203. 5 Things You Didn't Know About Depression feat. Jonathan Rottenberg

Oct 18

listen to this episode:

Today's guest is Jonathan Rottenberg— the director of the Better Outcomes Laboratory at Cornell University, which explores long-term functioning and well-being after depression and related conditions. His research has been covered in popular outlets such as the New York Times, The Washington Post, and the Wall Street Journal.

In this episode, we discuss:

+ How people with depression experience thoughts and emotions differently

+ Why our cultural views on emotions can contribute to rates of depression

+ Reasons why we’re seeing an increase in depression rates

+ Ways that our moods contribute to how we view ourselves

+ Whether people who have depression can ever achieve high levels of well-being

+ Factors that can contribute to well-being when healing from depression

+ If depression can actually lead to improved life skills & experiences

+ Connecting mental health disorders to our identities & stories

+ so much more!

Mentioned In The Episode…

+ Better Outcomes Lab

+ Ever After

+ The Depths: The Evolutionary Origins of the Depression Epidemic

+ Depression: What Everyone Needs to Know

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Rottenberg: It's okay to talk about it. I mean, I I think for me that's one of the main, motivations for studying and talking about life after depression is to To, to do my part to make it okay, , to talk about these experiences in their full measure of beauty and ugliness and confusingness.

I think it all needs to be part of the picture,

Hello, hello, and welcome back to another episode of She Persisted. We've done a mini hiatus because this is the busiest semester I have ever had.

I am working on grad school apps, and the GRE, and my normal load, and a thesis, and research, and all the things. I will, of course, do a grad school episode for you guys, regardless of how things pan out, but I think if you want to go into psychology, it's really important and helpful to just be aware of what the field looks like, and a lot of the times you don't become aware until you're very far into the process, so.

If you guys have interest in a grad school episode and questions for that, let me know. But I am so, so, so incredibly excited for today's guest. We have Dr. Jonathan Rottenberg on the podcast. He is a professor at Cornell and he has some really, really fascinating research about depression and positive outcomes after depression.

And so this conversation just gives a lot of nuance and insight about what it's like to function through the world when you're depressed, and then Why do some people have really positive outcomes and high levels of well being after experiencing depression? and I, just absolutely loved every moment of this conversation.

It was so fascinating and I think it just adds a lot of information that We aren't aware of when we're struggling. And I think a lot of the fear and anxiety and discomfort from these things stems from not knowing what you're experiencing. You're like, I feel this way. What I used to do to try and cope with things like this isn't working.

I don't know why I'm having these reactions to these things in my life. It's just distressing and overwhelming and what I know how to do isn't working. And so I think conversations like this, at least for me, offer a lot of insight and peace and kind of take away some of the mystery of that internal experience and hopefully give you more answers rather than leaving you with just questions about your experience.

So I'm so, so, so glad to have Dr. Rottenberg on the podcast.

He is a professor of psychology at Cornell and the director of the Better Outcomes Laboratory. His research is on long term functioning and well being after depression and his research has been featured in things like the New York Times, The Washington Post, Wall Street Journal. He It's two books you guys can check out in the show notes, and he also has a digital project called Ever After, which talks about life after depression, so you guys should definitely check that out.

like I mentioned, he's doing really incredible work in the space, and I hope you guys enjoy this conversation as much as I did. So with that, let's dive in and learn about things you didn't know about depression.

Sadie: Well, thank you so much for joining me today on She Persisted. I'm so excited to have this conversation about depression and outcomes and a lot of nuance that most people don't get when they've been diagnosed or they're in their psychiatrist or primary care's office and hearing that this is what they're going through.

And so I'm really excited to dive into your research and your story. , and also give people a greater level of understanding about what they're experiencing and what the path ahead might look like.

Rottenberg: Well, I'm excited right there with you, Sadie. I'm glad to be here.

Sadie: Amazing. Well, to get started, you have a really interesting area of research, which is depression and now more of the outcomes and why some people have better outcomes after experiencing depression.

And so I'd love to hear how you landed in that area of psychology. Why that became your research specialty and kind of your background there?

Rottenberg: Sure. I mean, my, like a lot of people who end up studying clinical topics, my road went through personal experience. , when I was, A graduate student, the first time studying history, had quite a significant episode of depression, lasted a number of years, was profound, interesting, strange, horrible experience, and I was forever changed by it, but not least of which, , deciding that I needed to understand this better and, , going into psychology in the first place, knowing I wanted to, , study mood disorders and to study that part of mood disorders that was this, , kind of overwhelming experience of not being in control of your feelings, not understanding your feelings, not being able to change your feelings.

So, scientists also sort of agree that , mood, they call it a mood disorder, that mood is at the center of the mood disorder. That is, people feel this terrible, low, depressed feeling and they can't enjoy things. And it suffuses their outlook and how they think. And it really alters their behavior.

So we did experimental studies where we were showing people standardized emotional, , stimuli, like films, and looking at, , , how they responded, how they, , responded. , reported emotions, how they showed emotion behaviorally, and we also measured physiology. , and I did that for a number of years, and, , I guess one of the major findings, , was contra to a lot of the thinking of the time, which was informed by cognitive theories of depression.

So, in these cognitive theories of depression, the main idea is that, depression alters how people are perceiving the world, how they're perceiving ongoing stimuli, in a very negative way, such that you'd be prone to notice negative information, remember negative material better than neutral material.

And from this theory, the expectation was if you present this standardized negative film, like a sad film to a depressed person, they're going to show this really vigorous response. It's just going to match this kind of cognitive template in their head. And that's not what we found. we found a very different pattern such that.

, being in this mood disorder seemed to, , diminish, , or shut down people's, , reactivity to all manner of different, , , stimuli in the environment. , so it's sort of a different understanding of, in part, what this mood disorder is and what it does in, , that it turns a person inward and it's not that they're not having emotions, but they're not necessarily having emotions to the same.

