The Quiet Crisis of Chronic Depression

Andrea Mantegna Presentation at the Temple (Detail)

Chronic depression, also known as dysthymia, is supposed to be a milder but longer lasting form of the illness than the more episodic and severe variety known as major depressive disorder. Yet I have come to believe that no form of diagnosable depression should be called “mild.”

My concern is not about the accuracy of these terms according to a standard measurement scale. I worry about the effect that words like “mild” and “moderate” have on people who are considering what to do about depression.

Years ago, when I was trying to ignore my problem, I liked to say that I had “minor” depression.

“Mild,” “moderate” and “minor” may not be the formal diagnostic terms, but they worked well in helping me downplay the illness and put it lower on the list of priorities for action. People devote themselves to solving big problems. No one has time for the little ones. I thought my depression was in the category of the little problems.

Major or Minor, Mild or Severe?

That bit of self-deception enabled me to sidestep the inconvenient truth that this “minor” condition had been with me since childhood and had played a part in undermining many aspects of my life. I chose to focus on the undeniably “major” depressive episodes as the real problem.

Those were the periods when I lost almost all motivation, energy, mental focus, ability to relate to people, and at times even the will to live. There was no denying that I could function only at a minimal level and that I needed help to get through the illness.

But when this acute phase ended, life rarely went back to normal. Because I had lived with depression for most of my life, I didn’t have a very good idea about “normal” anyway. To me, normal tended to be about 50% of the level of energy and drive that I needed to feel capable of doing everything I knew I could do.

Since I didn’t concern myself with “minor” depression, I never tried to learn much about its effects. Instead, I assumed that what it was doing to me was not the effect of an illness at all but simply a part of my personality, the given traits that made up my identity as a person.

I was willing to get treatment for the severe episodes, but the rest was just me. That’s what I thought back in the 1980s and early 90s before information about depression became so widely available.

Yet, today many people with chronic depression may believe the same thing and be slow to do anything about it. Perhaps they believe the condition is just the way they are.

Forms of Chronic Depression

Psychiatrists and researchers are learning that the distinction between episodic and chronic or between severe and mild breaks down if you look at the long-term course of depression. They’ve been adding types and subtypes of chronic depression, and the boundaries are overlapping more than ever.

Besides dysthymia, there are three other forms of depression that have the chronic label attached to them.

Double depression. This doesn’t seem to be a formal diagnosis, but it refers to the onset of a major depressive episode at least two years after the beginning of dysthymia. Most people with dysthymia also experience major depression at some point in their lives.

Chronic major depression. This refers to major depressive disorder that lasts for at least two years, and it happens to about 20% of people with this diagnosis.

Partial Recovery. The third form is also quite common. It’s an incomplete recovery from major depression in which you may get well enough to stop qualifying for the formal diagnosis, but you are still beset with many of the symptoms.

I have lived with all four forms of chronic depression as well as major depressive disorder itself. I have to wonder if these aren’t all different ways in which the same illness shows up in a human life.

The research seems to be showing that the apparently milder forms of depression are linked with more severe types. This becomes clear if you broaden the time of research study from months to years. Then you have a perspective that is closer to that of the person with depression.

Is It Depression or Is It Just Me?

These chronic forms of depression are the most resistant to treatment and usually have a long-term impact on cognitive functioning, self-esteem and the ability to feel or get pleasure from life.

According to a summary from the Harvard Medical School: “…[C]hronic depression causes more functional impairment, increases risk of suicide, and is more likely to occur in conjunction with other psychiatric disorders [than episodic depression].”
Most people with chronic depression never seek treatment and probably go through life believing that the illness is just the way they are.

My underlying reason for looking into diagnostic labels and criteria is mostly my concern about what people with depression think of themselves. If you’ve lived with depression for a long time, it’s hard to shake the idea that there is “really” something wrong with you or that you’re faking it because you can’t handle life or one of the other stereotypes that plague us.

