On Depression

As I begin treatment for depression, I find myself less certain than ever of what depression is and of whether or not I have the type of depression that will benefit from traditional treatments (i.e., antidepressants and psychotherapy).

I have always believed that everyone gets depressed from time to time, that depression is a normal and inevitable aspect of the human experience. Sometimes there's a identifiable cause--stress, relationship problems, etc.--and sometimes you just feel a little blue from time to time.

Then there's a more serious type of depression is characterized by deep emotional pain, feelings of hopelessness and despair, and irrationally negative thoughts. Sometimes this type of depression leads to suicide. This type of depression can be triggered by a negative life event--death, divorce, illness, job loss, etc.--or can develop with for no apparent reason. I've experienced this type of depression, too, but for me these periods only last a few weeks at most, and I've always been able to cope with them. I've never gotten so bad that I couldn't function, and I've never felt the need to ask for help.

About two years ago I began to get depressed over my libido issues, which I've written about elsewhere. Over the past two years, I've spent a lot of time examining my life and realizing that I don't like it very much. The depression has grown into something broader and deeper than simply being bummed out about my libido problems. I've coped as best as I can. I "keep on keeping on" as they say. Every now and then I actually manage to enjoy myself.

I'm highly functional. I get up in the morning, I go to work, I meet my obligations and I fulfill my responsibilities. I don't feel sad or miserable, and I'm not experiencing emotional pain, but I'm not happy, either. I take very little pleasure in life, and I have no energy, interest, enthusiasm, or motivation.

Here's where things get confusing for me: I've always been a low-energy person. I've always been a negative person; I'm cynical, skeptical, and prone to irritability and grumpiness. I've never been passionate about anything and I've never strongly believed in anything, even when I've wanted to. I've always tired easily and gotten bored quickly. Although I've never really thought of myself as unhappy, I've never really been happy, either.

I never saw these things as signs of depression. Since I've had these traits my entire adult life, I just accepted them as inherent aspects of my personality--not my best qualities, to be sure, but not signs of mental illness. (Apparently, this is a common perception among people with the type of depression I have: dysthymia. See below.)

Given what I just said, it's hard to explain what changed two years ago, but I know something did. I may not have been an upbeat person before, but back then I felt better about myself and my life, and I had hopes and aspirations for the future. Now I feel defeated and demoralized, and have very little hope left.

After talking to several doctors and a psychiatrist about both my libido issues and the depression, they've concluded that I've always been depressed--specifically, dysthymic--but that I wasn't really aware of it because I don't remember ever being any other way--in other words, dysthymia seems normal to me. Sometimes I get a little more depressed than usual, which is when I notice it. Consequently, they believe I need to be treated with antidepressants.

I'm finding this a little hard to accept, and yet I'm not sure they're wrong. The more I read about dysthymia, the more obvious it is that I have it, and have probably always had it. Apparently, it's common for dysthymic people to be unaware that their mood is abnormal.
http://en.wikipedia.org/wiki/Dysthymia
http://www.allaboutdepression.com/dia_04.html

One doctor suggested I may have Atypical Depression, a subtype of dysthymia, and much of the description fits.
http://en.wikipedia.org/wiki/Atypical_depression

But then I remember that I have real problems in my life. It's not all in my head. As I said to my psychiatrist, people have real reasons to get depressed. In my case, I have a high stress job in which I take very little satisfaction, I make very little money, I haven't got much of a social life, I have no love life, and I have no close friends. Taking a pill isn't going to solve any of these problems.

My psychiatrist agreed that depression often begins as a result of real problems and that taking an antidepressant isn't going to make me happy, improve my job, or solve my other problems. But he insists that regardless of the initial cause, depression is biological, the results of a brain not working right, and that to get better I most likely need medication.

He says that if we can find an antidepressant that works for me, which is largely a matter of trial and error, it will gradually, over the course of several months, improve my mood and energy level such that I will feel like my "best self" with a renewed interest in life and the motivation to address my other problems.