, kinds of external normative stimuli that, that non depressed people are. , so I, in my career I've always been open to the possibility that the conventional wisdom might not be right. , and that, can really open a lot of doors. So, like in a related, , , line of work we looked at whether or not depressed people were more likely to cry in the laboratory when you expose them again to kind of a standardized stimulus that we know non depressed people are likely to cry to.

And again, the, the hypothesis going in based on a lot of, , Clinical lore, like if you read the Diagnostic and Statistical Manual for Mental Disorders, the DSM, it mentions crying as an associated sign of depression. So depressed people, of course, they cry more, but they didn't, not in the lab. And this again suggested, not that all the clinicians were wrong about what they had been seeing in their patients, but that the nature of the crying might be different in depression.

That is, yes, when you have Someone who is sympathetic to you, who's ready to hear your story, and you've been keeping it all bottled up, you might cry a lot, but it doesn't mean you're gonna cry , when Lassie dies. so it really changes kind of how, how the behavior works, , in ways that were, , not what we expected.

This is why you do your research. You do research to learn things, , and that was sort of the first chapter of, of having some unexpected findings.

Sadie: Yeah, it's, I think it's something most people subjectively have experienced, and that, especially if they're a little bit further into young adulthood or adulthood itself, is that they feel depressed, and then they go and try these things that in the past have made them feel happy or feel better or invoked these different emotions, and it's just not working.

It's like it doesn't have the same effect that it used to, and like you're saying, the emotional experiences are literally different in the depressed versus non depressed population. And I think that's really challenging and gives people that huge lack of control, which I think is, is really hard thing to navigate.

There's a lot of unknown. And then there's just that I can't control what I'm feeling. And also what I've done in the past to try and control these experiences or cope with them. It's just not working, which is really, really difficult. And so I'd love to kind of hear your perspective, , based on the research and literature and also subjectively, are there any of these other shifts that we see in people that are depressed with the way that they feel and think and behaviors also, are a facet of that, , Where you're literally thinking and acting differently when you're depressed, which when you're first diagnosed, a lot of people aren't told that it's, it's really a challenging thing to understand.

Rottenberg: Yeah, I think what you're saying is really quite profound, Sadie. , this inability to change the way that you're feeling. You know, people who haven't gone through depression, they might be sympathetic, but not understanding this, they could be quite confused about why depressed people are doing certain things.

So for example, , depressed people might do things to themselves like they might, , burn their arm or, or pick their skin, , and do other things where the person is like, well, how could that be helpful? And don't they know, don't they know that you should go for a walk and do yoga and drink water?

And depressed people are not stupid. They have a, they have this unique experience of cycling through, , all manner of emotion regulation strategies, including all the ones that were suggested to them on numerous occasions. And finding that They didn't work So then depressed people might start doing things that they might actually not be such great ideas, but they're trying.

, they haven't given up and they, might get locked into some of these counterproductive strategies, but you can only, you can only really, , understand that. If you have, you know, empathy and also knowledge that depressed people don't on day one, the first day I'm depressed, I go immediately and start screaming into a pillow or, , you know, banging my fist through the door like that is not what happens on day one.

So, , not as much research as you would imagine, , tries to take people through time to understand how the experience changes, because you're right. It's not the same as, , as everyday life when people experience all manner of disappointments. in real life, , for most people, when you experience, , sadness or dejectedness, you don't get, , what you want.

You feel disappointed. That's a rather transient experience. And one of the interesting things, and we know from basic research, I find this fascinating, is that non depressed people, they tend to mispredict. So for example, if you have a favorite team and, , someone asks you, so if your team doesn't win the Superbowl, how are you going to feel?

And the The people systematically, they overestimate. They say, I'm going to feel horrible. And man, I can't even imagine. , it's going to take a long time to recover from, but the truth is that even, things that are more significant than, , your football team not winning, , people tend to bounce back from.

And so this is the normal experience that people have that these really strong moods don't last. , so it's only people who are in the, These clinical states where the mood might last for three months, six months, a year, two years, that, , they really don't, experience as much relief. And it's quite confusing because their whole previous life, when they were able to either change what they were feeling or just spontaneously experience change in what they're feeling, they're no longer experiencing that.

And it's confusing.

Sadie: Yeah, it's really overwhelming and disorienting and all you want is to feel differently and everything you're trying isn't working and you're not hearing that narrative that like you're feeling things differently and you're thinking differently and the skills you've worked before Might not work now.

We're just not told that until you're like very deep into the depression world and treatment process, which is really unfortunate and and really, I think, makes a lot of people feel really hopeless and confused and overwhelmed. , another thing that you've, , touched on in your research is this emotional reactivity idea, which we talked a little bit about with people crying and, the emotions that are elicited.

But I think this is another piece of the puzzle that is also very confusing and disorienting and overwhelming, which is that you're feeling these things differently and the to which you're feeling them is, is also, , on a whole other level in addition to how you're coping with them. and just like you were saying, the way that you used to operate within your life and the way you used to feel about different things, like it's completely different.

It's like you have a different brain and, you don't know how to navigate with those, new levels of emotional reactivity. So what does the research say there with how we are reacting to. Um,,

Rottenberg: Yeah, I consider emotional reactivity, even negative emotions. They're not the enemy. , and so I think when people start to come out of depression and then they start experiencing, , Sadness, , when something sad happens and happiness, when something happy happens.

And even outrage when something, unjust happens as rather, , soothing in reassuring. , because, the research with the emotion context insensitivity, one of the main morals is that. the way that people are feeling has become disconnected from the usual environmental stimuli. So, I think again, that is what's, can be terribly frustrating because all the things that a person normally could experience, , and expect to experience a different, , feeling.

So whether that's, , going out with friends or, having a delicious meal, , or, you know, going for that walk, , it doesn't seem to have much immediate impact on the way the person is feeling. So, you know, again, in our, in our common lore, I think there is sort of the idea that, oh, it's better to always feel good.

