Understanding and living with depression

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Despite the multitude of resources and information available, as a person who has experienced depression in many forms and contexts, it is my experience that most people – even those who may have gone through a depressive period – don’t actually understand depression, it’s many forms, and how it manifests differently in different people.

The society I live in, and probably most modern societies, tends to pay lip service to acknowledging how debilitating and dangerous living with untreated depression can be while at the same time making receiving actual treatment of the type and duration needed virtually impossible to receive.

There’s an awareness and informational understanding that depression is physiological: hormonal and neurochemical, in nature. However, there is an impatience and stigma for those who are medicated to try to balance out the biochemistry. Those who find medications too difficult to stay on and slide back into symptoms after going off meds are looked down on and criticized, often treated as if they are responsible for their illness, “I don’t understand why she won’t stay on her meds. She just doesn’t care how she affects others. If she did, she’d stay on her meds. She’s just selfish and self-centered.”

Women experiencing postpartumn depression get judged and labeled as bad moms because they have fears and feelings, outside of their control, that society says no mom should ever have. When the truth is that, as human beings, we all have scary, negative thoughts that we don’t like to have, about even the ones we love the most. A woman experiencing postpartum depression just has less ability to filter, censor, and control those thoughts and feelings. She recognizes and understands on an instinctual level that those filters and control are fragile and absent and becomes even more anxious.

People in our society – I include my past (and sometimes present) self- have learned mental health terms, then use them as labels to criticize, demean, and judge others by. We stop seeing individual people and just try to assign the label so we can determine the appropriate amount and kind of time, attention, and care we should invest. We place unrealistic expectations on those experiencing depression, whether it is ourselves or others.

What follows is a list of various forms of depression that I or those I love and care about have gone through or are dealing with now. I have provided links and brief descriptions. It is my hope that the next time you or someone you know starts showing signs of depression, you will remember this and seek compassionate, empathetic responses, offering understanding and patience instead of platitudes, minimizing statements, and the attitude that they, or you should, “just get over it.”

Major Depressive Disorder, via the Mayo Clinic:

More than just a bout of the blues, depression isn’t a weakness, nor is it something that you can simply “snap out” of. Depression is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure.

Dysthymia, via Medline Plus:

The main symptom of dysthymia is a low, dark, or sad mood on most days for at least 2 years. In children and adolescents, the mood can be irritable instead of depressed and lasts for at least 1 year.

In addition, two or more of the following symptoms will be present almost all of the time that a person has dysthymia:

• Feelings of hopelessness
• Too little or too much sleep
• Low energy or fatigue
• Low self-esteem
• Poor appetite or overeating
• Poor concentration

People with dysthymia will often take a negative or discouraging view of themselves, their future, other people, and life events. Problems often seem more difficult to solve.

Bi-Polar Disorder, via MentalHelp.net:

a category of serious mood disorder that causes people to swing between extreme, severe and typically sustained mood states which deeply affect their energy levels, attitudes, behavior and general ability to function. Bipolar mood swings can damage relationships, impair job or school performance, and even result in suicide. Family and friends as well as affected people often become frustrated and upset over the severity of bipolar mood swings.

Cyclothymic Disorder, via PubMed Health:

Cyclothymic disorder is a mild form of bipolar disorder (manic depressive illness) in which a person has mood swings over a period of years that go from mild depression to emotional highs.

Think dysthymia with episodes of hypomania.

Postpartum Depression, via Web MD:

Postpartum depression is a serious illness that can occur in the first few months after childbirth. It also can happen after miscarriage and stillbirth.

Postpartum depression can make you feel very sad, hopeless, and worthless. You may have trouble caring for and bonding with your baby.

It is now recognized that “you can have postpartum depression any time in the first year postpartum.”


PMS/PMDD, via Psych Central:

For a woman to have premenstrual syndrome (PMS), the symptoms must be severe enough to interfere with her social or work life. Severe cases of PMS are diagnosed as premenstrual dysphoric disorder (PMDD). Symptoms of PMS and PMDD include those for depression as well as breast tenderness, headaches and joint and muscle pain.

Women who have a family or personal history of depression or postpartum depression are at higher risk for developing PMS or PMDD. PMDD affects five percent of menstruating women.

Seasonal Affective Disorder, via NAMI.org:

The symptoms of depression are very common. Some people experience these only at times of stress, while others may experience them regularly at certain times of the year. Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression, usually in late fall and winter, alternating with periods of normal or high mood the rest of the year.