I remain skeptical. I suppose I should want him to be right. If he is, within a few months I could be feeling better. But I'm nevertheless relunctant to accept the idea that I need psychotropic drugs. I'm not quite sure of the reason for my resistance. I prefer the idea that my depression is a natural response of an intelligent, sensitive, perceptive person to life in an unhealthy culture, rather than the idea that I've got a malfunctioning brain that needs to be chemically altered.

In various threads throughout this forum, I've mentioned my dissatisfaction with various aspects of my life--my job, my libido, my sexual experiences, etc. I want to acknowledge the advice and support from several lpsg members, particularly Dave_NoCal, jason_els, Phil_Ayesho, Bbucko, vince, and Nick8.

In a recent thread in which I complained that I haven't really lived a very full or interesting life, particularly as a gay man, Bbucko asked me why I felt tied to Western Mass and suggested that I travel to Boston or New York City. People have suggested that to me before. The truth is I've never seriously considered going to Boston or NYC, because I know I won't do it. It's hard to explain why. I don't know those cities and I don't have any friends or family to visit who could show me around. To me that's reason enough not to go there.

I've always been uncomfortable with unfamiliar people, places, and situations. I travel when I have to (e.g. for work), or when there's sufficient motivation (e.g., visiting a friend or relative). I worry about crazy traffic, getting lost, getting sick, losing my wallet, my car breaking down, or otherwise finding myself in a difficult or uncomfortable situation and not knowing how to deal with it. Far from being unrealistic, these things have actually happened to me when travelling, which reinforces my fears.

In general, I tend to avoid situations where I don't know what to expect, where I'm not reasonably certain of a positive outcome. The wikipedia article on dysthymia states that "people suffering from dysthymia are usually well capable of coping with their everyday lives (usually by following particular routines that provide certainty)." Yup, that's me.

I haven't been diagnosed (yet) with avoidant personality disorder or social anxiety disorder, but from what I've been reading, dysthymic people often suffer from these sorts of personality disorders.

I'm extremely indecisive. Any major purchase, or even not so major ones--a TV, an MP3 player, a mattress, etc.--begins with lots of research in an effort to find the most versatile, highest quality product with the most features for the best prices. If I'm thinking of taking a vacation, I can't decide where to go, or when to go, or which hotel to stay at. or what to do when I get there. I usually end up deciding that I don't really want to go that badly anyway, and it costs to much money, and I'll just stay home. Apparently, this is also a common symptom of dysthymia.

As ambivalent as I am about taking an antidepressant, I also think it might be my best hope. I have little faith in psychotherapy. I've been through it before and I found it mostly useless. I just don't see the point in talking over and over again about my problems and about my unhappiness. I know what my problems are. I know that I'm unhappy. I don't see how reiterating that information is supposed to help. In fact, I sometimes think that it encourages an unhealthy degree of self-centeredness and self-pity, creating in patients an obsessed preoccupation with their own depression, and potentially causing them to identify too closely with their illness.

Well the weekend is done, I should have been in bed an hour ago, I've spent way too much time writing this, and I don't know what else to say.
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Meniscus,

Bless your heart... I too suffer from Dysthemia and before I got to your diagnosis, I had already named it for you. One of the problems is that people quite often throw around the term "depression" when in fact it may be a temporary situational effect. Not to quote the Cymbalta ad, but as you and many here on the board already know it is a whole body experience.
I dont know if you ever watched the movie "The Hours" but I shared it with at least one depressed buddy here because I felt it actually showed a number of forms of depression. I could relate to the Julianne Moore character. She was a housewife during the rather stifling 50's , trapped in the perfect mother role, one that she was struggling mightily to present. I could so relate to one scene where she repeated the directions to making the cake she was stirring in a bowl and her rather precocious four year old said to her, "Mommy it's not that difficult" The sad fact was that it was that difficult for her since her brain synapses were not coming together enough to keep her train of thought. She ultimately had to leave her family in order to keep from killing herself.

My therapist told me that I HAD developed a degree of avoidant personality disorder ( thank goodness I can still function to a high degree) , probably for some of the same reasons mentioned above. I too have felt like this most of my life . The wild thing was that when I took Prozac ( to which I ultimately found I was allergic) what had taken me a half an hour to do unmedicated took five minutes...I grieve the difference. But I will continue to travel along this road unmedicated ( I havent found one yet that I tolerated) attempting to deal in the best way I can...
I wanted to tell you to reward yourself for any small steps of improvement you make. Do not let others beat you further down into a greater state of depression. I am sure as a gay man in this world out here it cant be easy, but you are loveable and capable and I wish you the best....
 