, why should we don't want to feel bad, but emotions do serve us. They're time tested, , kind of responses to the world that over evolutionary time have. Proven their their worth, and so if you could choose, , whether to have emotions or not to have emotions , the better choice is to have them

Sadie: and

Rottenberg: and actually I think depressed people in some ways they would wish that they , they would have appropriate emotional reactivity rather than either perceiving that they feel nothing or that they feel overwhelming kind of negative states like anxiety or sadness that suffuse everything and They feel a little control over so I think you know Yes, there is of course some dynamism It's not that nothing ever changes when people are depressed, but there does seem to be some disconnection between What ordinarily prompts changes in how the person is feeling.

, you know, and what the person is actually feeling.

Sadie: Yeah, it's also so tough when you kind of dive into that emotion education piece a little bit with depression and we think like, Okay, our emotions are serving a purpose. They get us to do these things that help us survive and thrive. If we're scared, we get away from that thing.

, if we're feeling lonely, we go find other people so we can connect and, you know, survive in a tribe and not be left in the middle of the wilderness alone with no resources. And when you're depressed, a lot of your emotions are telling you to do the opposite thing. It's like, withdraw from people, don't engage, all these negative thoughts about yourself, that increased fear and anxiety, which may not be totally effective or accurate given the facts of the situation.

And so it's this really tough thing to grapple with where it's like we know our emotions are good and they're telling us something and when we're depressed it's like they're telling us the wrong things and the messages are not the things that will work or be helpful. And like you're saying, even when you do the right things and go through the motions, it's It may not have that return on interest when it comes to improving your mood immediately, or shifting the way you're thinking about your environment.

Rottenberg: Yeah, so I have a lot of things to say about meta emotion. I think it's really interesting. So thoughts and feelings about emotions, these are, largely learned, these largely come from, our surrounding culture. And, you know, one of the great mysteries is, is why there is so much depression now and in certain demographics, like young people, people that are listening to your, show and are interested in, , what people are talking about here.

, and so what, are the, Meta emotional beliefs that are kind of in the air and what are some that might be kind of depressogenic. But we don't have all the answers here, but it strikes me that we have some kind of unnatural views about, feeling states. So if you watch TV, for example, , and you watch commercials, they show people that are in these really high activation states of positivity, people kind of jumping around You know jumping beans and really excited and peppy

Sadie: can't believe there's a sale

Rottenberg: Exactly.

Yeah, it's between that and in , people's, , common social media persona Where life is basically just a series of peaks and people start to represent this idea that That's normal to experience this really pumped up, jacked up, positive affectivity. And so people walk around and they compare what they believe to be what other people are experiencing and what is normative in the culture to what they're actually experiencing and they're noticing this enormous scale.

The tragedy or that also the fascinating thing is that it's a myth that people are actually experiencing This peppy activated positive affect all the time, you know, why because it's impossible That's not how the affect system works. It's it's sad, but it's true that you know when you get The promotion or when you get the new car.

And again, you expect, , I'm going to be excited for the next three weeks. , that in fact you're, you're excited and you're really happy. And then it, it. Drops off it slows down. that's really how the affect system works Because it's in part because it's forward looking and always wants you to get to the next , you know the bunny to the next carrot now the the wage worker to the next payday and so forth It's always about what's next.

But in any case, I think it it does trap people in this belief that what they're feeling is not normal So you have a double whammy you feel bad You And feeling bad feels bad, but you also feel like I'm alone in these feelings. Other people are feeling something very different, and why can't I get out of it?

And it sets people up to start monitoring their, , emotional experience in a way that probably is not, well precedented in human history. , and some of those, some of our solutions, I wonder if they're If they're really solutions, so all these apps that many people are wanting to make graphs of their mood with 15 minute intervals and so forth, it again is making us very focused on the ways that are feelings are falling short of some expectation rather than.

And again, this may sound like someone, Telling someone, , unwelcome news, but some degree of acceptance of these, , even sometimes negative emotions, can go a long way to helping people be okay with at least some of these feeling states and not feeling like I'm a freak, I'm a failure, why can't I control this, , and so forth.

Unfortunately, I don't think research given meta emotion fully its due. But we, know that it's important. We just don't know quite how it's important in like a systematic way.

Sadie: Yeah, you mentioned that there's this huge increase in depression, which most people are aware of, especially with young adults, and there's been a lot of buzz recently about that topic and research that's come out about smartphones, and then there's differing opinions that this was on the rise prior to that, , What are your thoughts there?

Do you have a strong opinion on, on why we're seeing this increase, especially in that demographic? I think what you mentioned with the, the meta emotion piece and how we're seeing emotions represented is definitely a piece of the puzzle. , but do you have an, opinion or, or a theory on, why we're kind of in this position?

Rottenberg: Yeah, like, anything interesting, , there's almost, Certainly a multitude of factors that are going into it rather than a single factor and the world's not a Controlled experiment where you can isolate the factors. So all these things are happening simultaneously but I will say as you're saying there are some real cohort effects.

So depression Surprisingly more likely among those who have lived fewer years on earth , then, then, people who are in their seventies, they've accumulated about the same amount of lifetime risk, even though, , the younger people have been alive much less long, , does appear like that's real, not just a reporting bias, in all of the kind of worst correlates of depression, , like hospitalization.

Suicide attempts again densely clustered in these younger folks. So there's something real happening. It's not just people Whining or just a greater tendency to report depression, which is in a you know, another possible explanation for it So I do believe that , like meta emotions, that depression often is about expectations, so, not only the expectations for, , the way that you're feeling, but also expectations about where you should be in life, relative to where, you You're actually in life.

So again, this is a hypothesis. I think there are some data that are, you know, consistent with this that you do have a lot of people who have very, very high aspirations that may not be fully plugged into reality. So people saying, Well, I'm going to be a millionaire before I'm 20 years old. I'm going to be instagram famous.

going to be seen as the most beautiful or the Most popular, I'm going to get into Harvard or wherever , those most, , desirable places are, and they may not, to the extent that they don't have, , a plan for making this happen, that's opening the door to tremendous, , disappointment.

