• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Storied Mind

Recover Life from Depression

  • Home
  • About
    • Commenting Guidelines
  • START HERE
    • Archives
  • Self-Help
    • Recovery Stories
You are here: Home / Depression Symptoms / The Quiet Crisis of Chronic Depression

The Quiet Crisis of Chronic Depression

by John Folk-Williams 18 Comments

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.)

Related Posts

  • The Recovery Tweets

    Some Rights Reserved by glenn_e_wilson at Flickr. People - sorry -tweeple have been finding all…

  • Aging Out of Depression

    Some Rights Reserved by MVI at Flickr I've published a post over at Health Central…

  • Depression and Worry: Tales of Mere Existence

    I hope you enjoy these classics. They're good notes to end the summer on. 1.…

Filed Under: Depression Symptoms Tagged With: awareness, diagnosis, identity

Reader Interactions

Comments

  1. Michael says

    January 10, 2018 at 10:53 am

    I am not sure if I have posted here before or not. Of all the websites and blogs I have visited, this one seems to appeal to me most.

    A little background on myself. First in my life is my son. That’s right I am a proud father of an amazing teenage son. I am also a 50 year old man who has struggled with depression and hypo-mania for over half my life. I have been married and am now divorced.

    Presently, I am in a depressive episode. I say that because as always, I’m sure there’s a hypo-manic season right around the corner.

    It sucks. The disease, condition, the diagnosis. Call it what you like. I often daydream about how my life would have been different had I managed my condition earlier. You know, the important things that men my age typically attain. I’m talking about a stable work history, perhaps financial responsibility and however many – “I should have…by now.”

    As much as it is hard to live with personally, I have a horrible history of isolating. I hope to begin to return to what I feel like is the person who loves to laugh and be around others.

    Anyhow, thank you for your forum.

    I am thankful for today.

    Michael
    Who Dares Wins

    Reply
  2. Vickie says

    March 13, 2017 at 10:15 pm

    Hi,
    I’ve just found your website and I’ll be signing up for emailed updates; it looks as though it is full of wonderful information and advice!

    I struggled with chronic depression (I believe those in the know now refer to it as persistent depressive disorder) for 21 years. I finally sought help and things started looking up. On anti-depressants (and off again, three times!) and feeling better, but with hindsight, I think I felt better because I was finally taking action towards eliminating the symptoms from my life. I’ve been well for nearly a decade and off the meds for about 4 years.

    Through my reading and thinking, I’ve come to the conclusion that chronic depression is a sign that something is out of whack, something’s not right in your life. I’ve looked back over my life and identified the times when I’ve felt better and had a good look at what I was doing during those times in relation to exercise, nutrition, social connectedness, my thinking patterns and whether I felt I was in meaningful work. So interesting to see that the times when I was better were when I was active in most of these areas and when things were beginning to fall apart was when I had neglected some of them.

    It’s not an easy road from chronic depression to a peaceful, rewarding life but it is possible. There is definitely hope!

    Reply
  3. Bess says

    January 14, 2016 at 2:48 pm

    I said “for better or worse . . .”. It could be worse, I have always said but now, after 35 years of marriage, my compassion has just turned to sadness and wondering, now what? Can I really continue??

    After 18 years, my husband was formally diagnosed with XYZ depression, major depressive disorder, anxiety, etc., etc., etc. No matter the label of major, minor or otherwise, he suffers from it and I, along with our three grown children, have suffered as well. Having said that, he doesn’t know any different and he is a good man with a severe illness. He doesn’t feel the upside of life, only the downside and he does recognize the difference and is glad for the absence of the downside, regardless of the side effects of the medicine because again, it could be worse. His medication leaves him flat line, which is FAR better than the alternative negative episodes that can plummet him into severe anger and rage, irrational thinking, extreme moodiness and total apathy, about everything in life.

    So back to the now what? If it were me, and my spouse couldn’t handle it any more, how would I feel? Probably pretty bad. It’s not his fault he has this condition, although he’s not willing to do anything more than take a pill, which is a fault and a problem. Lacking the empathy and sympathy for my feelings puts him in a place where working any more to improve what might be is too much work – all that proverbial water under the bridge. He understands cognitively how I feel, and that’s where it stops. His work is the engine that drives him. Love is the engine that drives me. I think my engine died. His will always be there.

