Oops. I missed Anti-Depression Month, which was October. Happy belated Anti-Depression Month! (Which should really be called Pro-Joy Month!) Was it because I'm feeling out of touch, dull, tired, going to bed early but not staying asleep after 5 a.m., but wanting to sleep, sleep, sleep, out of it, distracted, indecisive….that is, that I'm chronically depressed? According to my therapist, it's possible that I may suffer from Dysthymia. I think it's possible that I've suffered from it, on and off, for a long time.
So I've begun reading up on the subject!
Chronic Depression, or Dysthymia, is a type of depression that's not as obvious as the kind of depression I've always thought of when I think of depression — which is Major Depressive Disorder (or MDD), which is so dangerous to spirit, mind, and sometimes also to yourself and others. I wrote about MDD last fall. That's the one where you and everyone else knows you're depressed: you're visibly listless, and practically unable or truly unable to carry on with a typical day in your life.
This fall I'm writing about Chronic Depression (Dysthymia), which is a common enough type of depression. As measured here in the United States, 10.9 million people suffer from chronic depression, according to the National Institute of Mental Health. And, for whatever unfair reason, more women than men have it. Since depression tends to run in families, it's important to include your family history in your thinking about where you're at with regard to your mental health.
Clearly, I'm not alone. I'm one in ten million and I come from a family with a history of mental health ills that include anxiety, compulsion, hyper-sensitivity, melancholy, isolation, and other manifestations of depression. So–I can't just shrug off this possible diagnosis without at least some thoughtful investigation.
But I've Always Felt Like This – This is How I Am
What does Dysthymia (Chronic Depression) mean exactly? Well, it's Greek for "bad spirit/courage," "melancholy," and "ill humor." That's a bit of a window into its meaning–and how it manifests itself in us.
Dysthymia is the kind of depression that can exist for quite a while (two years or more — or, on and off for a lifetime). I read somewhere that people suffering from it may think, "But I've always felt like this–I thought these feelings were just me, just how I am." I can relate. That sounds like what I said to my therapist: "I thought this stuff was adult-child stuff–the dips into worthlessness, struggling to make decisions, and moments of deep sadness…" And he agreed that the result of being raised by addicts in an inconsistent home environment plays out a lot like the characteristics of chronic, low-grade depression.
People with this kind of depression get along in life just fine; it's just that "just fine" isn't as good as it gets. There's better than just fine. People with this kind of depression look fine, act fine, and have "great" lives. So, what's the problem? It's like, are the woman and the guy in the above photo at peace — or depressed? It's a hard call. (If you're happy, you'd be inclined to see the woman as happy; if you're sad, you might wonder if she's sad too, too sad to really smile. It's often quite subjective!)
This type of depression lingers, lasts a long time (two years or more), and can be set-off by stressful life events (work/home/relationship changes — I've got those). And all the while you can be totally functioning like a "normal" person as far as everybody else can see…and you may even look "fine" to yourself in the mirror, but inside (where it really counts) people with chronic depression feel plagued by a persistent and general sense of unhappiness that you just can't shake. There's a little, inner black cloud that exists, which creates rain where there might be hope. And chronically depressed people have difficulty making decisions. And trouble focusing. Trouble sleeping or staying asleep, too.
One medical researcher says that people with this type of depression feel bad "most/part of the day" and on "most days" of the week for two weeks or more, and can for one or more years, but may experience freedom from symptoms here and there, for a few days or even a couple months during the depression. (Confusing, right?) That's part of the characteristic of this type of depression — it's tricky to pinpoint, tricky to describe, but those who have it, I believe, know it.
Wait, This Sounds Just Like Being an Adult Child
That is pretty much the same result as growing up the the child of alcoholics (or other narcissistic or child-like parents). It's no wonder that I attributed my state of mind to adult-child issues. It makes sense, it adds up. The truth is, when it comes to psychology and diagnosing someone, it's not an exact science. Sometimes the diagnosis is clear only after someone has been on a certain medication, whereby a therapist can see what the mental health issue was — because the drug worked. It's like, say you have a headache and feel irritable. Then, you eat and drink a glass of water. And you feel better. Well, you were hungry and/or dehydrated. The absence of the symptoms post-treatment bear out that conclusion.