That's not necessarily depressional by itself, but disappointed aspirations, I think, is a part of the mix. And part of that, those disappointing aspirations, and I'm sure you've heard this, from people who, who watch your show or listen to your show, is the sense that, , it is harder. It is harder to make it, ,

Sadie: in,

Rottenberg: a complex, competitive society than, than maybe it was for parents or grandparents, it's hard to break in economically, it's hard to finish your education, there's such rapid change, and, Yeah, I don't think it's as simple as there are these screens that people are looking at that have evil messages You know, I think disconnection could potentially be part of the mix on the ways that screens can be isolating as opposed to IRL Interactions and friendships and so forth, but those are those are a few ideas.

I mean, I think it's really quite a rich area and There, again, like beta motion, there's lots of room, I think, to improve our ability to explain what's going on.

Sadie: Yeah. Before we get into outcomes, which I'm so excited to dive into, , you mentioned earlier the psychology research on our expectations about how things pan out, , and how it can be kind of helpful to understand that when we're depressed.

Are there any other of those, like, psychology facts or insights that you really enjoy or find really interesting, , that are applicable to depression?

one of my favorite ones is how people estimate the, , consistency and importance of things going on in their life now.

Like if how I do on this test is going to drastically impact my life in 10 years. I'm going to like the same bands and these relationships are going to have such a big impact on my life. And then when you ask people 10 years later, like, I don't even know what you're talking about with that test. And I don't talk to that person anymore.

, and, and the way that we're thinking about those things in the moment is really ineffective and also inaccurate and can add to these emotions that we're experiencing and the pressure that we're placing on ourselves and, , the goals, like you were saying, that we have for ourselves in the future, kind of these, like, psychological, ineffective things that we're doing, , that we're, we're not aware of when we're feeling and thinking these things, but also might not be serving us.

Rottenberg: Yeah. , so something that really strikes me as deeply related to a lot of phenomenon in depression that we don't always give its due is just how mood dependent a variety of processes are. And it's, and it's amazing. So like, if you ask, This even goes to diagnosis. If you ask someone, , who's in the middle of a depressive episode to talk about times in their life, when they were experiencing depression, they'll have no trouble.

They'll go into great detail. , and, and, and if you ask them, So, could you tell me about times, , when you were feeling well? They'll draw a blank. They really have a great difficulty accessing that information because the mood suffuses their cognition and their attentional spotlight on things that are congruent with the mood.

reverse is even more striking, that you, someone, if you, , follow someone who was depressed and interview them 20 years later and you ask them about depression, there's evidence that people literally forget the depressive episodes. They're no longer salient They don't you know, it's because you ask the screening questions about depression.

Did you ever have a time when you? felt depressed Most of the day nearly every day for two weeks. They're like, ah, nothing really bringing a bell there

Sadie: Let's hope we all get to that point. That's what we hope for people

Rottenberg: I mean, I I don't know that I hope for it because I I like the idea that They remain grounded in reality and are aware of all the ways that we are kind of a amalgam or summation of all the experience that we have and we don't run we don't run away from the fact that maybe we had depression and we can still appreciate that but it probably is You know a tribute to to how powerful the mood dependent, , phenomena are that people literally forget episodes.

Yeah.

Sadie: That's wild. Hard to believe. Yeah, and especially because when you're in that depressive state, it's literally all you can think about, and it impacts everything you're doing. And so I remember being like, I, there will never be a time where I'm not constantly thinking about depression or my emotions or how I'm feeling.

And like you're saying, it's very mood dependent. Right. The fact that we're feeling depressed is pushing a lot of those thoughts, but also as our mood shifts after the fact, our memories and the intensity of that period also, , decreases.

Rottenberg: And it works the other way around. So, , you, you can show someone, Information that shows conclusively that there was a time before this when you appeared to be quite happy and the will look at you like you're completely crazy.

almost have no memory of this person. again, this feeling of being trapped in depression because other parts of your life become inaccessible if it goes on long enough.

Sadie: Yeah, yeah, I remember that. I was like, I don't remember a time when I didn't feel this way. And you can logically be like, that's probably not true.

But you really do feel like this has been such a salient experience.

Rottenberg: For sure.

Sadie: Outcomes. I'm really excited for this because this is something that I think the general population doesn't hear a lot about and, your research on why some people have positive outcomes from depression, , and why some people don't I think is really interesting.

So can you give people a little bit of an overview of this research, , for those who are not familiar?

Rottenberg: I'd be happy to. I'll start by saying that was doing depression research like everyone else. I was interested in outcomes. And I I was looking at the standard things that people usually examine in mood disorders research, which is, , do people have more episodes of depression, , do they recover, do they have, , symptoms of depression?

And we know a lot about that, , for sure. But I started to get a little restless and I started to wonder, , what about the things that the average person would talk about, , as things that they want for their life? So, you know, yes, I think it is true that when people are depressed, say, I would rather have fewer symptoms.

But symptoms is not a very rich mapping of all of the domains of life and functioning. So people want, , healthy relationships. They want to live that are purposeful. They obviously want to be happy. They want to function well in different domains like work. And I realized that. Wow, research had really missed the boat.

They had almost completely ignored, , these outcomes. And for sure, when we talk about functioning, they ignored good functioning. So there used to be this thing called the global assessment of functioning scale. And basically they weren't very interested. If you were functioning fine, that was okay. But when someone said they were doing poorly, that would really affect the scale a lot.

So basically the best you could do would be like. No problems functioning. so that's how I got into it. And I was interested in the first question, all these different outcomes that you could imagine that could be important to people, , like, , health, happy relationships, doing well on the job.

I thought that psychological well being shared a lot of promise, A, because That is something that people will identify as important. I want to feel positive emotions. I want to feel that my life is purposeful. , that I have control and things like that. And we know how to measure this pretty well.

