How to Measure Real Recovery in Major Depressive Disorder

Throughout your treatment for major depressive disorder (MDD), your therapist or doctor will likely track your progress by routinely measuring symptoms like your mood, energy level, and outlook. They’ll typically use standardized scales, such as the Quick Inventory of Depressive Symptomatology (QIDS) and Patient Health Questionnaire-9 (PHQ-9). By comparing your current scores with previous scores, your care team can determine how you’re responding to treatment and whether you’ve reached full remission.

But tracking recovery isn’t just about numbers. “It's also about checking in with you,” says Naomi Torres-Mackie, PhD, a clinical psychologist at Northwell Health’s Lenox Hill Hospital in New York City. “There are these formal measures, and then there's informal measures, as well.”

Your care team will assess recovery across several areas, many of which can be monitored by you first at home. In particular, paying attention to changes in your mental clarity, energy level, and daily functioning can help you and your provider better understand how MDD is progressing.

• Processing speed
• Ability to concentrate
• Attention span
• Memory

“With depression, a number of symptoms — including impaired sleep, low energy, poor appetite, and difficulty concentrating — can be compounding,” says Jarrod Ehrie, MD, a clinical assistant professor of psychiatry and behavioral sciences at Stanford University in California. “They really limit your ability to navigate your day or accomplish your responsibilities.”

Small improvements might go unnoticed, so tracking how well you’re able to think, remember, and focus can help you spot progress. Your doctor may recommend cognitive behavioral therapy worksheets or daily mood journaling to make note of changes, says Dr. Torres-Mackie. One caveat is that “sometimes self-tracking can increase anxiety. It depends on the person,” she says.

To support cognition and optimize recovery, make a point to stay physically active. “Exercise and moving your body can be very helpful,” says Torres-Mackie. She also recommends maintaining a healthy diet and avoiding the temptation to load up on caffeine for energy, which often ends in a crash.

If tracking your symptoms feels helpful, Torres-Mackie recommends noting your mood and energy three times a day — morning, midday, and evening — along with what you were doing at that time, since how you’re feeling can fluctuate. Reviewing your notes can help you identify patterns around which activities boost your energy and which feel draining.

But don't get lost in the details, says Dr. Ehrie: “You want to look for the bigger trends and not miss the forest for the trees.” Focus on overarching patterns in your energy and mood rather than every small fluctuation.

Gauging recovery from MDD isn’t just about mood — it also involves looking at how depression affects your daily life and relationships. Pay attention to your performance at work or school and your involvement in your daily life and relationships. Torres-Mackie advises people to “ask yourself: ’How connected am I feeling to other people? ‘How connected am I feeling to myself?’”

Part of the equation should involve measuring how much enjoyment you get from hobbies, social connections, and daily activities. “Sometimes depression has this very disconnective quality — with other people and even with yourself,” says Torres-Mackie. “If you’re feeling more connected with yourself, more in your own body, more in your own mind, in your own experiences, that’s a great sign of recovery.”

While tracking your own recovery is useful, sharing your observations with your therapist or doctor is also important. “It's really helpful to have someone to work through this with,” says Ehrie. “It’s nice to have someone else who can provide additional context for what you're experiencing day to day, week to week, month to month.”

• Recovery from depression involves more than just mood, combining formal assessments like the PHQ-9 and QIDS with your day-to-day thinking, feelings, and functioning.
• Tracking cognition and energy in addition to emotions helps you notice improvements in focus, memory, and fatigue that may lag behind mood changes.
• True recovery is reflected in quality of life, including engagement at work, connection with yourself and others, and enjoyment of daily activities.