At some point in your life, you may have heard from some well-meaning, older individual, that as you grow older, you come to “know yourself.” And that in “knowing yourself,” you find peace and some level of decreased anxiety. While the jury’s still out on this, a new study by Kelly and Mezuk (2017) indicates that in the case of adults with Major Depressive Disorder (MDD; characterized by a low or depressed mood for 2 or more weeks) and Generalized Anxiety Disorder (GAD; characterized by persistent, excessive, and unrealistic worry about everyday things for at least 6 months), symptom remission may, in fact, be associated with age.
What is Remission?
Generally speaking, remission refers to a decrease in symptoms to the point of no longer meeting criteria for a formal DSM diagnosis. Thus, remission may refer to the complete absence of symptoms for an extended period of time, a mild level of symptoms that don’t quite meet the criteria for a diagnosis, or really anything in between. Such a broad definition makes remission difficult to measure consistently. However, in general, you can think of remission as a significant decrease in symptomatology.
Remission sounds great! How do we get there?
Although psychiatric disorders such as MDD and GAD are often thought to be chronic and unremitting, research indicates that individuals with MDD or GAD do experience remission (Yonkers et al., 2003; Eaton et al., 2008). To better examine this, several studies have focused on identifying the factors increasing and decreasing the likelihood of remission in GAD and MDD. For example, studies have identified comorbid psychiatric disorders (Bruce et al., 2001), adverse childhood experiences (Schilling et al., 2007; Danese et al., 2009; McLaughlin et al., 2010), and a parental history of either disorder (Wickramaratne and Weissman, 1998) as increasing the likelihood of remission of GAD and MDD. In Kelly and Mezuk’s (2017) study, the authors found that about half of the individuals with GAD (41.1%) and MDD (54.4%) experienced a full remission of at least one year, as well as identified older age and higher income as additional predictors of remission in GAD and MDD. Additionally, although having both GAD and MDD predicted a lower rate of remission in MDD, it did not affect GAD remission.
So make more and get older?
Not so fast. While the study indicates that these factors were related to remission, the results do not mean that these factors lead to or caused remission. As Dr. Mezuk states, “for the relationship between older age and remission, it likely represents, at least in part, the fact that someone who has lived longer has just had more years in which to remit from their condition.” Other factors not examined in the study, such as social support, time in therapy, medications, cultural factors, and marginalized identity statuses, likely interact with age and income to explain symptom remission. While further study is necessary to better examine and to account for these other factors, the study does further pave the way for us to gain a better understanding of the factors increasing remission in disorders, such as MDD and GAD. Most importantly, as Dr. Mezuk says, “remission happens… A diagnosis is not necessarily a life sentence.”
Sources
1. Bruce, S.E., Machan, J.T., Dyck, I., Keller, M.B. (2001). Infrequency of “pure” GAD: impact of psychiatric comorbidity on clinical course. Depression Anxiety, 14 (4), 219–225. http://dx.doi.org/10.1002/da.1070.
2. Danese, A., Moffitt, T.E., Harrington, H., et al. (2009). Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch. Pedia. Adolesc. Med., 163 (12), 1135–1143. http:// dx.doi.org/10.1001/archpediatrics.2009.214.
3. Eaton, W.W., Shao, H., Nestadt, G., Lee, B., Bienvenu, O., Zandi, P. (2008). Population based study of first onset and chronicity in major depressive disorder. Arch. Gen. Psychiatry, 65 (5), 513–520. http://dx.doi.org/10.1001/archpsyc.65.5.513.
4. Kelly, K. M., Mezuk, B. (2017). Predictors of remission from generalized anxiety disorder and major depressive disorder. Journal of Affective Disorders, 208, 467–474.
5. McLaughlin, K.A., Green, J., Gruber, M.J., Sampson, N.A., Zaslavsky, A.M., Kessler, R.C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: associations with persistence of DSM-IV disorders. Arch. Gen. Psychiatry, 67 (2), 124–132. http://dx.doi.org/10.1001/.
6. Schilling, E.A., Aseltine, R.H., Gore, S. (2007). Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health, 7, 30. http:// dx.doi.org/10.1186/1471-2458-7-30.
7. Wickramaratne, P.J., Weissman, M.M. (1998). Onset of psychopathology in offspring by developmental phase and parental depression. J. Am. Acad. Child Adolesc. Psychiatry, 37 (9), 933–942. http://dx.doi.org/10.1097/00004583-19980900000013.
8. Yonkers, K.A., Bruce, S.E., Dyck, I.R., Keller, M.B. (2003). Chronicity, relapse, and illness—Course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depression Anxiety, 17 (3), 173–179.
Carol S. Lee is a clinical psychology doctoral student at University of Massachusetts Boston. She received her Bachelor of Arts in psychology from University of California San Diego in 2012 and her master’s in clinical psychology from UMass Boston in 2015. Carol works with Dr. Sarah A.
Hayes-Skelton to examine how and why therapeutic exposures and behavioral experiments in treatments for anxiety disorders work. In an effort to examine one piece of this, Carol’s current research draws from both social and clinical psychology to examine the process behind engaging in a behavior despite any fear or anxiety associated with that behavior. Carol and Dr. Hayes-Skelton collaborate to write articles for Anxiety.org.