There's a pretty deep literature on psychological well being. Some of these other domains, like how you're functioning at work, or how is your spiritual functioning, they're a bit harder to measure. So, we capitalized on the idea that , we have big population samples that have completed measures of psychological well being that allow us to say, this is what it means to be doing well.

So for example, if you're in the top of people, , who, in the non depressed population, for well being, that's pretty good. , so the question then became, if you have a history of depression, what's the likelihood that in the future you will have recovered from your disorder, so you're not reporting the symptoms of depression, and you're reporting high levels of psychological well being?

So, for example, being in that top quartile of a non depressed person, , group based on the epidemiology. And I guess maybe this sort of speaks to, , whether this, , research should build people's hope or, how we should feel about the research, , going in the epidemiology of depression said pretty consistently.

, that we might want to, , adjust our expectations. A lot of the epidemiology is based on, , clinical samples. , so people who had depression who were seen in therapy, in treatment, a lot of were inpatients and followed over time. And the course of depression in those groups doesn't look that terrific.

I mean, there tends to be a lot of recurrence of depression, , in not a lot of well periods. And so going in, just like, oh, well, this will be like 1 percent that, , recovers from disorder and reporting high levels of wellbeing. And so in that context, essentially what we found in the first study was using U.

S. national data that depression, it about halved the likelihood that the person would report well being. , and I'm a glass half full kind of person. , as I said, like that's far from eliminating the chance. And so about 10 percent of the sample that had depression, , at the initial point was reporting very high levels of well being consistent with that top quartile.

So I thought, This is amazing. , these people exist in much larger numbers than the conventional wisdom, you know, would have us believe. , and we replicated this pattern in a Canadian sample. And, and so I think question of whether or not there is well being after depression or whether there's systematic evidence I think has been answered.

And we're kind of in the more interesting, , phase of research, which is to understand What explains these good outcomes? So in the initial studies, these were archival data analyses, so they were collected for other purposes, and they didn't really give us the tools to understand what are the factors that explain why some people, , are, , attaining or reporting well being in the future where other people are not.

And so we might have a lot of hypotheses about what would explain this, including some things that are awfully hard to control. So, how severe your depression was in the first place, which could in part be function of someone's biological vulnerability, or it could be a function of how much, , early life adversity, , they, they were subjected to.

, but I, I also imagine, , that in this equation where we look at a, number of variables that influence future well being, that some of those variables are going to be within human control. And that's very exciting because, , Those are things that you can do something about, whether it's your attitudes towards depression or all the things that we were alluding to ways that people try to influence their mood through different habits like exercise or diet or sleep, that may prove to be, , important.

It's also likely, I think it's almost certainly the case that there is more than one. pathway, , to well being. So what I think we'll be saying in five or ten years, , is that there's several different pathways. Some involve control more than, , others. And though, you know, it's not as strong as you can just choose your own adventure.

, this does kind of suggest that, , people can experiment and find it. To what extent things that work for other people are helpful for them in building this kind of sustainable, , well being over time. Because, you know, I think, having well being in a snapshot that's what that is.

These research studies were showing is very important, and as you're suggesting, is very hopeful because I do think that there is a lot of gloom and misery out there about what you can expect if you have depression and unfortunately there isn't fantastic prognosis information out there.

And this isn't to blame clinicians, but to say in reality, they are going largely based on the published epidemiology, most of which is based on clinical samples. I mean, you would be amazed by how few studies look at a representative sample of depression as it happens in the community and follow those folks for decades.

I think there's maybe three studies. Like that in the entire literature now, it's a lot of work the population samples are a huge amount of work. We have enough trouble, you know, saying who is going to vote for President, in five days and getting a representative sample. So when we're talking about things that are not as common, , like depression that You know, maybe only 5 or 6 percent of people might be experiencing it any given time.

And then we're talking about, how people are functioning in 20 years. That sort of work is, really challenging. But the work in community samples, it definitely suggests that there are many people who do not have, , these chronic courses, , of depression, including many people who have only a single episode of depression, , there's probably a lot to that story that, , remains to be, , teased out and understood. there could be some overlap, , between, in the, , wider world that single episodes are pretty common. , even though the DSM still, , , says, , when they just talk about depression and epidemiology that it's typically recurrent.

I think it's, , like a 50 50, , it's in about half of cases it's recurrent and in those cases it's often very recurrent, , but the half that it's not recurrent is not unimportant because it's half. And I also think that there could be some ways in which it's useful for people who experience more recurrent forms of depression to simply know that there are other pathways and understanding Again, what is the explanation?

Because anyone who has recurrent depression would surely like their depression to be less recurrent.

and so I don't think any of this is completely destiny. So, I'm very, a big believer in what I call realistic hope. So, don't think hope, by itself is all that helpful and sometimes it can be, , I don't want to say toxic, but it can be almost demoralizing when people are giving you helpful messages that are, not really well anchored in empirical facts.

But like this 10%, 10 percent of people who have a history of depression go on to experience high levels of well being and now we're finding that in multiple samples. We found some things. similarly striking in a sample of adolescents who had history of a suicide and survived. The surprisingly large percentage of those youth went on to report well being.

And again, it's not the majority, but these are facts. , and so I think we can Once people accept that these are facts, we can start to understand, well, what are the implications of these facts? And, , I think some of the implications, of these facts is that the, course of depression is not uniformly bad.

, it's just not, it's just not uniformly bad. And I'm interested in to what extent this knowledge could help us improve, , the average, I mean, because ultimately, you know, Epidemiology is not, it's not destiny. we're not talking about something like, , I mean, there are diseases like this, , at least in our present ability to intervene.

So, , you know, Huntington's disease, it does not appear to be a disease right now that we have an intervention, , or even understand what explains this progression, but it is a highly progressive disease, , depression. Appears to be more reversible, , than a neurological disease like, , Huntington's disease.

And that's not just happy talk, that really seems borne out in the facts.

