Gregory Simon, MD, MPH
Investigator, Center for Health Studies Group Health Cooperative
Can You Thrive with a Mood Disorder?
The Depression and Bipolar Support Alliance has designated 2014 as the Year of Thriving. Throughout the year, they are challenging the organization and the mental health community to set higher goals, to shift the conversation from “surviving” or “managing” a mood disorder to truly thriving.
In a recent DBSA podcast, Dr. Joseph Calabrese and I discuss the limitations of current treatment options for mood disorders and the need within the clinical and patient communities to shift expectations and raise treatment goals to complete remission of symptoms and sustained wellness.
We are challenging our entire field—clinicians, researchers, administrators, and policy makers—to set higher goals for mental health treatment. Our goal is not simply to control or reduce symptoms, but to eliminate them.
Is eliminating symptoms of depression or bipolar disorder a realistic goal? We think so. What we have now is not what we hope for, and we should not allow the inadequacies of our current treatments to diminish the importance of our long-term goals. Our current tools for treatment of mood disorders—medications, psychotherapies, and other treatments —often fall far short of eliminating symptoms and sometimes cause significant side effects or create long-term risks. With those far-from-perfect tools, patients may occasionally reach the target of zero symptoms. But most do not. If we hope to reach our target all of the time—or even most of the time—we clearly need more effective treatments.
In addition to better tools or treatments, we need a significant attitude adjustment at all levels of our treatment system. Our patients should expect—and even demand—better results of treatment. Sadly, consumers are, on average, quite satisfied with mental health treatment that is simply not very effective. Clinicians also need to re-orient toward higher goals. Our traditional metrics (like 50% reduction in symptoms or reducing symptoms to “subthreshold” levels) don’t help people to thrive. Most of us would prefer not to carry around a Hamilton Depression Rating Scale score of 12, even if it is 50% improved from what it used to be.
Thriving is, of course, about more than treatment to eliminate symptoms. Thriving is about total health—mental and physical. Thriving goes beyond eliminating the negative. It’s about developing the positive, and reaching personal goals in work and love and play.
In the podcast, Dr. Calabrese suggests that too much emphasis is placed on negative symptoms. Dr. Calabrese states, “we almost never target positive symptoms of recovery… feelings of calm, rested or cheerfulness.”
DBSA’s Target Zero campaign to support the Year of Thriving suggests a paradigm shift from the traditional concept of remission in two ways:
- First, it is a more ambitious goal: eliminating symptoms rather than reducing them to a tolerable level
- Second, it is a verb. It is about action
Embracing research that broadens the definition of remission to include the presence of positive symptoms, not just the decrease of negative symptoms is a major attitude shift. As the mental health community explores attitude adjustments around the word “remission”, I challenge researchers, policy makers, and providers to broaden their perspective.
- What can you tell your clinician as you aim to achieve zero symptoms?
- Should researchers, policy makers and the medical community include positive symptoms as a marker for successful treatment?
- How might policies change to re-orient treatment to achieve zero symptoms?