Wellness Optimization in Mental Health: Beyond 'Not Depressed'

There is a version of mental health treatment that declares success when you are no longer in crisis. Your PHQ-9 scores have dropped below the clinical threshold. Your sleep is somewhat better. You are functioning at work. Your prescriber notes “stable” and moves on.

But stable is not the same as good. And good is not the same as where you actually want to be.

The gap between symptom remission and genuine wellbeing is not a minor distinction. Research increasingly shows that patients who achieve remission of depression or anxiety symptoms still report significantly below-average functioning in relationships, energy, purpose, and daily satisfaction. They are not depressed. They are also not thriving. Treatment stopped at the wrong finish line.

Wellness optimization in mental health is about moving the finish line.

The Problem with “Stable”

When psychiatry defines success as the absence of disorder, it builds a system optimized for the wrong outcome.

A patient who no longer meets diagnostic criteria for major depressive disorder has improved. But if they are sleeping five hours a night, have lost interest in relationships, are running on low energy, and feel like they are surviving rather than living, calling that treatment success misses the clinical reality.

Research in positive psychiatry is explicit on this point: psychiatry has historically focused on the diagnosis and treatment of psychopathology with relatively little attention to factors contributing to mental wellbeing beyond the absence of disease. The result is a system that measures progress by what it eliminated, not by what it built.

Positive psychiatry is the science and practice of understanding and promoting wellbeing through interventions aimed at enhancing positive psychosocial factors: resilience, optimism, social connection, meaning in life, and wisdom. The shift is not about replacing evidence-based treatment with positive thinking. It is about expanding what treatment considers a successful outcome.

What the Research Shows

A 2020 review in Current Treatment Options in Psychiatry found that positive psychiatry interventions targeting social connectedness, meaning in life, and resilience produced meaningful improvements in wellbeing outcomes, with effect sizes typically small to medium in RCTs and meta-analyses. These are clinically relevant gains in areas that symptom-focused treatment does not reach.

A 2023 integrative review of measurement-based care (MBC) in psychiatry found that systematic tracking of patient progress produced increased remission rates, lower relapse risk, improved medication adherence, and stronger therapeutic alliance compared to usual care. The mechanism is direct: when treatment tracks toward specific goals that matter to the patient, including goals beyond symptom reduction, adherence and outcomes both improve.

The research on positive psychosocial factors is also relevant to relapse prevention. Patients who achieve both symptom remission and genuine wellbeing improvements have significantly lower relapse rates than those who achieve only symptom remission. The wellness baseline is not a luxury outcome. It is the buffer against the next difficult period.

Five Wellness Domains Treatment Often Skips

Sleep Quality as a Wellness Target

Most psychiatric treatment monitors sleep as a symptom indicator. But sleep quality is also a direct wellness outcome. Patients who achieve remission with persistent poor sleep are at significantly higher relapse risk and lower daily functioning than those who achieve genuine sleep restoration. Treating sleep as a wellness target, not only a symptom to monitor, changes the clinical question from “are you sleeping better than before?” to “are you getting restorative sleep that supports how you want to function?”

Energy and Motivation

Depression treatment often produces full symptom remission but leaves residual low energy and motivation. These residual symptoms are among the strongest predictors of relapse: patients who feel “fine but not good” stop treatment because they do not feel sick enough to continue, and later relapse because the wellness baseline never recovered. Tracking energy and motivation as independent targets, not only as proxies for mood, captures patients who are remitted but still at risk.

Relationships and Social Connection

Isolation and disconnection are both symptoms and consequences of mental illness. When treatment addresses depression or anxiety without explicitly targeting the social rebuilding that often lags behind symptom recovery, patients are left in a partial state of recovery that is clinically fragile. Research in positive psychiatry consistently identifies social connectedness as one of the highest-leverage wellness targets, with effects on mood stability, relapse prevention, and overall quality of life.

Purpose and Goal Engagement

Purpose-oriented treatment, where patients articulate what they want their life to look like and track progress toward that description, consistently produces better adherence and better long-term outcomes than treatment focused solely on eliminating what is wrong. Positive psychiatry explicitly targets the shift from symptom relief to actual wellbeing, with the PERMA model (positive emotions, engagement, relationships, meaning, accomplishment) providing a clinically grounded framework for this expansion.

Cognitive Clarity and Daily Function

One of the most common complaints from patients who have achieved symptom remission is cognitive fog: thinking feels slow, memory is unreliable, concentration cannot sustain. This residual symptom is frequently undertreated because it does not appear prominently on standard symptom scales. Treating cognitive clarity as a wellness target identifies and addresses a gap that remission-focused care routinely misses.

