Effects Of Long-Term Depression On Mental Health And Treatment Options

Persistent symptoms of long-term depression can cause physical, emotional, social, and economic repercussions that may impede functioning. For some, depression may last for years, which can start to feel like a “new normal.” Individuals living with this challenge or the people they love may grow concerned about how the symptoms could affect their general health and well-being over time. 

What is long-term depressive disorder?

There is no one definition or model for persistent depressive disorder or long-term depression. Several diagnoses may be given depending on your situation, and the diagnosis you receive may depend on how long you have had depression and the symptoms of depression present. Below are a few types of long-term depression. 

Persistent depressive disorder (dysthymia) in mental health conditions

According to the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), persistent depressive disorder, previously called dysthymia, is a type of depression that persists for two years or more. With dysthymia, symptoms of depression may not be as severe as with major depressive disorder, but they are consistently present and can cause functioning difficulties. 

Double depression

Double depression is defined as a bout of major depressive disorder soon after a diagnosis of persistent depressive disorder. With double depression, you may go from a mild long-term depression into a more severe major depression episode, returning to persistent symptoms afterward. While double depression can be difficult to treat, therapy, medication, or a combination approach may be effective. 

Chronic major depressive disorder

Major depressive disorder (MDD) is a depressive disorder in the DSM-5 that lasts for at least two weeks. For some people, major depression lasts longer than two weeks. Some people experience long-term depression that is debilitating and can cause major impacts. In some cases, chronic MDD can develop into treatment-resistant depression that doesn’t respond to standard treatments like therapy or medication. 

Depression symptoms after partial remission: Effects of long-term depression

Relapses of symptoms may occasionally occur after depression is labeled in partial remission. Partial recovery may allow for improved social and professional functioning for some people. However, it may still involve prolonged sadness and distress. 

Persistent depression and the brain 

It is commonly believed that depression results from a chemical imbalance in the brain. However, this chemical imbalance, or side effects from the long-term depression itself, can cause additional changes to the brain and how it functions, particularly altering synaptic AMPA receptors, affecting Purkinje cells, and disrupting hippocampal synapses. 

AMPA receptors control the speed of communication between nerve cells, while Purkinje cells are known as the largest neurons in the human brain. Research has looked at how long-term depression affects the brain. These effects are outlined below. 

Hippocampus

The hippocampus is the part of the brain that plays a significant role in learning and memory. Those struggling with long-term depression may encounter challenges with memory loss and short-term memory due to the chemicals produced in the hippocampus and how its synaptic activity affects brain function.

One of the chemicals produced in the hippocampus is cortisol. In times of physical or mental stress, the hippocampus produces more cortisol than necessary. This process is sometimes known as hippocampal long-term depression because excess cortisol in the hippocampus can have long-term impacts, leading to a slowdown in the production of new neurons. This slowdown can further cause neurons in the hippocampus to shrink, potentially leading to memory difficulties. 

Amygdala

The amygdala is part of the brain that controls some emotions, including anger and fear, and encodes memory. The excess production of cortisol from the hippocampus during long-term depression can also affect synaptic response and strength in this part of the brain. As a result, the amygdala becomes enlarged and overactive, which may lead to difficulty managing stress and a cognitive bias toward perceiving the world and self as negative. An overactive amygdala can also cause sleep disturbances and changes in physical activity.  

Prefrontal cortex

The prefrontal cortex is central to cognition and controls several processes in the brain, including impulse inhibition, attention, and cognitive flexibility. This crucial part of the brain shrinks when cortisol overproduction occurs. When the prefrontal cortex shrinks, it may inhibit people from being able to form new memories. They may also experience difficulty making decisions or controlling emotions. 

Treatment-resistant depression 

For those experiencing long-term depression or persistent depressive disorder, some risks are not associated with brain changes or other physical factors. The longer a person is exposed to the effects of major depression, the higher the risk of these effects becoming acute.

There are ways to reduce the symptoms of depression or lessen their impact on your life. If treatments like medication and talk therapy have not reduced your symptoms, other inpatient treatments like low-frequency stimulation or electroconvulsive therapy (ECT) may improve synaptic plasticity and reduce symptoms. Consult a doctor or health care provider before taking medication or trying medical procedures.

Physical health and long-term depression

People with long-term depression may often have thoughts related to low self-esteem, sadness, guilt, shame, and distress. For this reason, some may assume that depression is primarily an emotional condition. However, there are several impacts on physical health caused by depression, including but not limited to the following. 

Cardiovascular deterioration

Researchers have found that people with long-term depression are at risk for cardiovascular deterioration. People who experience depression for a more significant period are at higher risk of heart attacks or heart disease. In addition, once a heart attack has occurred, those with major depressive disorder may find it more difficult to recover.

Appetite changes

Depression can often cause changes in appetite. People living with long-term depression may find it difficult to eat or may experience a desire to binge on food. If an individual’s diet is inconsistent in nutrition and timing, malnourishment or weight gain can occur. Long bouts of depression may worsen these impacts. 

The socioeconomic effects of long-term depression

There are a few socioeconomic effects of long-term depression that may affect your way of life. These impacts are common in people living with depression for many months or years. Like the challenges mentioned above, the risk for these effects increases as the exposure to stressors continues without care.

Social isolation

If you are living with long-term depression or persistent depressive disorder and feel socially isolated, you are not alone. Individuals with long-term depression report low self-esteem and a loss of interest in previously enjoyed activities, potentially contributing to a disinterest in social events or hangouts. 

Financial insecurity 

Long-term depression may also impact your finances by affecting your workplace performance. One study found that workplace performance often decreases significantly when an individual is living with MDD, persistent depressive disorder, or another depressive disorder. The study also found that workplace performance can improve after treatment. 

If you are having difficulty handling the stress and pressure of work, your workplace performance may take a direct impact. Sessions with therapists trained in treating persistent depression may provide you with guidance to work through these difficult symptoms and develop effective coping techniques. 

Counseling treatment options: Cognitive behavioral therapy

If you have been living with major depressive disorder, bipolar disorder, persistent depressive disorder, or double depression without relief, you might benefit from talking to a therapist, counselor, or social worker. Many individuals find cognitive behavioral therapy (CBT) and other evidence-based treatments helpful in managing symptoms. In addition, if you face barriers to treatment like financial insecurity or time, you can connect with a provider through an online therapy platform like BetterHelp.  

Online therapy can be more flexible and accommodating of busy schedules than in-person therapy, as some online therapists can make themselves available outside of standard business hours. Additionally, online therapy platforms can be more affordable than traditional therapy sessions. These platforms may offer unique modalities while providing diverse, high-quality resources. 

Effectiveness of online therapy: Cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and other evidence-based approaches

Studies also back up the effectiveness of online therapy for people with depression. A study by the Berkeley Well-Being Institute found that people who used an online platform experienced a significant decrease in the severity of depression symptoms, comparable to results from studies on in-person treatment. CBT, interpersonal therapy (IPT), and other structured approaches can also be effectively delivered through online platforms. Online therapy has also been shown to be effective for bipolar disorder, untreated depression, and substance use disorder, among other disorders.