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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Don_Bristol on April 9, 2006, at 10:17:24
I would like to ask you about depth of depression. I need some help to understand my experience of depression so far.
I am 40 and all my life I have been diagnosed as "depressed". All my life I have stumbled along in my own way. The joys never very great. And I guessed that was depression.
But late last year I went into a really deep depression. It lasted only a few weeks. I think psychiatrists call this MAJOR DEPRESSION.
Then it was back to my usual sort of depression. My usual depression is more like dysthmia than the full depression.
This made me wonder about people who are said to be depressed. ISTR that it is rare for someone to be in a major depression for "long". But what does that mean? How long is long?
Maybe you can help clarify this for me.
I would also like to know about this:
How often do you go into major depression?
How long does it tend to last?
What is it like for you in between the major depressions?Thanks!
Posted by Phillipa on April 9, 2006, at 12:03:35
In reply to HELP: How often how deeply do you get depressed?, posted by Don_Bristol on April 9, 2006, at 10:17:24
I have only heard that if you have a major depression the odds are that you will have another one at some point in your life. Love Phillipa
Posted by JaclinHyde on April 9, 2006, at 23:40:57
In reply to Re: HELP: How often how deeply do you get depressed? » Don_Bristol, posted by Phillipa on April 9, 2006, at 12:03:35
I have a few bouts here and there and they made me feel living was a chore. Then I got on my medication and it disappeared.
Hope you come out of it soon.
JH
Posted by SLS on April 10, 2006, at 6:01:08
In reply to HELP: How often how deeply do you get depressed?, posted by Don_Bristol on April 9, 2006, at 10:17:24
Hi Don.
You asked some very constructive questions. I am not a good example to represent the course of the average affective disorder (mood illness). I have an uncommon type of bipolar disorder. I stay deeply depressed all of the time year after year. I meet the DSM criteria for major depressive disorder (MDD).
You might have something known as "double depression". This condition presents as a chronic dysthymia (minor depression) with intermittent episodes of MDD. It is possible that you have not known what it feels like to be mentally healthy and free of depression for many years. The MDD is usually as treatable as any other case would be. However, the dysthymia can be more stubborn. I don't think there is any consensus among doctors how best to treat it, but generally it is treated as if it were MDD. Psychotherapy might be very helpful. I would definitely consider it as a treatment for the dysthymia, with the hope that it might break a cycle of depressive thinking driving or making worse the dysthymia. At the very least, it would be very supportive and teach you how to experience life more fully.
Can you describe how you experience life during the time in between MDD episodes? What makes you think that you might be experiencing a chronic dysthymia?
What has been your treatment history?
- Scott
Posted by Don_Bristol on April 12, 2006, at 19:05:52
In reply to Re: HELP: How often how deeply do you get depress, posted by SLS on April 10, 2006, at 6:01:08
This is a long posting
> You asked some very constructive questions. I am
> not a good example to represent the course of
> the average affective disorder (mood illness). I
> have an uncommon type of bipolar disorder. I
> stay deeply depressed all of the time year after
> year. I meet the DSM criteria for major depressive
> disorder (MDD).Scott, can I ask you something about yourself? If you are deeply depressed all the time then how can you be bipolar? The BI refers to two states and the other would be mania. Are you saying you are majorly depressed during your manic states?
It sounds strange to me because I thought that, by definition, mania was the opposite of depression.
> You might have something known as "double depression".
> This condition presents as a chronic dysthymia (minor
> depression) with intermittent episodes of MDD. It is possible
> that you have not known what it feels like to be mentally
> healthy and free of depression for many years. The MDD
> is usually as treatable as any other case would be. However
> , the dysthymia can be more stubborn. I don't think there is
> any consensus among doctors how best to treat it, but
> generally it is treated as if it were MDD.I am trying to understand what MDD feels like. It a quest to understand the definitions. I am certain I have had it and I am certain I have dysthymia. The bit I don't know is at what point does the depression get so much worse that it can be called a MDD.
