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.)

18 Responses to “The Quiet Crisis of Chronic Depression”

Read below or add a comment...

  1. Michael says:

    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.

    Who Dares Wins

  2. Vickie says:

    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!

  3. Bess says:

    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!!

  4. Aubrey says:

    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.

  5. Brent says:

    “…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.

  6. deborah says:

    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.]

  7. John, says:

    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.

  8. 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.

  9. Karen Wilhelm says:

    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.

  10. 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.

    • deborah says:

      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.

  11. 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.

  12. 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.

  13. 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.

  14. anne says:

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

  15. Brent says:

    “…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.


  1. […] 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…="" […]

  2. Storied Mind says:

    The Quiet Crisis of Chronic Depression

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

By clicking the Submit button below you agree to follow the Commenting Guidelines