I read this and had to just stop and pause. I know something is up with me, not sure if it was depression or what. Recently I had read something about avoident personality, and that was eye-opening since all of it applied to me. Now I read the Meniscus post and I learn even more. Dysthymia. Something for me to look into.

Thanks a lot for posting all this - like a whole new world to me!
 
I've struggled off and on in my life with depression. As I got older I gradually learned that it runs in my family, mainly on my father's side. It was some comfort to learn that.

I've gone to therapists at times but its difficult to quantify whether the treatment was worth the trouble and the expense. I remain skeptical of taking anti-depressant drugs for fear of becoming addicted or dependant on them. That's just a road I don't want to go down. I'd rather rely on therapy. Or just plain endurance.

I'm reading some books about male midlife crises and depression. I've learned alot. The information has been eye opening for me, to say the least. I seem to fit many of the classic profiles, for whatever that's worth. I hope to recognize more signs of midlife depression and cues for possible self improvement. Its a long and difficult road, to be sure, but I see the alternative as even more difficult.

Good luck, meniscus. You're not alone.
 
naughty, Musclebander, and SpeedoGuy:

Thanks for your replies. My blog entry was so long I seriously doubted whether or not anyone would read it.

naughty, thanks for sharing your experience with dysthymia. I've tried antidepressants before and always had a bad reaction. This time we're trying Wellbutrin because of the low-incidence of side effects, including the side effect of decreasing libido, which is already a problem for me.

I haven't yet seen The Hours. I've read about it and it sounds like a great film, but I fear that I might find it hard to watch.

Musclebander, I'm glad you found my post enlightening. As I understand it, dysthymia is insidious, especially if you develop it when you are young, because many people who have it don't know that they have it. They think they are normal because they've always been that way. Even many doctors aren't very knowledgeable about it and often misdiagnose it. It can be hard to diagnose, because people who have it rarely complain about it, and may attribute their low mood and negative feelings to stress, job dissatisfaction, boredom, lack of exercise, lack of a love life or social life, etc. The larger pattern can take years to detect. You might want to talk to your doctor to see what he or she thinks. Unfortunately, it can be difficult to find good mental health care.

SpeedoMike, I agree that it can be hard to tell if psychotherapy is worth the trouble and expense. I often think that something like meditation or yoga might be just as effective, if not more so.

I've never heard of anyone becoming addicted to ore dependant on antidepressants, but I have to admit that I don't know much about it. As I understand it, they are a tool to help improve your mood, energy level, and resilience such that you are better able to deal with life, that they decrease negative feelings, that they may increase your level of interest in life, and they may improve your ability to respond in a positive way to positive events. But there are often undesirable side effects, it can take a lot of trial and error to find the right drug (or sometimes a combination of drugs), and it can take months before you notice any benefits. Sometimes they only help a little bit, in which case they may not be worth it.

As much as I'm bothered by the idea of altering my brain with drugs, I'm trying it anyway. I figure if it doesn't work, then I haven't lost anything. If it does work, I may gain a lot. But I'm not going to rely on drugs alone. I'm going to therapy (even though I don't see the point), I'm trying to revitalize my social life, and I may start going to a weekly meditation session I recently learned about.

Thanks again for your thoughts, and best of luck to all of you.
 
Wow. I can empathize with you. Seems I am going through the same things you are. My situation is a bit different though, but the main feelings your expressing describe me. Likewise something has kicked in the past two years. Which I have entered this "new" state of being.
So far I been managing to just exist. I am functional, and what keeps my motivated is my sense of duty and obligation. I have tried the tradition psychotherapy but it never worked for me. I was deemed a difficult patient in the sense I already attempted the advice by the Doctor/Counselor. I myself, vowed never to take any drugs just because of the complications and possible side effects.
I know they say co-dependency is bad...but their are symbiotic relationship out there that are beneficial. I know the elusive cure for me is to find my soulmate. That sense of the other person who would compliment me.... but the probability of that happening is very low. I wish I could say something and be an inspiration, that I could provide an epiphany or workable solution. The only thing I can say for now is stick to the routines and whatnots that make you function. Even though we may be under a tempest of confusion, we do not have to be controlled by the storm. There are ways to cope, survive, and eventually thrive.
Remember Meniscus.... there are people out there who can care about you and may enrich your life. Even pets can bring some warmth. I know you will find your balm. :redface:
 