I recently hit an unusually low depressive state. The thing which prompted me to post my questions here in the first place (HOW OFTEN AND HOW LONG DO YOU HAVE MDD?) is that the state I went through was so awful that I can't imagine anyone having it for long. This is what I am referring to at that time of deep depression. In this description I have tried to keep my experiences accurate but it ihard to do.
----------- MY DEPRESSION -------------
It was Hell on Earth. It was no dream, no fantasy. You were there.I learnt the limit of just how low the human soul can go and what it feels like when ets to that pint of ultimate lowness.
And then I experience what it felt like to go even lower still.
How it feels after you have had your very soul removed. Your soul could not survive to be with you at this geat depth.
Your soul is gone, your self-identity is gone, your very sense of self is gone. Your place in the world has gone. The world – well – that hasn't gone. There's a lot of the world that seems to still be there. You care only about your immediate world.
Consciousness itself becomes a torment. And consciousness makes you weary. In the past you have travelled far and always had the energy to carry on just a little bit further in the the hope that maybe, just maybe things will get better but now the weariness starts to overwhelm you.
And all around you it is so totally devoid of light that the word "black" barely does this landscape, roomscape, worldscape true justice. It is black beyong black. The ground is flat - who knows why. There you are passing, stumbling, wandering, lost in a great blackness.
Cognitive processes ceased long ago during this descent. There is no thinking. You just feel painful "streaks" of emotion. Guilt: ("what have I done to deserve this?). Denial that your very self is nearly extinguished because it is simply too amazing for you to be able to accept it. Free floating fear - fear of of anything and everything because all that "is" out there has created this situation for you and so you cannot let anything near you. The thought that these things may come physically close to you is frightening.
You cower. Literally. You curl up. You don't know why or what this leads to next. You close your eyes; you open your eyes - it seems to make no difference.
There is no way out. You have tried everything to prevent this. You are surrounded on all sides by this hell. There is no tactic to employ. You are now well beyond coping tactics. And anyway you can't watch because you are too much a participant.
----------- END -------------I had several days of this. And it is completely out of character for me. It is not my usual experience.
I cannot see how anyone can experience this for very long. And so this is my question: HOW LONG and HOW OFTEN?
Maybe I am describing an acute period within a much larger and much longer period of what could be called MDD.
At what point on the journey from dysthymia to that state I describe above do I hit MDD? The DSM doesn't really convery the intensity of the criteria it describes.
> Psychotherapy might be very helpful. I would
> definitely consider it as a treatment for the dysthymia,
> with the hope that it might break a cycle of depressive
> thinking driving or making worse the dysthymia. At the
> very least, it would be very supportive and teach
> you how to experience life more fully.I am going through the options at the moment. I am familiar with some forms of cognitive type therapies.
> Can you describe how you experience life during
> the time in between MDD episodes?
> What makes you think that you might be
> experiencing a chronic dysthymia?
I have only has two such episodes in the last 10 years although it is qite possible I had some more many years ago – I am 50.Life seems very ordinary. There is a lot to do and that is probably from my obsessiveness (which is not really related OCD but of an OC personality). Things seems generally unsatisfactory and there are few moments of real happiness. But I do have some of the ATYPICAL traits such as mood responsiveness so my mood will improve quite markedly when I encounter something I feel is good.
See http://www.allaboutdepression.com/dia_specifiers.html
REJECTION SENSITVITY is very marked in me. However I do not sleep too much and my body may feel heavy but not massivel, so I can not tick those two.
My moods seems episodic and I entertained that I may have had a soft-bipolar. Then I felt that my mood may have been influenced a great deal by a chronic bacterial infection of my abdomen which is hard to remove and which makes me feel physically exhausted.
Ther are times when I have energy but it is all devoted into nonproductive things like researchng on the PC, or home repairs of the weirdest things (the actuator brushes on the electric motor of a $1 coffee whisker), complaining when I feel someone has cheated me (oh my and how I can chase this up the compony to senior managers or higher for what are small amounts of money but which seem "unfair" to me).>
> What has been your treatment history?
>At least a dozen shrinks. Rather fewer psychotherapists.
