"Double Depression"

I saw my new psychiatrist this week, and I really like her. I think this will be a good fit.

She asked me how my current meds were working. I floundered a bit, then said, "I've about come to the conclusion that I need to lower my expectations, that I need to accept that I won't ever be the person I used to be."

She said, "You do realize, don't you, that you have dysthymia as well as major depressive order?" I told her that, about a year ago, I noticed dysthymia as a diagnosis on my chart, but when I looked it up, it seemed to be contradictory to the diagnosis of major depressive disorder (dysthymia is defined as "mild, chronic depression;" I certainly knew that what I suffered with most of my life was NOT mild).

"Not at all contradictory," she stated, and she began to explain the impact of having both disorders. "Essentially," she said, "you have double depression." I was astounded. It explained so much. "So, yes, unfortunately," she continued, "you may need to lower the bar."

I've since researched her explanation, and now, dear reader, I will explain it to you. (Sorry, I just had a brief Brontë moment there).

Dysthymia is a chronic, depressed mood that lasts at least two years. Sometimes referred to as a "veil of sadness," this low, dark mood occurs nearly every day and persists for years. Dysthymia often begins in childhood. Since dysthymia is a chronic disorder, sufferers may experience symptoms for 10 to 20 years before being diagnosed, if diagnosis occurs at all. As a result, they may believe that depression is a part of their character, just who they are.

Symptoms of dysthymia include low self-esteem, a low capacity for pleasure, withdrawal from stressful situations, low energy, overeating, too much or too little sleep, feelings of hopelessness, poor concentration, chronic pain, headaches, and stomach disorders. People with dysthymia usually find little pleasure in regular activities and pastimes.

As time goes by, greater than half of people with dysthymia experience worsening symptoms that lead to the onset of major depressive disorder on top of their chronically depressed mood. This is known as double depression, a serious, potentially life-threatening condition. Double depression is under-recognized and harder to treat than either dysthymia or major depression by themselves.

A small study published in the Journal of Affective Disorders found that the distinguishing symptom of double depression, as opposed to a major depressive episode or dysthymia alone, seems to be hopelessness. People with double depression have given up on ever recovering from their condition and have a bleak outlook on life. It's difficult to motivate them to have treatment, such as medication and therapy. 

Symptoms of double depression are similar to both dysthymia and major depressive disorder but are greater in degree and impact. Extreme fatigue, feelings of guilt, withdrawal from family situations, delusions, and hallucinations are additional symptoms.

The constant stress causes changes in the brain and the body. Those with double depression are at a higher risk for heart disease, diabetes, and other major medical conditions. Double depression can also worsen other chronic diseases, such as rheumatoid arthritis and diabetes.

So. Now I have a much clearer picture of my depression, and hopefully my family will understand a bit better, as well. I'm always letting them down. I commit to things then cancel at the last minute. I get excited about family visits then back out. I've let down my little great-niece, age 7, so many times (including today), in both minor and major situations, that I worry constantly that she'll only remember me as an irresponsible person that was never there for her.

Guilt, worthlessness, fatigue, guilt, lethargy, hopelessness, guilt (did I mention that already?), withdrawal, self-loathing...

The battle rages on, but I'm a weary soldier.

Sources: WebMd, Mayo Clinic, National Institute of Health, Psych Central, Right Diagnoses, Florida State University, Depression Place, Wikipedia, and eHow.