Tag Archives: Chronic Depression

#Depression: What It Feels Like to Me

I have had experience with low moods since I was a child. Nonetheless, until a few months ago, I was never diagnosed with depression. During the last round of diagnostic revisions, my psychologst decided to diagnose me with depressive disorder NOS along with dependent personality disorder and borderline personality disorder traits. I am not sure I agree and my psychologist admitted at first that it was more her needing to give me a diagnosis on axis I to warrant me staying in the institution than my actually needing treatment for this.

Today, Aspiecat described what depression is like for her. I could relate to some of these experiences, but nto others. I am going to describe what it’s like to be depressed for me.

Let me first say that low moods are my default. I am pretty sure that dysthymia, ie. chronic but mild depression, is a more useful diagnosis for me than depressive disorder NOS. Apparently though my psychologist doesn’t feel I meet the criteria for that. Really not remembering a prolonged time when I did not feel low makes me wonder whether I’m truly depressed or just pessimistic. I know that depression and optimism do not mutually exclude one another, but I tend to gravitate more towards the negative than the positive.

Then there is the state, as opposed to the trait, of being depressed. Like Aspiecat, I experience two forms of depression: the first in which I feel numb and inert and the second in which I mostly feel despair, sadness and often anger. The former tends to last longer and be harder to overcome. During this state, I sleep more than usual, eat irregularly but usually more than normal, am slower than usual and generally unmotivated. I don’t usually experience the extremest of dark thoughts in this state. Rather, I worry and feel a bit anxious. I may experience suicidal ideation during this state, though it’s rarer than when I’m in my state of despair. I am also less likely to act destructively, unless you count binge eating. When I do experience suicidal ideation in this state, it’s more of a logical, thought-based kind focused on self-hate rather than an active wish to die. I just can’t be arsed to care about life.

In the state of what Aspiecat refers to as meltdown, I, like her, experience all kinds of negative emotions. I think I may be somewhat alexithymic (unable to read my own emotions) too. I often express my emotions as anger when I’m in this state anyway, even though I think I experience many other emotions. I am more likely to experience suicidal thoughts and to engage in destructive behaviors in this state. I am usually agitated rather than slow.

Unlike Aspiecat, I prefer the state of despair to the state of numbness and inertia. There are several reasons for this, one of which may just be the fact that I’m currently numb and not liking it. Any emotion seems better than this state of inertia now. I however also feel that my despair is more actionable, because it tends to be more situational.

Other people also tend to understand my state of meltdown more than my state of inertia. They see me lying in bed all day as a choice, whereas when I’m in meltdown, they see my despair. They may not accept my agitation in this state, but at least they notice that I’m not doing well. My medication also tends to help with this state more than with numbness. I do take an antidepressant in addition to an antipsychotic, but I’m not so sure it helps with my low moods. The antipsychotic and maybe the antidepressant too do take the edge off of my agitation.

Unfortunately though, people see my state of despair as more needing treatment than my state of numbness. This may be because I don’t tend to respond well to psychotherapy and medication-wise, there is simply more to be done against agitation. I take a high dose of an antipsychotic on a daily basis. I also have a low-potency neuroleptic, an anti-anxiety benzodiazepine and a sleeping pill (also a benzo) as PRN medications. All of these can be seen as depressants. Like I said, I do take an antidepressant too, though in a low dose. I am not so sure it works, but then again it isn’t a great medication for the kind of atypical depression I experience. By this I mean that it isn’t shown to be too effective with depression that is characterized by inertia, eating and sleeping too much and general anhedonia (numbness). This kind of depression is particularly hard to treat.

Because other people are more bothered by my meltdowns than by my state of anhedonia, I also feel they tend to want me to be numb rather than agitated. I mean, of course they don’t actively want me to be numb, but they see it as less of a problem, because it causes little disruption to others. I go along with this and have never asked for more help, medication-wise or otherwise, with my inertia-based depression. I am not so sure that I should.

A Lighter Shade of Blue?: Dysthymic Disorder

Most people think they know what it’s like to be depressed. We’ve all had a day or two when we’ve felt down and hopeless, had a hard time sleeping at night and dragging ourselves out of bed in the morning, and had a decreased or increased appetite. While these all are symptoms of depression, in major depressive disorder they are severe and occur for weeks or sometimes months on end. They also manifest as a clear deviation from one’s normal functioning

On the surface, dysthymic disorder (or dysthymia) seems less severe, which is why I’m using the metaphor of a lighter shade of blue. Dysthymic disorder, as it was described in the previous edition of the psychiatrist’s manual, DSM-IV, manifests itself in a depressed mood most of the day, on more days than not, accompanied by at least two of the following symptoms:

  • Poor appetite or overeating.

  • Insomnia or hypersomnia.

  • Low energy or fatigue.

  • Low self-esteem.

  • Poor concentration or difficulty making decisions.

  • Feelings of hopelessness.

However, while the symptoms of major depression need to last for at least two weeks, those of dysthymia last for at least two years (or one year in children and adolescents). Therefore, while everyone can probably tick off some (or even most) of the symptoms mentioned above every now and again, that is quite different from having dysthymic disorder. I have had symptoms of depression on many occasions, but I can’t say I’ve had them for most of the time persistently over a two-year period.

In the current edition of the psychiatrist’s manual, DSM-5, dysthymic disorder has in fact been replaced with persistent depressive disorder. This category includes both the “lighter shade of blue” of dysthymia, as well as chronic major depression. After all, the creators of DSM-5 felt there is no meaningful difference between chronic major depression and dysthymia. The difference between persistent depressive disorder and major depressive disorder is, thereby, no longer one of severity but one of pattern or course of development. In major depressive disorder, individuals tend to relapse and remit (get better and worse). Persistent depressive disorder tends to linger for years.

I do not have dysthymia. Why, then, am I writing this post? Quite frankly, just for the sake of raising awareness. When I found out that Mumturnedmom’s prompt for this week is “blue”, this is what I thought of. I hope I have educated a few people, including myself. I am a member of some groups on Facebook for depression, and I don’t know that I should be. I, after all, do not know what it is like to be severely depressed or persisistnetly depressed for a long time.

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