The Problem With Relentless Depression That Medication Can't Relieve
Dysthymia isn’t a word most people hear, even for those with a chronic depression diagnosis. According to the DSM-V, dysthymia (or PDD/persistent depressive disorder) is a mood disorder where you experience a low level depression that lasts for at least two years.
If you’re like me, depression is normal. When I reached high school and started to make genuine friends, I was shocked to learn that deep down, most people didn’t want to die. I was amazed most other people didn’t cringe at the thought of spending another 40, 50, 60 years stuck in your body, living with yourself. But not only was that not normal; it wasn’t healthy.
Depression runs in my family, on both sides, so I knew I had depression.
Unfortunately 15 years ago, no one would diagnose or medicate a teenager, let alone a child. But as an adult, I’ve tried every treatment for depression under the sun and when nothing seems to “fix you,” it’s easy to start thinking “maybe I was destined to be depressed.”
The problem with dysthymia is that it is exhausting and relentless.
Medication and psychotherapy improve symptoms but doesn’t relieve them. You don’t get a chance to “relapse” because you were never really in recovery. Hopelessness is hard to fight against when depression is relentless and its core is pessimism, sorrow, apathy, agitation, emptiness, lethargy and self-hatred. Compound that with never getting a break. That hobby you love can only placate you for a few hours (at the most). That movie will only distract you for minutes. It feels like no matter how hard you try, there is no escape route. Imagine the person who annoys you the most, that person whose company only agitates and shatters you. Imagine never being able to get a minute away from that person, because it’s you.
Getting out of bed often feels like I’ve exerted the same amount of energy as you would at a gym session. The motivation to make healthy choices and maintain personal hygiene is arduous. The mental and emotional preparation needed to participate in activities just wipes me out. It never ends. It is exhausting.
The problem with dysthymia is that it has nothing to do with life circumstances.
It was day two of my honeymoon when I texted my mom, “I love my job, I love what I am studying and I’ve just married the man I love, but I am still depressed.”
I was shocked as I sent it. Why can’t I just be happy? When you have dysthymia, you can’t honestly answer “good” when someone asks how you are, even if your circumstances are “good” and stress-free. This only compounds the hopelessness, adds to the sadness and intensifies to the guilt. You can see the good things happening around you. You can appreciate the beautiful people in your life. You want to enjoy the things
everyone else does… but you can’t.
The problem with dysthymia is the preference to die.
“How ungrateful! You should be thankful you are alive. Life is a precious gift. There are plenty of people who have it worse. Your life isn’t that bad.”
All of these statements are true and logically I understand it, but emotionally I just can’t. I’m not suicidal; I won’t kill myself, nor do I have the plan to do so – but all I want is to escape myself and end the depression. If a bus ran over me, I’d be OK with it. If someone told me that I had 24 hours to live, I think I would dance. Often the thought of living another 10 years is overwhelming, let alone 50 or 60.
Expressing these thoughts and feelings can mean and future, legitimate suicidal ideations appear fake or a cry for attention (rather than genuine help). To say, “I wish I were dead,” is not a lie. Unfortunately, most people cannot see the difference between a preference to die and despair that leads to genuine suicidal thoughts.
The problem with dysthymia is that it’s so easy to hide.
When you’ve been depressed so long, it’s not only normal for you, but also for those around you. People may not realize you’re depressed because that’s “just how you are” and it’s easier to be labelled a pessimist. If the symptoms are normal and treatment haven’t seemed to work, I think most people are less likely to seek extra help and support. If there appear to be no red flags to, well, flag – why bother why waste my time and the doctors? It’s can be easier just to keep trotting away, as you have been, pretending everything is OK.
The problem with dysthymia is the high rate of comorbidity.
Due to the chronic nature of dysthymia, it rarely stays at that “lower-level” – enter double depression. Depression (major depressive disorder) is episodic – it has a beginning and an end. Many who receive effective treatment only experience depression once and others relapse, but it ends.
But, imagine you have had a low-mood, unsettled sleep and fatigue, unbroken for two years and then experience a major depressive episode. When the depressive episode begins and ends is blurred, so the feeling of hopeless deepens and the preference to die develops into fantasy and suicidal ideations. Even though dysthymia is symptomatically low compared to major depression, the chronic nature increases its potential as a life-threatening illness.
The problem with dysthymia is that treatment is as long-term as the disease.
I’ve been taking medication since 2008 and I am likely to be taking it until the day I die. I have seen a string of counsellors, psychologists, psychiatrists and other mental health professionals since 1998 and I will probably have to for the rest of my life.
Because our brains have the ability to adapt constantly, cognitive behavioral therapy (CBT) is one of the most effective forms of treatment. CBT about thought monitoring: consciously catching, challenging and changing your thoughts. Over time, the way your brain processes information changes, your feelings follow and eventually this becomes the norm – welcome to recovery.
Thought monitoring is exhausting, but for me, it never ends. Despite nearly 20 years of CBT, my brain hasn’t quite been able to make it natural. So, if I want to manage my mood and maintain some control, I have to constantly assess and monitor my thoughts so I can challenge them. It’s the only way not to spiral into a dark pit when stress rears its ugly head. It’s the only way I can try to shorten and minimize the frequency and intensity of an episode of double depression.
Long term depression can also trigger other health issues, like anxiety, side effects from medication, chronic pain, chronic fatigue, tension headaches, addiction, obesity and insomnia. Persistent depression is rarely “just” dysthymia.
The good news is you don’t have to suffer alone.
Unfortunately, mental illness is common. The good news is, this means awareness is increasing and mutual support is easier to find. It means everyday stigma decreases and a treatment becomes more accessible. Find comfort in the fact you are not alone.
With the right support networks – GP, psychiatrist, psychologist, family and friends – I have become more aware of my mood and have finally learnt to manage it. Double depression is decreasing, as the depressive episodes get shorter. I’m learning to practice self-compassion, rather than guilt. Every day, it gets a little bit easier to exercise and convert my unhelpful thoughts to helpful thoughts. Hope shouts a little louder than hopelessness.
Exercise, forcing yourself out of bed every day, taking your medication regularly, contributing to your community, meeting with friends, participating in therapy and leisure activities are just a few thing prescribed to treat depression. Be patient. Persevere healing and developing healthy habits takes time. Be honest about how you’re feeling and coping with life. Follow the guidance and advice of health care professionals. Find people who understand and will show you compassion when you can’t show it to yourself.
Follow this journey on Breaking Stigma.
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