Sadie: Yeah, it's really interesting because it is such a gap in the research and our understanding of depression, but it also makes so much sense because these people that are experiencing really high well being versus still really in the struggle, like one population, you're like, it absolutely makes sense that they're still in this clinical setting.

It's easier to follow these outcomes. There's potentially more, , hospitalizations or incidents or prescriptions being filled, whatever data you can look at. And then these people that are doing really well in well being. Kind of makes sense why we see them like drop off the map when it comes to these things that we check in on.

And so I think that's really interesting and I, also wonder, the reasons why these high Levels of well being occur after depression. I know for me Anecdotally going into college. I heard from so many people that it was the hardest thing.

They'd ever gone through emotionally and going through that huge period of change and Deciding their own schedule and the stress levels like a lot of people experience depression for the first time in college It's such a huge shift in life and they've never experienced anything like it before And I remember getting to college and having gone through dbt and having done a lot of therapy and been through such a worst time emotionally being like I have every single skill I could need to navigate this experience and navigate this new arena and build relationships And I know that schedule is really important and and sleep is something that absolutely has to happen and so it did feel like there was that skill set there that some people just didn't have and I did feel like that Anecdotally correlated with being able to maintain and improve while being in college I'm curious if you have in speaking to people who have kind of ended up in that camp with higher levels of well being post depression or, , subjectively, if you have any thoughts or, , predictions on why some people have such positive outcomes after those depressive episodes.

Rottenberg: mean, I love your story. think it's, it's so telling and again, not the, not the default or mainstream view of, , about the effects of depression. I mean, ordinarily, I think people think, Oh, if you have depression, you're damaged, you got damaged. , and so like the best you can do is you have all these scars and just kind of like repair the damage.

But what you were describing, Sadie, with your experience, if I'm understanding it, is that, , depression was kind of a proving ground for you in some ways, that, , you emerged with some, with some knowledge and some skills, both about yourself and about the world, that you wouldn't have had. And it doesn't mean that, like, it's a blessing for everyone or just a Good thing that, , you know, we just should be more depression. And so we would all have these skills, but I think that we ignore this at our peril, because this is like a really profound experience that, people, , go through and it, it does change people. And I think we've ignored the ways in which those changes are changes that are, helpful in later life, whether that's being more empathetic to other, people who might be struggling.

, better self knowledge, a better, , tuning of your aspirations, , to, , projects that are meaningful and purposeful. A part of what happens in depression is people often experience kind of a crisis of meaning and purpose, and it, doesn't always get solved, but sometimes it does. I mean, I'll just say again, Anecdotally, and to relate my own experience, I think that changing what I was doing, , from the study of history, which I loved, to the study of psychology, it wasn't 100%.

It's hard to put an exact number, , but it was a significant component, I think, in In how I was able to pull out of the depression and after the episode kind of gather something that was meaningful and purposeful, , for me. So understanding depression was very near and dear to my heart and the idea that my experience could be something that, actually leads to something good, , in scientific knowledge and helping other people, that would be a great example of how depression could change someone in a, in a positive way.

And I think that's really been very badly neglected in psychiatry and clinical psychology because of this almost exclusive focus on the ways that depression creates good different kinds of collateral damage, , you know, in cognitions, in relationships, in income, and so forth, and you, in other psychopathology.

And look, I'm not trying to put those people out of business, , in talking about positive outcomes or positive life change. I just, I'm asking for a little bit, , More balance. So, you know, we could again have a discussion about what, what is the right level of balance in terms of studying negative outcomes versus positive outcomes.

And I'd say, well, 50 50, I would, but realistically, even if a quarter of the research, was aimed at ways in which, , depression for some people is a kind of a bridge to a better place. I think it would be very useful. I think it'd be very useful clinically. That is, in people who are still struggling.

Because, , we don't have to always reinvent the wheel. There are a lot of common themes are shared between people who have these experiences. And as you're suggesting, the experience of depression as it is happening now is very disconnecting. So you have people who are still, quote unquote, still in it.

, versus people who, , feel like they've come out, the other side and they're now a different person. And very little conversation between those, those two groups.

Sadie: Yeah.

Rottenberg: And it kind of almost like each is kind of threatened by the other, and I think like, wow, everyone has something to give here, you know?

and so, . , I, I think this dialogue about the ways that depression can change you and the ways that depression can change you even for the better, or at least it can be an opportunity for change, , better or worse, is a kind of dialogue that I think a lot of people who've had these experiences would be interested in having, regardless of whether they're depressed right now, , or not.

Sadie: Yeah, it's exactly like you said earlier It's literally a blind spot for the people that have come out of it and now don't as vividly remember the experience and the people that are in it that aren't able to Contemplate what it could look like on the other side and so I couldn't agree more that that conversation is so so so needed

Rottenberg: But it is complicated because it sort of speaks to , these issues of identity.

So identity is a complicated topic, right? And so people have multiple things that they identify, , that, that comprise their identity. And, and there's a question of how does mental health intersect with that?

Sadie: Yeah. So,

Rottenberg: you know, typically people, , don't integrate mental health problems into their identity, very much or very well.

And part of it is that there is a fairly dominant model of mental health problems, , that's biomedical to that, that conceives of these problems as fundamentally a disease. And so, , it's hard to identify with the disease. It's harder because it's a, disease. It's something that happens to you, , result of genes or biochemical processes doesn't really feel like it's you.

, but that I think it's too bad in the sense that for everyone, is a profound experience and does lead to changes in how people might think of themselves or their experiences or their future. And so it does intersect with that. And people have difficulty figuring out how do I relate to this thing?

Does this mean that I'm a bad person what does it mean? , and so I think part of this dialogue, what it could do is to help reconnect these profound experiences to people's identities. It's not only in ways where people feel diminished because they had a mental health problem, but also in ways that they feel a sense that this is a important part of them, that they maybe even want to hold close, that they appreciate.

