"It turns out that between 65 and 80% of people on antidepressants are depressed again within a year." Johann Hari writes in his new book on depression (Guardian article)
But, you also have to flip it. 20% to 35% of people are not depressed after 1 year. If you look at one 15 year long term study, there are some people who seem to fully recover.
Cognitive therapy and other non-drug therapy also have efficacy rates similar or better to drug therapy. Although this still means a majority of relapse after 1 year.
Hari writes in his book about 9 causes which have a social root (and 2 which are biological tendencies, ie genes which make it more likely to suffer).
"We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most – people. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us.
Let’s look at one of those causes, and one of the solutions we can begin to see if we understand it differently. There is strong evidence that human beings need to feel their lives are meaningful – that they are doing something with purpose that makes a difference. It’s a natural psychological need."
If you take that writing and compare it posts I have written on gratitude (eg Sheryl Sandberg, see end) and purpose (Oprah Winfrey, many others particularly Emily Esfahani Smith, on the power of meaning and purpose, the post on it here), you see an interesting chime, I think.
Especially when looked at through the lens of a job, which most of the population spend most of their time doing. If you view your jobs as a calling, not a chore, you are happier, more fulfilled.
Hari makes the flip point, an unfulfilled job can and does lead to depression (as can no job).
"Gallup... found that 13% of people say they are “engaged” in their work – they find it meaningful and look forward to it. Some 63% say they are “not engaged”, which is defined as “sleepwalking through their workday”. And 24% are “actively disengaged”: they hate it. Most of the depressed and anxious people I know, I realised, are in the 87% who don’t like their work."
" Professor John Cacioppo of Chicago University taught me that being acutely lonely is as stressful as being punched in the face by a stranger – and massively increases your risk of depression. Dr Vincent Felitti in San Diego showed me that surviving severe childhood trauma makes you 3,100% more likely to attempt suicide as an adult. Professor Michael Chandler in Vancouver explained to me that if a community feels it has no control over the big decisions affecting it, the suicide rate will shoot up"
And so Hari finishes on:
"“This pain you are feeling is not a pathology. It’s not crazy. It is a signal that your natural psychological needs are not being met. It is a form of grief – for yourself, and for the culture you live in going so wrong. I know how much it hurts. I know how deeply it cuts you. But you need to listen to this signal. We all need to listen to the people around us sending out this signal. It is telling you what is going wrong. It is telling you that you need to be connected in so many deep and stirring ways that you aren’t yet – but you can be, one day.”
If you are depressed and anxious, you are not a machine with malfunctioning parts. You are a human being with unmet needs. The only real way out of our epidemic of despair is for all of us, together, to begin to meet those human needs – for deep connection, to the things that really matter in life."
Hari at his 2015 Ted talk above. There's a side story here about Hari's own quest of redemption after some large misdeeds in the public eye around 2011 (major plagiarism and malicious wiki editing).