These stereotypes, I think, are just as deeply rooted in depressed people as they are in those who don’t want to understand mental illness.

We’re the ones most at risk of confusing the symptoms of negative thinking about ourselves with the reality of our human potential. Because of that concern, I think it’s better to stop imagining that depression comes in mild versions that can be treated like a chronic cough.

If something plagues you for months and years, it’s serious and severe and needs to be at the top of your list of life problems to work on.

(This post is reprinted from the newsletter archive.)

6 Responses to “The Quiet Crisis of Chronic Depression”

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  1. Mark Noo says:

    I have found that the people I know do not believe depression is real. Because depression cannot be seen under a microscope or x-rayed it must not be real.

    I rarely talk about how my life is because people don’t want to hear it.

    I was told that the Affordable Health Care Act was supposed to make mental illness diagnosis just as much a priority as any other condition. I have not seen this yet. My hospital has told me there is no way for me to see a psychiatrist because they don’t have enough and that they are only for the people with real mental illness. That a regular doctor would be able to treat me because I wasn’t weird enough. Apparently depression does not count as a real problem, so it looks like my family and friends are right. It isn’t real.

  2. Depression is caused by a wide range of issues. A chemical imbalance in the brain helps cause it. Stress is another major factor in depression. Daily life brings stress, period. Depression does not play favorites. It’s a disease for rich people and for poor people. All the types of depression have similar symptoms. Dramatic shifts in personality and up and down mood swings are some. The advent of sleeplessness is another sign of depression. Helpless feelings or feelings that the future holds no hope are signs. When everyday life becomes a chore, that’s depression. But the depression afflicted has hope.

  3. Chance says:

    Thank you so much for writing about this issue. I am living with a partner who has dysthysmia. I agree that people might think that “minor” depression is better. I thought so too at the beginning of this relationship, especially after reading about the hardships people with major depression can go through. “At least my partner can do what he needs to do everyday,” I thought. I certainly had my attitude set straight by living with his “minor” depression everyday.

    No, my partner doesn’t ignore me. He is able to get up and go to work, contribute to the household, tell me he loves me, and is 75% of the time “fine” on the outside. But at what cost to himself—and to me? He often “doesn’t have the energy” to hang out with me when he gets home. He is always managing his symptoms and triggers, down to miniscule details like how many cups of tea he can have. He has told me that if he could, he would go weeks without seeing anyone. Like other forms of depression, he is irritable, moody, sad, with major “episodes.” But those “mild” symptoms never go away. Never.

    This site has been a great resource to me as I struggle to understand depression. Thank you for writing about this. Without a place like this to read and talk, I would feel totally alone.

  4. Alan says:

    Where does one end and the other begin? After a while it’s all a blur. I’ve suffered chronic “mild” depression since I was a child plus several major episodes. Due to several bad events/decisions, I am currently in a major depressive episode which has been going on for several years now and which I fear is the last one because I can’t seem to shake it. I’ve lost just about everything now, and have been either unemployed or underemployed for most of my life. (I’m a lawyer so everyone thinks I should be rich and successful which is BS) Most of time it has been about just about daily survival, so it was extremely difficult for me to think about or plan any future. I’ve tried many different meds and rTMS, but they either don’t work or work very well.

    Whether it is mild or major depression, it gradually wears one down and limits the scope of your life. When I was younger, the only thing that kept me going was hope for a better future, but at 48 that future is worse than I ever imagined it would be. I was taking one SSRI or another for the last 20 – 25 years, and while it may have kept me out of the deep abyss, it also numbed all my emotions which prevented me from realizing the major ways my life was not working and to make necessary changes. But after quitting SSRI’s, I’ve think that many of the decisions I made about my life were wrong for me because my emotions were so blunted.

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    The Quiet Crisis of Chronic Depression

    The Quiet Crisis of Chronic Depression Chronic depression, also known as dysthymia, is supposed to be



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