I guess that's a more radical view, but I think there's something to it, and maybe you, experienced something similarly in your experience that, , it's become a part of you and you can talk about it. It's not whole of you, but, but it would be a shame if you have to always put this in a closet, , and never be able to talk about it.

Sadie: Yeah, it's so interesting you say that, that people have that resistance to identifying with a disease, because I remember for some reason feeling the exact opposite. I did an IOP program twice, and we would do occupational therapy, and they'd have us do art, and maybe it would positively impact our mood.

But one of the activities we did was drawing or painting. painting or collaging your sense of identity. And I remember my identity drawing and a lot of other people's really prominently included depression and anxiety. And it was like, I go to school, these are my interests, and I'm Depressed like that was the sense of identity and I think it was not only that so much of my life was consumed by depression and I was in and out of the hospital and doing intensive outpatient all the time and everything I was feeling and thinking kind of had that negative tilt to it.

But it also was the self esteem side of things it felt like depression was something that was maybe broken or wrong or not normal or not how normal people are functioning. And that was absolutely me. Like something was wrong and I was depressed and that was. It wasn't like I have depression, it was I am depressed.

And so I think it's really interesting, like you're saying, the positive and negatives about how we talk about this thing, whether it's the chemical imbalance theory, or depression is more a signal and we need to change something in our life, , or it's a disease that we're experiencing and that happens to us, or we are the disorder and it's something follows us for the rest of our lives.

It's really interesting.

Rottenberg: It is really interesting. Let me give you an example, sort of explain, , what I mean by talking about it as a positive, , because I don't want this to come off as like, Oh, , John is saying that depression is good and, you know, we should all experience depression so we can become better people.

, I have a very specific kinds of, insights and experiences, , you know, that I think are pretty commonly experienced, even if they're not, , discussed much. And some of them come from some of the most awful, , parts of depression. So for example, a lot of people, you know, , when they experience depression, I experienced this as well, obsessed, , with different aspects of death, that, things die, , that, , the planet is dying, that, your life is finite, and people become even, , fixated on the idea, , that maybe this wouldn't be a bad thing.

And they have passive death wishes and they think about suicide. and this is really quite alarming and, horrifying. And it's horrifying, not only the person experiencing, but it's horrifying to the other people around them. And, what are the things that I find really remarkable on the other side of depression, reflecting on these experiences and on, in some ways feeling like, , I was immersed, I was saturated in, in death and death experiences for probably about 18 months of my depression.

I was thinking a lot about death. On the other side, I realized A, I'm alive, B, I don't want to die, , C, I'm really grateful that I'm alive, and D, things actually seem more alive than they did before, and it's kind of just like, my head explodes sometimes.

Sadie: Yeah.

Rottenberg: and again, it's, I don't think if I had had this experience, , that I would be in this place.

So it's, it is a horrible experience. It is a difficult experience. There are some potential benefits if you, if you look for them and in talking about them, I don't think diminishes the horror of the pain, or make it all go away. But I think there are a lot of people who experience this and, you know, we, we don't have much time we get in this world.

And there are a lot of people who don't experience depression, who are, you could say, maybe sleepwalking through all or part of their life and not seizing on the opportunities that they have and enjoying what they can. And one thing that can happen, and I hope happens to a lot of people who go through a really painful experience.

And do get some breathing space from it on the other side is, realizing, maybe not always in that order, but that A, B, C, and D, but, you know, ending with like, it's kind of a miracle that I made it in that I'm able to enjoy things and there's a lot of amazing things, you know, in this, in this world.

Sadie: Yeah, there's this thing on TikTok called the butterfly effect and it's like one thing happened and there was all these positive repercussions And I think like when I look at all the things that I love and are my favorite parts of life and that I enjoy it. It really all goes back to depression like my relationship with my family That was built.

There was nothing when I was depressed. It was completely destroyed. There was no communication or closeness or vulnerability All those skills were learned because I got depressed and now we have an incredible relationship the podcast I started because I got depressed and have reached so many people what i'm doing for school and studying psychology and wanting to go to grad school all of that is because of what I went through and All these other little things that I look and i'm like these are my favorite parts of life None of that would have been there if I hadn't gone through that depression And so I I really agree with what you're saying, and I think it hopefully will give people a lot of hope and that other side of the picture that it doesn't just have to be downhill.

Rottenberg: It's okay to talk about it. I mean, I think yeah, I think for me that's one of the main, motivations for studying and talking about life after depression is to To, to do my part to make it okay, , to talk about these experiences in, in their full measure of beauty and ugliness and confusingness.

I think it all needs to be part of the picture, , cause it's not like even the words that we use. So language is very powerful. The word that we use that, that often it's people's goal. , you know, we use recovery like you were working on a, word document and then you got a message that the, the, the file was corrupted and then you call it and you're hoping, can I recover my file?

your file was recovered. You open it up and it's the same words, right?

Sadie: Yeah. So

Rottenberg: it's sort of like this idea of like, well, you, went back to the way things were before, and, , this bad experience, , this corruption, you know, is now, been purged, and that's your life.

And that, A, that's not true, because you're gonna change, , even if you didn't have depression, and B, I don't really think the goal, I don't think most people's goal when they really think about it, when they really think about it is just to Go back and recover the words from the file.

people have rather more complex aspirations for the rest of their life.

So you know talking about ways maybe that depression is transformative and changes people as opposed to in ways that are good or bad is more interesting to me than simply saying Oh, we're we're all aiming for this recovery state and it's all kind of we all know what that is Just going back to the way that it was before Whatever that is

Sadie: Yeah, no, I've never thought about that, but it's very true.

Our goal is not to revert to original. There's so much beyond that

Rottenberg: I mean this is this may also interact with your experiences, the idea that You know, the goal is zero depression, zero depressive symptoms, you know, sort of the recovery model, like, Oh, I don't, I don't, not even in the same zip code as depression.