    John I have read through much of your website and I feel for those in situations far worse than mine which leaves me feeling somewhat blessed, albeit not better. I know decisions are individual; you can only do what you can do. I’m not a selfish person and struggle with where to go next, but feeling empty is troublesome now. I’ve given 300% I think, although my husband may feel and think differently. Hard to tell, he won’t talk and when he does, it’s not feeling related, it’s intellectual. I wonder how your wife goes on, or how other spouses go on, feeling less than significant in a relationship where significance is everything. Is it selfish to call it quits? People rarely speak about God, or their otherwise superior being that drives their ethics and morals. When you make a promise, abandoning that promise because it got hard doesn’t seem like an option but, losing yourself in the situation and not being your full self for those others that depend on you isn’t an option either. For 35 years I’ve invested in many other distractions so I don’t rely on what isn’t there, and have been content with that, somewhat ignoring the reality. All of a sudden, it’s now too hard, and yet walking away feels equally as hard, like I’m doing something wrong, something I wouldn’t want to happen to me.

    I’ll keep reading, I’ll keep praying, and maybe someday, something will click and I’ll find the answer. For now, thank you for your site, it’s a help!!

    Reply
  4. Aubrey says

    September 7, 2015 at 1:33 pm

    Many new mothers suffer from some fleeting form of the baby blues. Postpartum depression, in contrast, is a longer lasting and more serious depression triggered, in part, by hormonal changes associated with having a baby. Postpartum depression usually develops soon after delivery, but any depression that occurs within six months of childbirth may be postpartum depression. Learn more.

    Reply
  5. Brent says

    February 14, 2015 at 9:09 am

    “…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.”

    Yes, I’ve thought this way for many years. I am now intent on changing the way I perceive and think of this. Thanks.

    Reply
  6. deborah says

    January 8, 2015 at 9:30 am

    I can’t believe I finally found a website that I can relate to so much. I’ve been depressed it seems like forever. I’m at a stage where I’ve stopped taking anti-depressant medication and I am relying on herbs and vitamins. I am having some improvement with this regimen but I believe I need to add exercise. I am having a hard time with motivation and when I read your article “Depressed and Waiting for Motivation to Arrive” I started journaling. I’m hoping to open up as to why I sabotage myself. I want to thank you for what you’ve written. I feel like I can finally move forward. [What a relief.]

    Reply
  7. John, says

    December 19, 2014 at 5:39 am

    For me, definitions are of value to sufferers in that they can perhaps help you get the correct medication. They also provide some comfort, and also help you to connect with fellow sufferers of your particular condition.

    However, these definitions are rather complex and everybody is different anyway. Each person needs to be individually evaluated according to his/her own personal needs. We all need our own personalised treatment.

    Reply
  8. Kimberly Fitzgerald says

    September 25, 2014 at 3:42 pm

    In my 16 years as a psychotherapist it has been the most heartbreaking to journey with those who have struggled with depression as you so clearly describe. Friends and family most often dismiss or can’t fathom the depth of such struggles. You truly do understand and I’m thankful that your insights and experiences are here for others. It was 8 years ago that I began to explore alternative options to treatment for depression and other mental health challenges and found Energy Psychology to be, like your wife’s beautiful garden, a truly, healing gift.

    Reply
  9. Karen Wilhelm says

    September 9, 2014 at 7:20 am

    Another form of “difficult to treat” lasting depression is a form of bipolar disorder, which is also undergoing the recognition that there are different diseases being collected in that category. I prefer the recent term “bipolar depression” because it is more like what I get.

    That said, after trying every combination of drugs on the market for stabilizing mood and lightening the depression, I’m fortunate in that my insurance covers most of the cost of my gifted psychiatrist who has never stopped empathizing with my pain.

    I’m still stuck with the inability to do all the things that I could do if I had the strength. Learning how to do many things is also lost to depressive episodes, making you less knowledgeable and skilled than you might have been. I’m retired at the age of 66, but I know I’d have more years of work, paid or vulunteer, or travel than I can handle now.

    Yes, it deserves treatment and also deserves much more research and available treatment. Besides political and administrative decision makers who have never experienced depression, there are the others who can’t “come out” about their depression and weigh policy more in our favor.

    Stigma is the root cause of our prolonged suffering.