Atypical Depression, via Discovery Fit & Health:

it’s a very specific subset of the mental health disorder, with careful criteria for diagnosis. All “atypical” means here is that some of its symptoms are the opposite of what doctors had come to expect with depression.

Melancholic depression is what most people mean when they talk about being depressed. You can’t sleep, you can’t eat. You can’t concentrate on anything. And nothing seems to bring you out of it. Things that used to make you smile leave you feeling empty.

With atypical depression, some of those symptoms are reversed. Patients oversleep (hypersomnia), overeat (hyperphagy) and exhibit mood reactivity — they’re able to brighten up in response to happy news; it just doesn’t last long. Because of that latter quality, they may not even know they’re depressed. They may think that their baseline of depression is just how everyone feels.

They do know, however, that feeling like your limbs are so incredibly heavy that you can’t move is not normal. This symptom, leaden paralysis, is different from a lack of energy — it’s more like being physically anchored to your bed. With actual metal anchors.

Atypical depression tends to set in fairly early, in the teens and young adulthood, and it’s more common in women.

Situational Depression, via BeForLiving.com:

Situational depression, also known as reactive depression: This type of reaction is thought to be universal and frequently seen in patients who have had to cope with events of personal injustice, humiliation, frustration, and helplessness (Linden et. al., 2007). A stressful life event (SLE) can be events that would seem insignificant to others, however, to you the event was perceived as an offense to you. A feeling as if there has been a small pinch to your inner self. Any situation that leaves you feeling deflated and helpless can be considered as a SLE. When this happens, it is imperative that you ask yourself some difficult and honest questions.

When did I start to feel this way?

What was said or done that served as a precursor to my ill feelings?

Do I feel ashamed?

Do I feel embarrassed?

Do I feel humiliated?

Do I feel exposed?

Do I feel powerless?

In my research, I found that three of these depressions can also be exhibited with signs of psychosis, where the people experiencing them can also suffer hallucinations and delusions that can be dangerous and frightening for them and for those around them: major, bi-polar, and postpartum depression.

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I was first told I was experiencing depression in my early teens by a school counselor. I later received a diagnosis of dysthymia. I have had a couple of major depressive episodes and experienced postpartum depression after each of my three children were born. I recently realized that I do have periods of hypomania, PMDD, and SAD.

It seems that every year or two situations occur which trigger a situational depression that often coincides with or leads into one of these other forms of depression.

Lack of consistent access to treatment, incomplete/inaccurate diagnoses, and the subsequent treatments which may include medication have led to additional problems or issues. My own poor and incomplete understanding has played into exacerbation of symptoms at times. I have been afraid of judgment, stigma and how the assumptions and misunderstanding of others, especially those in positions of power and authority over my life, could and have impacted my life.

I’m doing better than I’ve done in many years. At least I’m more in tune with the symptoms and triggers. I’m more cognizant of my own thought processes and choices that can help manage the symptoms or make them more difficult to manage. Sometimes it’s a moment by moment daily struggle. Some days I feel like I’m done with the depression, only to be frustrated when the signs start popping up again.

I’m still here and I’m still fighting.

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16 comments

    1. Ross,
      I appreciate your visit and the sharing of your excerpt from your post. The points you make therein are valid.

      That being said, for persons, like myself who have consciously struggled to move through the clinical forms if depression, working to apply and implement the changes and mindset described in your post, there is a disregard or lack of validation and recognition that additional tools and supports are necessary in order to move beyond “living in a constant state of being down and unhappy.”

      Often being able to recognize and understand that there are layers of co-factors and root causes to experiencing such a state which need to be accepted, processed, and new ways of thinking, acting, and responding to be learned and practiced.

      It is a process to unlearn the habits of thought, belief, and action while developing and acquiring new ones to replace them.

      Blessings,
      Kina

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  1. My wish is that you, and everyone like you, can get the medical help you need. It’s absolutely criminal that we don’t have single payer universal healthcare in this country; it’s even more criminal that mental illness is stigmatized the way it is.

    I had no idea they were so many categories of depression. I think I might have situational depression, but so mild that it doesn’t need medication. I recognized a lot of myself in that description. Thanks for all the information.

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  2. Kina, your informative blog was helpful to me. I have a friend going through depression right now and it was interesting to be able to make comparisons as I read. HUGs. I hope my encouragement has not appeared to be platitudes. Please feel free to call me on it when it is. I am way PROUD of you girl for ALL you have accomplished.

