Anxiety and Depression: Why “Feeling Better” Is Not Enough. My analysis, the day after World Mental Health Day.

The day before yesterday, as every year, we celebrated World Mental Health Day. Today, with the spotlight off, it is time for analysis. The World Health Organization's figures are a stark warning: over a billion people do not enjoy good mental health and, among these, almost 700 million who suffer from depression and anxiety disorders are unable to regain complete well-being.

Many patients, despite treatment, do not really recover. They are told “you are better than before,” but their lives remain limited. The prison of mental illness expands its boundaries but does not disappear. While this may be understandable in some psychotic disorders, it is unacceptable for anxiety and depressive disorders.

After more than thirty years of clinical practice and research, I have identified two fundamental obstacles that prevent millions of people from regaining their freedom.

1. The first obstacle: The crisis of diagnosis

The first problem is widespread diagnostic superficiality, which stems from a lack of knowledge of psychopathology. We too often hide behind vague labels such as “Anxiety-Depressive Syndrome,” a non-diagnosis that translates into generic and ineffective therapies. The result? People who are “less worse,” but certainly not well.

The clinical reality is more complex and requires a clear distinction:

• Sadness is not depression: Many people complain of low mood, but do not suffer from pathological depression. They are demoralized, exhausted by environmental factors. These people do not primarily need medication, but targeted psychological support or, sometimes, a change in their living conditions.

• True depression must be recognized: On the contrary, too many people with pathological depression are not diagnosed correctly and do not receive the drug treatment that would be crucial for them.

• Anxiety is not just anxiety: Anxiety, even intense anxiety, can be a normal defense reaction. Our task is to distinguish this physiological activation from pathological anxiety that limits life, accurately identifying whether we are dealing with panic attacks, social anxiety, phobias, or an obsessive disorder. In these cases, low mood is not concomitant depression, but a healthy and understandable emotional reaction to the suffering caused by the primary anxiety disorder.

2. The second obstacle: Generic and non-personalized therapies

Even when the diagnosis is correct, the choice of therapy often proves problematic. Too frequently, decisions are not based on solid scientific evidence. Unvalidated combinations of drugs, incorrect dosages for inadequate periods of time, or overly generic and unfocused psychotherapeutic interventions are proposed.

The real therapeutic breakthrough lies in integrating science with clinical experience to create a personalized therapeutic plan: a therapy tailored to “that” specific person, maximizing the chances of achieving 100% well-being.

Addressing objections: Realism versus Resignation

I know these words may sound harsh or, worse, abstract. I can already hear the entirely legitimate objections of many colleagues on the front line.

·  “Professor, it's obvious that correct diagnosis and treatment are needed.” Of course they are. But if it's so obvious, why do the data tell us that we are failing? Mine is not an academic exercise, but a call never to take the application of this fundamental principle for granted in daily practice.

·  “We don't have time to make such thorough diagnoses.” This is the most serious criticism. Our society and our healthcare system demand that we be fast, prioritizing quantity over quality. But this cannot be a justification for giving up. This is not an accusation against individual professionals, but a denunciation of a system that we must change from within. As educators and clinicians, we have a duty to fight for the time necessary to ensure attentive and empathetic listening, which is the basis of any good diagnosis. Myself first and foremost.

·  “This is an elitist model, for the few.” On the contrary. My goal is to make this standard of care the norm, not a luxury. Diagnostic excellence and personalized therapy are not academic quirks, but the right of every patient who turns to the healthcare system for help.

The way out: A new therapeutic pact

The solution, therefore, is not only technical, but deeply human. It is based on three inseparable pillars:

1.  Diagnostic Competence: Invest relentlessly in psychopathology training.

2.  Personalized Treatment Plan: Integrate science and experience to offer each patient a tailor-made treatment plan.

3.  Therapeutic Alliance: Create a relationship based on understanding, empathy, and hospitality. No therapy, however perfect, can work without the active and trusting participation of the person seeking help.

Our goal as clinicians cannot be limited to partial improvement. We must aim for complete well-being, because only that can reopen the door to freedom and self-determination. It is a difficult goal, and we must be honest enough to admit that, in some cases, unfortunately, even the greatest effort may not be enough. But we cannot afford to start with a lower goal.