Wellness Optimization in Practice

Wellness optimization is not a separate program from treatment. It is an extension of treatment that applies once acute symptoms are managed. What it looks like in practice:

• Patient-defined goals. The patient describes what they want their daily life to look and feel like. These goals become clinical targets alongside symptom measures. “I want the energy to be present with my kids in the evening” is as legitimate a treatment goal as “I want my PHQ-9 below 10.”

• Baseline measurement. Establishing what “good” looks like for this specific patient, including sleep quality, energy, relationship satisfaction, and daily functioning, creates a standard against which progress can be measured over time.

• Ongoing progress tracking. Checking in on wellness goals at regular intervals gives the clinical team data to respond to. When energy improves but relationships do not, or sleep normalizes but cognitive clarity lags, the picture directs the next intervention.

• Preventative monitoring. A patient who has established a wellness baseline knows what “off baseline” feels like. Tracking it in real time and surfacing departures to the care team before they become clinical episodes is how wellness optimization functions as relapse prevention.

How SiggyMD’s Six Pillars Support Wellness Optimization

SiggyMD was built around a thesis: mental health care should not stop at “not sick” any more than physical health care stops at “not injured.” The six pillars of the SiggyMD care model each map to a component of the wellness optimization approach:

• A history that evolves with you: symptom and treatment continuity prevents repeating the same story and builds the longitudinal record that makes optimization visible.

• A treatment plan tailored to your needs: personalized and continuously adjusted toward your goals, not just toward reduced symptom scores.

• Instant med adjustments: side effects caught early keep medication on track so it can support wellness, not just suppress symptoms.

• Always-on therapy that informs treatment: check-ins capture what matters between visits, including the wellness signals that never come up in quarterly appointments.

• Preventative care with wellness as baseline: pattern tracking identifies early warning signals before they become clinical episodes.

• Wellness optimization driven by your goals: “not depressed” is a start, not a finish line.

“The moment I’m most interested in is the transition from ‘better’ to ‘genuinely good,’” says Elizabeth Lokenauth, PA-C, of the SiggyMD clinical team. “Patients often don’t realize there’s a next phase after symptoms resolve. They’ve been so focused on not feeling bad that they haven’t thought about what feeling good actually looks like for them. That conversation is some of the most important clinical work we do.”

What Members Are Saying

NW

N.W., 44

Depression, Anxiety

“My last prescriber told me I was stable and did not need more frequent check-ins. I felt stable. I also felt nothing. When I started with Siggy, my provider asked what I actually wanted my life to feel like. That question had never been asked before. It changed how I thought about what treatment was for.”

CV

C.V., 38

Major Depressive Disorder

“I had been on medication for three years and considered myself managed. Then my daily check-in data showed that my energy scores had been consistently low for six weeks without my mood being affected. My prescriber flagged it and we looked at sleep and dosing timing. I hadn’t realized something fixable was being missed.”

Member stories reflect real experiences. Names and identifying details have been changed to protect privacy. Results vary. SiggyMD is currently invite-only.

Bottom Line

“Not depressed” is a necessary milestone. It is not the destination.

Treatment that stops at symptom remission leaves patients in a stable but fragile state: functioning but not thriving, compliant with medication but uncertain why to continue, susceptible to relapse from stressors that a genuine wellness baseline would have buffered. Wellness optimization does not replace evidence-based treatment. It extends it toward the life your patient actually wants, and the data consistently shows that moving that finish line forward is also what keeps people from sliding back.

Sources

• Eglit GML, Palmer BW, Jeste DV. Overview of measurement-based positive psychiatry. Nordic Journal of Psychiatry. 2018;72(6):396-403.

• Lam JA, Aftab A, Lee E. Positive Psychiatry Interventions in Geriatric Mental Health. Current Treatment Options in Psychiatry. 2020;7(4):471-488.

• DeSimone J, Hansen BR. The Impact of Measurement-Based Care in Psychiatry: An Integrative Review. JAPNA. 2023;30(2):279-287.

• Rettew DC. Incorporating positive psychiatry with children and adolescents. Current Psychiatry. 2022;21(11).

• American Psychiatric Association. Lifestyle to Support Mental Health. APA. Accessed May 2026.

• National Institute of Mental Health. Depression: Overview. NIMH. Accessed May 2026.

• Bejerholm U, Roe D. Personal recovery within positive psychiatry. Nordic Journal of Psychiatry. 2018;72(6):420-430.

• Seligman MEP. Flourish: A Visionary New Understanding of Happiness and Well-Being. New York: Atria Books. 2011.