When depression improves but patients still grapple with symptoms

For years, Ren Fernandez-Kim assumed the way they felt was normal. When people asked how they were, the answer was always “fine.” Then, as a college freshman, the exhaustion, endless rumination and brain fog they had long pushed through became impossible to ignore.

“It was so hard even to get out of bed, eat breakfast, go to class,” says Fernandez-Kim, now 34. “And I couldn’t focus. No matter how much I studied, nothing was sticking.” The experience compounded the anxiety that had also been a constant presence for as long as they could remember.

Still, Fernandez-Kim, now an online creator, educator and mental health advocate, often answered “fine” when people asked how they were doing. That began to change when one of their professors gently suggested they seemed stressed and might benefit from psychotherapy.

That conversation in 2012 marked the beginning of Fernandez-Kim’s mental health journey. They took a semester off, started therapy and, two years later, began taking medication.

“I’m still on that journey,” Fernandez-Kim says. “It’s not perfect, but I’m in a much better place now than I was when I started.”

Their experience reflects a common but often overlooked reality in depression care: Even when treatment helps, symptoms can remain. And those symptoms—disrupted sleep, fatigue, changes in weight and appetite, trouble concentrating, loss of interest or pleasure—can continue to affect daily life long after someone begins to feel “better.”

When depression improves but symptoms remain

Fernandez-Kim is one of an estimated 332 million people worldwide living with depression, also known as major depressive disorder (MDD).

They are also part of another large group: people with depression who experience meaningful improvement with treatment but do not reach full remission. Research  suggests that only one in three patients achieves remission after their first antidepressant, leaving many with lingering or residual symptoms.

That gap between a major depressive episode and full recovery is the focus of Generation Fine, a global initiative launched by Johnson & Johnson this year to bring attention to residual symptoms and to challenge what it means for people with MDD to feel “fine” in depression care.

The effort is designed to encourage people living with depression to think beyond “good enough” and talk with healthcare professionals about symptoms that continue to affect daily life.

“Clinically, residual symptoms can be easy to overlook,” says Wayne Drevets, M.D., Vice President, Disease Area Leader, Neuropsychiatry, Johnson & Johnson. “Treatment often prioritizes mood symptoms, such as hopelessness and suicidal ideation, which are considered more urgent to address, while other lingering symptoms go under-treated.”

One of the most common and persistent residual symptoms is sleep disturbance, including trouble falling asleep or staying asleep or waking too early. According to Dr. Drevets, disrupted sleep patterns are present in at least 75% of people with depression, and research shows the relationship between sleep disturbance and depression is bidirectional.

Sleep problems can have a ripple effect, affecting energy, attention, memory and overall well-being. And the issue is not only how much sleep someone gets, Dr. Drevets explains, but also the quality of that sleep.

“During a major depressive episode, a person manifests more shallow sleep and less of the deep sleep that’s important for optimal cognitive and metabolic function,” he says. For patients, lingering depressive symptoms can become part of the background noise of daily life—noticeable, but often endured because they are perceived as being inescapable. Many learn to struggle through them rather than recognizing them as persisting parts of the depressive illness—which can and should be more completely treated.

Why “fine” may not tell the whole story

Fernandez-Kim understands that dynamic well. When they first tried medication, they encountered a challenge familiar to many patients: different medications work differently for different people. They had to try two before finding one that felt effective.

“There’s always a fear or anxiety that this one will stop working for me and my symptoms will return,” says Fernandez-Kim.

That concern is a common one. Findings from a 2025 global survey commissioned by Johnson & Johnson underscore how often symptoms linger:

• Only 10% of people taking antidepressants report being fully satisfied with their current antidepressant.
• Almost three in four said their residual symptoms have a moderate to significant effect on everyday life.
• More than half said they isolate themselves from others more frequently than they normally would because of how they are feeling.
• Nearly four in five people said they don’t believe antidepressants will help them reach remission, so feeling “just okay” is accepted as good enough.
  

“Depression with residual symptoms shows up in a variety of ways functionally,” says Dr. Drevets. There are higher rates both of missing work (“absenteeism”) and of showing up for work but not functioning well (“presenteeism”).

“Many people feel a sense of inertia or brain fog; others experience a nervous energy or agitation,” he adds. “Symptoms of depression can also differ directionally across individuals with MDD within a symptom domain; for example, some lose their appetite and lose weight, while others have increased appetite and gain weight.”

The varied ways those symptoms affect everyday life underscore a central challenge in depression care: MDD is not one-size-fits-all.

That complexity is partly because depression is diagnosed as a syndrome based on a constellation of symptoms, Dr. Drevets explains. To meet diagnostic criteria, a patient must have five out of nine symptoms listed in the  Diagnostic and Statistical Manual of Mental Disorders, leaving significant room for variation from one person to another.

This growing understanding is helping reshape how depression is viewed and treated. Rather than seeing residual symptoms as a byproduct of depression, clinicians and researchers increasingly recognize them as part of the illness.

That perspective is also guiding research into more targeted, biologically informed treatments. In addition to its approved therapies, Johnson & Johnson is studying investigational medicines designed to work differently from traditional antidepressants, targeting distinct biological systems in the brain that may drive depression and its lingering symptoms.

The goal is to move beyond approaches focused on depressed mood alone toward a fuller understanding of what recovery can mean.

Moving beyond “good enough”

These days, the main residual symptom for Fernandez-Kim is brain fog.

“It was really bad before; now it’s more like moments of haziness or not quite remembering things,” Fernandez-Kim says. “Using technology to record or keep track of things has been incredibly helpful, because if it’s not in my planner or my diary, it never existed.”

What that has meant, Fernandez-Kim says, is learning how to be “functional with my depression.”

Today, Fernandez-Kim describes themself as “a person who lives with depression.”

“I no longer say I ‘struggle’ with depression—it’s a part of me that I need to listen to and respect and work with,” says Fernandez-Kim, whose work with Generation Fine has reinforced the importance of acknowledging both progress and ongoing challenges. “I’m a lot better at being honest with myself and with people close to me when I’m not feeling fine, but with anyone outside of that circle I still tend to put up the front.”

For someone caught in the habit of saying “fine” while still living with significant symptoms, they suggest asking a more specific question: What does a truly good day look like—and does that match how life feels right now?

“If they don’t match, there’s no shame in that,” Fernandez-Kim says. “It will be a journey to get there. If you’re transparent and honest with your healthcare professionals, they can take that information and hopefully find you a better solution.”