good friend, first of all, and also my isolating further contributed to depression’s strength.
This is an example of being inhibited by depression. I value community, and as someone new to the area it’s extra important for me to be there when a community-building opportunity presents itself. I know these things. Yet, this knowledge didn’t stop me from bailing (even though going probably would have made me feel better anyway).
In contrast, being uninhibited looks like going to the social gathering, even when you don’t feel like it. It looks like exercising even when you’re tired. It looks like standing up for what’s right amid adversity. Does “cutting symptoms in half” allow us to live uninhibited? Maybe, but not necessarily. Let’s focus more on our new definition and less on the stats.
Your mission this week is to act on some of your values, even (maybe especially) if you don’t feel like it or it feels scary.
Thank you for being here.
I love you.
-Ethan
I just shared my definition of success. What’s yours? Please share with us in the comments.
This page is not intended to be medical advice. Consult with a psychiatrist or other provider before pursuing any treatment options discussed here.
If you are in crisis, call or text the National Suicide Hotline: 988
Courtesy of Stanford Med