Therapists can't make a diagnosis without their client's input — we have to tell them how we're feeling, how we think, how we react, and how we internalize situations. We have to tell them what our weekend mornings are like, our decision-making, and all of our guilt feelings, anger, and worries. Only then can they begin to see what's going on, objectively as possible, and begin to take a stab at what's going on…and what kind of therapy, and possibly medication, will bring us more joy.
Sometimes ADD or ADHD looks like depression. Sometimes being the offspring of alcoholics or other types of addicts creates people who act like the chronically depressed. It has to be talked about to be sorted out. That's not as easy as it sounds because if, like me, we assume we just are who we are, and like we've always been, then it's not easy to explain, "I don't feel right," when, after all…it's nothing new.
Low but Not Low-to-the-Ground
People with Dysthymia have lower highs than "normal" "happy" people. When a person with Dysthymia gets good news, they get happy, but just not to the level that a normal person might. Same with lows. A normal person won't have as low a low as someone with Dysthymia will — but, yet, a person with Dysthymia won't get as low as a person with major depression (MDD).
Imagine a ruler where 12" is "total joy" and 1" is bottomless sorrow. People with Dysthymia tend to live in the mid levels mostly — there's not the jump up very high, not high enough to reach that 10", 11" or 12" mark, certainly, and there's not the sinking low, either, not down to the 3", 2", 1" levels either (that's where the really pronounced depression lies).
Symptoms of the Dysthymic (Chronically Depressed)
- Sadness or hopelessness feelings
- Struggles with decision-making
- Difficulty concentrating on things
- Feeling slow or sluggish
- Not really enjoying things fully
- Guilt & shame feelings
- Aches and pains (headaches, backaches, etc.) that just won't go away
- Lack of, or low, sex-drive
- Little appetite (or, alternately, eating a lot)
- Low energy
If You Might Have Dysthymia/Chronic Depression – Next Steps
See the Doc. Definitely go get a complete physical exam from your physician, including blood work to test your hormonal levels, and vitamins (Vitamin D, iron, etc.) as well as your Thyroid, which is the regulator of your hormones. It's possible that a hormone imbalance is impacting your happiness.
Research YOU. Observe yourself and think about times you've felt depressed in this way, and make notes about your "findings," when/where/who/what triggered those feelings and how long they lasted.
Read. There are so many books on depression, so many. There is a lot of information available to you! Buy a couple or check out a couple from your local library (or the library near work) and see if anything resonates with you or clicks.
I can recommend this classic (recommended to me), "Listening to Prozac," by Peter Kramer
Diet & Exercise Overhaul. Examine your eating and exercise habits, and consider herbal or natural (not "natural" but truly natural) remedies for depression, such as St. John's Wort.
This brief WebMD article discusses the benefits of St. John's Wort for mild depression which includes Chronic Depression/Dysthymia.
Medicate? With your doctor's and therapist's support and guidance, explore the options for SRIs, read about medication, and see what works.
This book, which I have not read, may be important to read as well — it's the anti-medication book, which talks about the benefits of diet, exercise, and St. John's Wort, Prozac Backlash by Joseph Glenmullen (Harvard).
Do not just medicate, it's essential to do therapy also.
Get Therapy. Without a doubt, you must see a therapist, if you're not already, and focus on building self-esteem and loving yourself. No pill is a substitute for therapy!
See Your Doctor Again. All good doctors will be sure to follow-up to see how the pills are working and tweak your prescription. Don't miss these appointments! Talk to your therapist, too, about the impact of the medication you take and question how it's working to be sure it's right.
(Someone else may have prescribed the pill, but it's your responsibility to communicate about how it's working so that you can have the best possible experience. You deserve the best possible experience! )
And, remember, you're not alone! There are, clearly, millions of others, there in the shallows with you! (And that's just the U.S.).
Be good to yourself -
Related Articles -
Amy-Eden's Depression 101
Fall is Here, Are You Depressed Yet?