    Reply
  10. Mark Noo says

    June 25, 2014 at 12:57 pm

    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.

    Reply
    • deborah says

      August 16, 2014 at 5:44 pm

      I have found that people who haven’t experienced chronic depression just can’t understand how it is different from being sad. I know what you mean about avoiding talking about your depression. It’s just another argument.

      I think it’s going to take a while longer before we really get the help we need. I have meds that help, but I’m, as you mention, only running at about 50%. On a good day.

      Reply
  11. About Depression Definition says

    June 21, 2014 at 1:43 pm

    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.

    Reply
  12. Chance says

    June 5, 2014 at 2:29 pm

    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.

    Reply
  13. Alan says

    July 23, 2014 at 8:24 am

    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.

    Reply
  14. anne says

    February 2, 2015 at 5:20 pm

    Many months later… Alan, I hope you are ok.

    Reply
  15. Brent says

    February 14, 2015 at 9:02 am

    “…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.”

    Thank you for mentioning this. Here’s why: I’ve recently been contemplating taking one of these once again after having been on a couple different ones about 10 years ago for about 6 months. I experienced very short term and limited benefit, but plenty of negative side effects, so I discontinued them. Your observations about how they affected you are helpful.

    Reply

Trackbacks

  1. Suicide and Self-Harm with Borderline Personality Disorder says:
    May 24, 2014 at 2:09 pm

    […] the Corner(A page that tells his story from the beginning and has links to several of his articles)Hey.  It happens.  End of article.Just kidding.  Just like with Mary Poppins, I find that humor c…="http://bipolardisorderdepressionanxiety.com/so-what-causes-borderline-personality-disorder/" […]

    Reply
  2. Storied Mind says:
    May 22, 2014 at 11:17 pm

    The Quiet Crisis of Chronic Depression

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

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Sign Up for Email Delivery

Get updates and blog posts by email.

Surviving Depression Together Now Available at Major Retailers

Surviving Depression Together


Surviving Depression Together

"John, this is a ... much needed resource. Thanks for writing it!"

- Therese Borchard, author of Beyond Blue


Learn More...

A Mind for Life Ebook Now Available at Major Retailers

A Mind for Life: From Depression to Living Well

A Mind for Life Ebook

The inner work of getting your life back from depression. This ebook is now available in most common ebook formats at major retailers.

LEARN MORE

Living Depressed

Depression affects emotions, mental abilities, self-concept, behavior, relationships and the entire body. These core posts describe the full range of symptoms affecting daily life. Read More.

Choices in Healing

Hoping for recovery gives you a motive but not a method for getting there. This section has posts about therapies and healing methods you can work with either on your own or with professional guidance. Read more.

Living Well

If you've learned how to manage your depression, you'll want a fulfilling life rather than one dominated by fear that the illness might return. In this section, you'll find posts about how to work toward that goal. Read More

Relationships in Crisis

One of the hardest challenges of living with depression is holding onto your closest relationships. This section features posts on how to help a relationship survive. Read More.

Recent Posts

  • Storied Mind Ebooks Ready to Go!
  • Notebook: Healing the Whole Person
  • Why Writing Helps Heal Depression – 2
  • Why Writing Can Help Heal Depression – 1
  • Re-Reading the Story of Depression’s Meaning

Search Storied Mind

Categories

Recent Comments

  • Linda on Helen: A Great Film on Depression
  • Anonymous on 10 Ways to Help Yourself When Your Partner Is Depressed
  • Karthika on How Can You Communicate After Your Depressed Partner Leaves?
  • Adam on How Can You Communicate After Your Depressed Partner Leaves?
  • Karthika on How Can You Communicate After Your Depressed Partner Leaves?
  • Adam on How Can You Communicate After Your Depressed Partner Leaves?
  • Anonymous on How Can You Communicate After Your Depressed Partner Leaves?
  • Karthika on How Can You Communicate After Your Depressed Partner Leaves?

Privacy and Cookie Policy

Privacy Policy

Cookie Policy

Terms of Use

DISCLAIMER: None of the content on this site should be interpreted as medical or therapeutic advice about the treatment of depression or any mental illness. If you feel you need help, you should seek treatment from qualified professionals.

AFFILIATES: We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites.

Copyright © 2023 · Dynamik-Gen on Genesis Framework · WordPress · Log in