Many meds (a dozen or more different trials). But so many still to try!
All SSRIs are no good.
Reboxetine (and SNRI) was good but side effects were a problem.
Moclobemide may have shown the beginnings of usefulness but dose was an issue. Nardil was not bad but the side effects were weird (slow movement and slow talking).
Parnate has been best and I take it now at 50mg. Current idea is to augment it with olanzapine (start at 2.5mg and then see where to go). Well that *was* the current idea.
I now have a new doc and he is musing that it may be worth checking out alternatives such as lithium.
What are your (or anyone else's) thoughts on the above?
Don B
Posted by SLS on April 12, 2006, at 21:09:55
In reply to Re: HELP: How often how deeply do you get depress, posted by Don_Bristol on April 12, 2006, at 19:05:52
> Scott, can I ask you something about yourself? If you are deeply depressed all the time then how can you be bipolar?
There are a few things about my case that indicate bipolar disorder.
1. I have had severe manic episodes precipitated by taking antidepressants.
2. My symptom profile approximates that of atypical depression, but without the mood reactivity. This is common for bipolar disorder.
3. I was an ultra rapid cycler with an 11 day cycle.> The BI refers to two states and the other would be mania. Are you saying you are majorly depressed during your manic states?
In a way. Several of my manias were dysphoric or mixed-states. This is conceptualized as a state that produces symptoms of mania and depression at the same time.
> It sounds strange to me because I thought that, by definition, mania was the opposite of depression.
These mood disorders can be a bit too complicated to approach using an either/or model.
> I am trying to understand what MDD feels like. It a quest to understand the definitions. I am certain I have had it and I am certain I have dysthymia. The bit I don't know is at what point does the depression get so much worse that it can be called a MDD.
There are several rating scales that are used to assess severity.
1. Zung
2. Hamilton
3. Beck
4. Montgomery-Asberg
5. GoldbergEach has its own numeric scale that calculates or represents severity.
> I recently hit an unusually low depressive state.
> I had several days of this. And it is completely out of character for me. It is not my usual experience.
How long do these episodes last for?
> I cannot see how anyone can experience this for very long.
It is quite unpleasant.
> And so this is my question: HOW LONG and HOW OFTEN?
There really is no consistent global pattern or periodicity to affective disorders. Rapid cycling is defined as four or more mood episodes per year. Of course, this seems like an arbitrary number. Symptoms must be present for two or more weeks according to the DSM for a diagnosis of major depression. This, too, seems arbitrary. For me, my system has been stuck on the down side for 25 years.
> Maybe I am describing an acute period within a much larger and much longer period of what could be called MDD.
It still sounds like double depression to me.
> At what point on the journey from dysthymia to that state I describe above do I hit MDD?
There might not be such a smooth transition so as to label it a journey. The MDD is more of an episode that tends to distinguish itself from dysthymia by being very much worse and punctuated. It comes and goes.
> The DSM doesn't really convery the intensity of the criteria it describes.
It does seem incomplete in its descriptions. I hope the next revision will help gauge severity.
When was the last time you feel that you were euthymic or normal?
- Scott
Posted by Phillipa on April 12, 2006, at 23:54:44
In reply to Re: HELP: How often how deeply do you get depress, posted by Don_Bristol on April 12, 2006, at 19:05:52
Can you be super anxious too? and depressed at the same time? this is the main thing that confuses me. Love Phillipa
Posted by ed_uk on April 13, 2006, at 15:58:30
In reply to Re: HELP: How often how deeply do you get depress, posted by Don_Bristol on April 12, 2006, at 19:05:52
Hi Don
>Reboxetine (and SNRI) was good but side effects were a problem.
What side effects did you have?
Ed
Posted by Don_Bristol on April 13, 2006, at 17:23:34
In reply to Re: HELP: How often how deeply do you get depress » Don_Bristol, posted by ed_uk on April 13, 2006, at 15:58:30
Ed wrote ....
--------------- START -----------
Hi Don>
> Reboxetine (and SNRI) was good
> but side effects were a problem.