Meniscus,

I rarely respond to a blog. First off, I must say you are an incredible writer. You explain perfectly in words what you are feeling and I actually felt how you feel through your words.

While changes in your life probably make you uneasy, changes are definitely what is needed. I am a firm believer of looking in the mirror and blaming myself for many of my shortcomings. If I feel tired and listless, while yes there may be in your case some depression linked to it for sure, what better can I do than to get my lazy ass to a gym and gain some natural effects to feel better. In your case, you would gain multiple benefits of a gym.

1. Join a couple of exercise classes so you can be with people. Just being with people can make you feel better and not so alone.

2. Work out. Working out releases chemicals which are good for your condition.

3. If you keep going and keep it up, you will begin not only to look better but to feel better. You may even find after time that you need to workout almost daily to get the "runners high" which makes you feel so good.

4. You energy level should increase after awhile of going. At first you will be sore, achy, etc. But at least you know where it is from. After awhile of working out (4-6 weeks) most of the aches and pains subside and you begin to feel stronger.

5. As you begin to look better (I have no idea what you look like now) you may find yourself gaining confidence and you WILL notice changes in your body, subtle at first. Gaining a muscle where you never noticed one before is a thrill; it also encourages you to keep going to get some more.

Even if you go to the gym alone, it gives you reflection time while also doing something productive. Buy an IPOD; load it up with your favorite music. Listen to it when you work out; it helps to put me in the zone.

In any event, what you need to do is take a bit, just a bit of the blame yourself. You seem to recognize the symptoms which is a great start. Now it is up to you to make some changes that benefit you. The worst thing you can do I think is "hole up" in your house or apartment not doing anything to make yourself feel better except for taking meds/counseling type routes.

I think meds/counseling can be good and needed for some people. But I think some people sit and wait for it to perform a miracle change. I'm a firm believer that if you don't take some of the responsibility yourself and take some positive instead of negative action about it, you can help yourself combined with meds/counseling to feel better.

Wishing you peace of mind in the long run. Give it time; you didn't get here overnight and you won't come back overnight either.
 
I'd emphatically agree with Stephenmass. Joining an athletic or outdoorsy club that requires maintaining a daily commitment to fitness proved to be a big help for me. I sometimes believe the daily workouts are the only thing keeping me going during tough times.
 
Meniscus,

Speedoguy and Stephenmass may be on to something about the exercise. My doctor told me at one point that the only other way for me to naturally kick in the production of Seratonin would be to begin walking or running on a daily basis. So there really may be a point in it on top of the fact that it may also get your body in better condition.

As for "The Hours" it really isnt that scary. I was riveted to it. Though it can be dark there is triumph of a sort in the end.

There are also four books you may want to check out. They are the following"

"Loving Madly, Loving Sanely" (this one talks about how many of us may be suffering from various issues and how it effects all aspects of our lives)

"I dont want to talk about it" (this one is on male depression)

Also there are diet books by both Dr Mehmet Oz and Andrew Braverman who discuss the element of diet in the discussion of depression and how certain foods affect the functioning of hormones which regulate mood.
 
I still find it hard to believe that anyone actually took the time to read and reply to my post. It was sooo long. But I do appreciate it.

conclave, thanks for the supportive words. I can relate to what you said about your sense of duty and obligation keeping you motivated. But wouldn't it be great to actually enjoy your life, to do things because you genuinely want to do them? That's my goal.

I suppose I'm a difficult patient, too. I see therapy as a big waste of my time and money.

Stephenmass, thanks for the compliment about my writing. It really brightened my day. Actually, it's the nicest thing anyone has said to me in a long time. Also, it's always nice to hear from someone from Massachusetts.