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    1. Yoyo,
      I’m really glad it was helpful to you and gives you an idea of how to support your friend.

      As far as platitudes go, I think we all say words and phrases that could fall into the platitude category. However, for me, it comes across as a platitude when I sense the person offering the words is not saying them out of true caring but more as a way to basically pat me on the back saying, “there, there,” and expecting that to make me feel better and hurry up and get over it.

      Of course, there is the difficulty that many who experience depression are defensive and our perceptions are skewed toward the negative. So, we can make it extremely difficult for people who truly do care to express it without either withdrawing further into ourselves or going on the offensive – because everyone knows the best defense is a good offense, right?

      So, if your friend withdraws more or attacks, try to understand that neither of those responses have anything to do with you or what you said or did. They have everything to do with what is going on inside your friend’s mind and emotions in reaction to thoughts, perceptions, and even reliving memories that may have been trigger by an interaction with you.

      Being a friend and support person to someone experiencing any form of depression is no easy thing. Make sure your supports are in place too.

      Blessings,
      Kina

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  3. You rightly point out that there are many complicating factors that at times inhibit a person with a mental illness from taking certain medications. Just one example — my heart goes out to woman taking psycho-tropics who become pregnant and must wrestle with the question of continuing to take medications not knowing how they will affect their developing children.

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    1. Tony,
      That is exactly right. We don’t even know how those meds affect the sperm and ova, much less how ongoing, daily use affects the genetic and biochemical development of a fetus. We know smoking, alcohol, and other substances cause birth defects and can affect cognitive development.

      Therapies that have proven efficacy with some aspects of the different depression symptoms identified in this article, such as Cognitive and Dialectical Behavior Therapy are very expensive and not necessarily covered under some insurances.

      Our country seems to have most employers cover EAP – Employee Assistance Programs, so employees who are experiencing difficulties get some access to treatment. However, my experience has been that what used to be five to eight covered sessions has now dropped to three sessions in many cases. Three 50 minute hours, the first of which is generally spent doing a quick hit assessment of current events, is barely enough time to formulate a hypothetical diagnosis, much less establish recommended treatment.

      In an economy where more people than ever have to choose between putting food on the table, paying housing expenses, and the cost of transportation to work, losing work time to seek treatment and/or paying co-pays for treatments and meds just aren’t options.

      Thanks for joining the conversation.

      Blessings,
      Kina

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  4. I believe I was first diagnosed as suicidally depressed around age 10 (maybe as late as 13). The court therapist had my mom come in told her the diagnosis & in front of me said most kids my age who felt the way I did killed themselves within a year (or something similarly hopeful). Umm… Yeah… Not very helpful since that would be the only time I’d see that person as it was related to custody issues.

    So I’ve been in and out of therapy since then. I’ve been on and off meds. Usually ended up off because they weren’t working. I’ve been lucky in that I’ve always had access to medical even when we didn’t have money. So I’m 46 now. I’ve had 1 year without being in some state of depression when I was 30, who knew a divorce would be great for my mental health. LOL

    For most of my life few people knew I was depressed or how close I was to suicide. I’ve become a bit more open about it over the years. More in talking about what has helped me or a friend when someone talks about being in a depression/suicidal/concerned about a friend/family member and suggesting they give it a try. Or even suggesting things that didn’t work for me but might for them because our depressions are not all the same.

    Wow as usual you always get me to open up. I’ve never felt judged for my depression, lots of other reasons why I’m useless/failure depression is just another of my medical problems. See I just don’t get anything right not even depression.

    So what I’m trying to say is yes it cycles. But the more aware you are the less deep down I’ve found the depression goes. At 20 a depression would always spiral to suicidal. But the more aware I am and the more tools and support I have the fewer suicidal attacks I have a year. So go you. Try to keep the focus on the things you are getting better at. It does get better. Don’t beat yourself up during the down cycles – yes I had a note to remind myself of that for a while. Take care of yourself.

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    1. Tasha,
      Thank you for opening up! It does help to know the experiences of others. You are right. All depressions are not the same and what isn’t helpful for one person may prove to be the best thing for another.