>What side effects did you have?
Ed
--------------- END -------------
Hello Ed.First excuse my typo when I posted.
I guess you understood I meant to write "(an SNRI)".The chief side effect was Reynaud's Syndrome. My extremeties would, when they got a bit too cold, shut doen their blood flow and I would get very cold.
This was not a listed side effect at the time and when I reported it to the Doc he was a bit sceptical. I think this is now a listed side effect.
The Reynaud's was rather painful and I would get it in my hands in winter or when immersing my hands in cold water in the home. I would get it at the tip of my nose after a night in a cool bedroom (!!!) and don't blame the bedroom for being chilly because I never had that before or since the Reboxetine.
However it was a good med. Maybe because it is inherently energising and I seem to find that sort of med the typ which helps me (unlike the SSRIs).
Other side effects for me were minor increase i sweating, sliught mental confusion (not welcome), strange sexual response of reaching a weak orgasm *before* actually ejaculating, a sort of queasiness-nause-restlessness-tension (not much fun but just about tolerable).
Also some extra smell in body odor and smelly urine (but may have been due to a urinary infection).
Sleep was fine. Daytime physical *energy* (not mood) was not noticeably improved.
I trid it for about 6 or 7 weeks. Started at a gentle 2mg a day then went up quickly to 10mg but had to reduce it. Reduced slowly in 1mg steps every 10 days or so but saw that the side effects were still there even at very low doses.
HTH
Don
Posted by ed_uk on April 13, 2006, at 18:47:25
In reply to Re: HELP: How often how deeply do you get depress » ed_uk, posted by Don_Bristol on April 13, 2006, at 17:23:34
Hi
Have you ever tried lofepramine (Gamanil) or nortriptyline (Allegron)?
Ed
Posted by capricorn on April 16, 2006, at 14:23:52
In reply to Re: HELP: How often how deeply do you get depress, posted by Don_Bristol on April 12, 2006, at 19:05:52
Where is the demarcation line between 'major' and 'minor' depression? Sure one can define it via the criteria as defined by the DSM or ICD
but then deciding who fits into those observation based constructs is the task of psychiatrists
who are as prone to subjectivity as the the rest
of us mere mortals.That is not to say that there is not a quantative distinction between the two but that the distinction may not always be as clearly definable as the DSM etc indicates.
Also there is the fact that we as individuals may subjectively give differing interpretations
of objectively equal levels of those symptoms that
are lumped together and called depression.It is one of those things that i have against those depression rating scales that rely on
questions to which one is offered a choice
such as Just a little,Somewhat,Moderately,Quite a lot,Very much.
I have experienced what is clinically defined as 'major depression' .My worst episode being that which first lead to my being hospitalised at the age of 18.
I still gets bouts of depression that are endogenous but in the main suffer from what would
clinically be described as non-endogenous
event/stress related depression. It is a depression marked by dysphoria and too much emotion of a negative kind in a way that so called clinical depression isn't.The endogenous
depression being much more vegetative.With one i can't be bothered and don't what to do much or say much with the other ie non endogenous i am full of despair etc that is vehemently and angrily expressed.
The stress/event related depression is very accute and intense much more so than the endogenous depression but lasts for a couple of hours to a day or so at a time .
I can feel empty and emotionally dead then something happens and i'm plunged into a intense state of despair/depression and dysphoria with the emotions so intense that it feels not only that one could touch them but be badly burnt by the touching of them only for that intensity
to dissipate as rapidly as it appeared.By it's very lability it does not qualify as 'major depression' and yet those who think such
depression is a beast of a lesser kind ie not 'major' in it's own way are, to put it bluntly,shallow minded fools drowning in the sands
of their own barren intellectual wasteland.'Major depression' as clinically defined is a phrase of palpably limited worth .
Posted by ed_uk on April 16, 2006, at 19:27:07
In reply to Re: HELP: How often how deeply do you get depress, posted by capricorn on April 16, 2006, at 14:23:52
Good points Capricorn.
Ed
This is the end of the thread.
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