I agree that I can't use depression as an excuse for my bad habits, but on the other hand, I'm extremely self-critical and have spent years blaming myself for my inability to get out of this rut. I could admit that I was "a little depressed," but I saw my depression as a response to the circumstances of my life. For a long time I was unwilling to accept the idea that I had an illness. I saw my low energy, lack of enthusiasm, etc. as character flaws. It's only after repeated failure at trying to work through this on my own that I finally decided to seek help. Unfortunately, I have little faith in the help that I'm getting, but I'm trying to remain open, and I'm hoping to be pleasantly surprised.

I've also spent years thinking about getting into shape, possibly by joining a gym, but I've never worked up the motivation to do it. One of the doctors I saw told me that the research shows that there are 3 effective treatments for depression: antidepressants, psychotherapy, and exercise. However, 1 out of 3 is not enough, you have to do at least 2 of the 3. Right now I'm doing the first 2. Perhaps at some point I will work up to the 3rd.
I really do hate exercise, though. Usually I find it unpleasant, even a bit of an ordeal. At best it's boring.

naughty, thanks for the book recommendations. I will look into them.

--Meniscus
 
Sometimes, and I like the gym, working out makes me dig into my self discipline to get the workout done for that day when I don't have the motivation.

I definitely was not saying and I hope you didn't read it that way, that I felt that what you are currently doing is a waste of time. It's not at all. Antidepressants, if they find the right one for you, can sometimes work wonders. Psychotherapy can also be a great tool; the problem is finding a therapist that challenges you. That listens to you AND responds to what you are saying. I've had a couple that just sit there with the occasional "nod" or whatever. THAT is a waste of MY time. I found a good one and he was good because not only did he listen, he spoke often, challenged my words. He was really good. Another piece of advice that I have. Get all of your hidden truths (I don't want to know any) out in the open early so it is not a waste of your time. Once I "let go" of everything going on inside of me was when I began to get challenged. He challenged me in little steps, building a walkway of sorts until I reached the top. It helped tremendously; your attitude going in Meniscus needs to be open, not what I just read. If you already feel it won't work, it probably won't. Don't be afraid to challenge the therapist yourself if you feel he is being too quiet. There is nothing worse than exposing yourself (not that part man!!) for an hour, only to be practically pushed out the door and told "continue the medication" without any indication that he "truly heard" any of what you said.

Good luck in your quest to become healthier with a better outlook. When I went thru the same problem, I felt almost mechanical, roboticized if you will. I went through all the motions of what I was supposed to do every day, but I wasn't getting any enjoyment from it. The next day would come and I would do it all again, over and over for what felt like an eternity.

I do wish you well, and I do hope you find your road back. We all have different ways of getting to the same place!
 
Again, I see things the same way as Stephenmass. Working out regularly is a benefit in a number of ways: it provides a physical benefit, workouts increase energy and motivation, and they induce a sense of satisfaction. At the end of a day, I feel much more satisfied and content when I've done my daily workout rather procrastinate. There are cumulative benefits.
 
Meniscus,

My doctor told me that activity is the only thing other than the anti depressants which was going to get my body to start creating enough seratonin naturally. I have to ask... do you suffer from gastrointestinal issues? Many people who suffer from depression also have GI problems because the GI system is the largest area of the body that uses seratonin to help proper functioning.
 
Thanks again, everyone.

Stephen, you are wise beyond your years. My last therapist didn't challenge me and we got nowhere. My current therapist sits there, smiles, and says, "So..." and then it's all up to me to talk. It told her in the very beginning that I didn't understand the process, how it was supposed to work, or what I was supposed to get out of it, and that I needed her guidance with regards to what to talk about. She's also overbooked. My next appointment is a month away, and in the middle of the day, which is not a good time for me. I'm thinking I need to give up on her before I waste to much time and money on this, and find someone else.

Anyway, I could go on and on.

naughty, the answer to your question is yes, but not as bad as a few years ago. SSRIs make it worse, so this time I'm on Wellbutrin. No side effects so far. Maybe this time I'll be able to take it long enough to find out if it will work on my depression. Which reminds me, I need to take my pill.

Thanks again, everyone.
 

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