That may not be super realistic for a lot of people. And it may not be entirely healthy, too, because You're likely going to have to be coping if you're the kind of person who, had a significant depressive episode. You have that propensity towards a kind of melancholic state. It's going to happen at some point on some level and being able to accept it and cope with it and and dial it back seems really vital.

And I don't know that the terminology of recovery really gives people those, kinds of tools.

Sadie: Yeah, and the fact that you have those skills that like you know something's not where it should be and you can Then kind of shift your life and shift these things to put yourself on the path you want to be on That's really something to celebrate and something you gain from that experience Even though it there might not have been positive things there.

Those skills are really Incredible and a lot of people don't have them

Rottenberg: Yeah. I, really love that, idea that, , we should give people a lot of, , positive reinforcement for going through the experiences of depression. Again, recovery is like, you know, the file was recovered. We have the words, you know, you're relieved, but it doesn't really, the gravity, , of how much work was required to, you know, endure this state.

depression, anxiety, all these mental health problems, , can be just so draining and so hard. And getting to the end, outlasting them or, finding some clever way, , to, get to their end really is something that, , I think we just don't spend as much time, in really luxuriating and giving people the full measure.

It may be in part because, , it's not really widely, , appreciated or understood what it is like to go through a full episode. , and it is hard. It is hard. And language is, , , not that well suited to conveying these experiences. I mean, there are some good books people can read that I think give some of, the experience.

I think part of, part of the thing is you may have encountered this in classes you've taken and so forth, this whole idea of phenomenology, so what it's like to experience. And there is something, you know, if you really think about it, , Incommensurate. That is hard to communicate between my experience and your experience.

We can use words. You can tell me what you're feeling and you can say, that's a beautiful sunset and I have an idea. There's a famous essay by this man, Thomas Nagel, , called, What's it like to be a bat? Which really, , puts, a fine point on it because bats do and we really have no idea, right, really what it's like to be a bat.

But, you know, I don't really know what it's like to be Sadie. You don't really know what it's like to be John. We try with, with words and so forth. And then we talk about these really profound experiences like depression, where even I don't have trouble putting into words something that happened to me.

, you really see that we have a challenge here and maybe that's part of why. You know, at the end of these depressions, people are just like, Oh, I'm glad you're back.

Sadie: Yeah. Yeah. But

Rottenberg: not really, understanding what the person went through.

Sadie: Totally. I remember my sister was working on her college applications and the first process was just like writing down everything impactful that had happened before she narrowed down on what she wanted to write a personal statement about.

And she was like, my sister was really depressed and she put up a good fight I was like, you're making it sound like I died. Like I'm still here. I'm on the other side. , I'm doing great. And you're right. There's not a good way to distill that and explain that and give space for all the painful experiences, but also All the potentially positive things that have come with that experience as well.

Rottenberg: Yeah, but I honestly I think you're doing you're doing yeoman service is I think What I understand , you're very interested in what the experience is is like in in good ways and bad and I think the more people become familiar with it the more it gets Detoxified and it becomes a little bit less radioactive.

It's still not easy. There still is a tremendous amount Uh, , discrimination that happens for lack of a better word and often in high stakes, you know, , situations like, , when people are, , applying for jobs or people are, forming relationships, , there's a lot of fear, , a lot of fear of mental health problems and they can be seen as absolutely disqualifying and we're wasting of just a huge amount of, of some of our most talented people.

, because the difficulty of understanding, , what can be a wide gulf, , between people's experiences. So I think we really do need more of this, , and, and not just kind of speaking in some of the cliches that it's easy to do, but just not that helpful, give people the, the 3D, , picture of these sorts of experiences and bringing them back into.

Rottenberg: the things that are discussable in polite conversation and it doesn't make you weird or a bad person or needing to talk about this all the time. But it is a real shame. And maybe it's generational. I think that the younger generation is going to be the one, I think, to fall.

To finally, , break through here and it is, it is bad as things are, , with mental health for younger people. That will be a really good thing that comes of it, I believe. And, , you guys are gonna get through it. and, and, and, and, and I don't think, and I don't think that the situation is necessarily, .

A one way, , a one way train. I mean, again, the picture that we have of mental health problems is that they're escalating, that if you had these problems, you're going to accumulate other problems. So if you had depression, you're more likely to get substance problems than anxiety, and you're going to be kind of trapped forever.

Again, understanding the , the heterogeneity, so knowing that there are a variety of outcomes and that things are not set in stone by any means, , to me is, again, back to this realistic hope, , that, that people need, they need to know and, and, and I think, , I think it's, I think it's really quite important to, I could say morale, , morale of, , morale of younger people and, and, , people who are.

Sadie: Yeah. Well, if people want to follow along with your research or read your books, , or connect, where can they do that?

Rottenberg: Well, probably the best one stop shopping, , is to visit our website at the Better Outcomes Laboratory. So this is at my laboratory at Cornell University, , and if you go there, you'll see, , you'll see some of the, , Programming that I was talking about on life after depression, which is happening both in research and on social media.

So we have a new set of channels That we're calling ever after and it talks about these some of these , profound experiences in ways that depression can change people both for, , for the worse as, as, as many people have discussed, but also for the better and that potential, , for, for mental health problems to, , lead to a life that's more beautiful, more meaningful and more happy.

Sadie: Yeah. Well, thank you so much. This was absolutely incredible.

Rottenberg: , it was a real privilege. Thank you for having me on.

Sadie: Thank you so much for listening to this week's episode of she persisted. If you enjoyed, make sure to share with a friend or family member, it really helps out the podcast. And if you haven't already leave a review on apple podcasts or Spotify, you can also make sure to follow along at actually persisted podcast on both Instagram and Tik TOK, and check out all the bonus resources, content and information on my website.

She persisted podcast.com. Thanks for supporting. Keep persisting and I'll see you next week.

© 2020 She Persisted LLC. This podcast is copyrighted subject matter owned by She Persisted LLC and She Persisted LLC reserves all rights in and to the podcast. Any use without She Persisted LLC’s express prior written consent is prohibited.