      I think that in my life, nothing has ever had clear lines, which is probably true for most people in one or two areas. The same has been true with the depression. I’m not sure what the correlation is with growing up in poverty, semi-orphaned, with multiple broken homes – but having consistent access to medical treatment has never been part of my life experience. I know that depression isn’t truly any more prevalent in one socioeconomic “class” than any other. I also know that each sub-cultural group has different perceptions and stigmas related to it. I know, also, how easy it can be to lose access to treatment when that is attached to a job that is lost due to unidentified or chronically unmanaged depression.

      I’ve been treated as if I use the depression and Fibro as excuses and crutches. Criticized and put down by family members who have been affected by my depression and unrecognized hypomanic episodes. I’ve had friends give up on me and disassociate themselves from me because I wouldn’t get my act together and start consistently fulfilling my potential and meet their expectations. I’ve been criticized for being on medication, then later told to mellow out and smoke a joint to deal with the pain and anxiety.

      In every interpersonal conflict I’m expected to be the reasonable one. Go figure.

      You’re right though – the more I’ve educated myself and increased my understanding, the less difficult it has become. I’m finally at the point where I’ve stopped judging myself for it and am not letting the judgments of others affect me as much. I’m coming up for air more often and staying up longer.

      A year without symptoms? Good for you. That would be really great. It must have been a bit devastating to have them show back up.

      Thanks again for sharing.

      Blessings,
      Kina

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      1. What caused them to come back was devastating. Mostly it’s just frustrating to still be going through the cycles. On the other-hand accepting that being sexually abused, raped a couple times, and then almost dying in a car accident being tough to get over has helped a lot. I used to think I should “just be over it by now” you know? And there are so many things that trigger for me: songs, books, movies, someone I’m supporting, news, social media…

        I do love your blog because it makes me face stuff and remember how far I’ve come.

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        1. Tasha,
          I’m really glad to know that what I white here has value for others and is helpful for them on their journeys.

          Being able to let go of value and judgment around these thing really is helpful. Understanding and accepting ourselves and others as and where we and they are is one of the most valuable things I’m learning.

          Blessings,
          Kina

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  5. Thanks for sharing such an intimate part of yourself and the summary of different types of depression and mental disorders. From having worked on a 24/7 suicide crisis line, I know how affected people are by the ignorant remarks they hear from others. It’s so easy to make assumptions about how people suffering from anyone of these disorders should just snap out of it, make choice or do something, anything differently. We need to be more sensitive and remember that we never know what is really going on in another person’s life.

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    1. Deb,
      You are right, passing remarks and how people who don’t know or understand can be hurtful. I think though, that how those who are closest to us react can often be the most damaging.

      The disconnectedness and isolation that is growing in our society and all the advice to get rid of “negative” people in our lives and only surround ourselves with positive people, is just adding to the isolation that those experiencing depression, in whatever form may feel.

      Knowing that I need to redirect and focus on the positive and having the capacity to do so are two different things. It’s really difficult to realize that someone may genuinely be trying to help me, yet only experience a sense of being criticized and judged. It can be a monumental task

      Thanks for your compassion and understanding. Thank you also for your service on the 24/7 helpline.

      Blessings,
      Kina

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  6. I don’t think I meet or have ever met (quite) the various diagnostic criteria for any of the above disorders (Dysthymia comes closest), but one thing I do know is that as dark and deep and hopeless as depression feels, there’s something about hiding in that hole in the mind where not much light gets in that feels sort of “safe.” I say that somewhat hesitantly, but for me, when feeling really dark, it’s more “comfortable” to stay there than to work hard enough to get out. Also, once “out,” what challenges will I face that could potentially knock me right back into the abyss again?

    In the end, I can’t let myself stay at the bottom of the well too long. God keeps calling me back out, tossing down ropes, shoving in ladders for me to climb.

    It’s only when I get to the top that I remember how good it looks to see a world lit up with beauty and to breathe clean and fresh air.

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    1. James,
      The blurbs I listed here are not comprehensive and like myself, you could experience a variant combination of these things.

      Like you, there are definitely times when my will tends more toward “caving” it and dwelling in the apparent safety and isolation of being in that dark place. However, I also realize and understand that I need to do what I can to not stay there and welcome it too much. It’s just that there are moments that my will is not to be there at all, and regardless of how hard I scrabble to grab the ropes tossed to me, I can’t keep a firm enough grip.

      Thankfully, as you stated, God does reach out and down – primarily through people and circumstances I encounter – to lift me from the depths.

      I’m learning to see and appreciate the beauty that is and breathe.

      Blessings,
      Kina

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