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.
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.