Dysthymia/Atypical Depression/Walking Depression

[spryte]

So...I've been struggling with this...exhaustion, for the last - going on three years now. It's weighed me down, it's affected every aspect of my life...it effects my thinking, how physical I can/want to be, my social interactions, my job, when I was in school - my school work - and definitely played into my decision to put off graduate school.

I was convinced that it was something physical. I have a lot of physical issues, so I just assumed that the tiredness was something that went along with that. "I'm deficient in some nutrient" "My hormones are off" "I have some unknown virus" (I was told by several practitioners that they saw evidence in my bloodwork/mineral analysis that I had some kind of low level virus)

What I've found interesting though...is that as hard as this emotional excavation that I've been doing lately has been...the more I do...the less tired I am. I'm still having a hard time getting off my couch, but I am not going through my days feeling like I'm dying from the inside out which is what it's felt like.

I haven't changed my diet.
I haven't started any medications.
I'm not taking my vitamins.
I'm not exercising.

I'm not doing any of the things that I've been telling myself, or have been told, that I'd need to do to not wake up in the morning counting the minutes before I could crawl back into my bed before my eyes even open.

All I've been doing is...this. Writing about stuff, talking about stuff, feeling about some stuff.

And I was reading a blog post about the stages of grief, and read this about depression:

Depression - Recently someone told my sister, that after she experienced the loss of her baby seven weeks after his birth, that the pain was so intense she wouldn't have been able to breathe, if her body hadn't done it automatically.  Sometimes "things" keep a person going - a memorial service to plan, children to care for, and when those tasks are accomplished, the grief and pain knock a person down and sit on our chests like a sumo wrestler.  We feel like not only can we not get up, but that we will never, ever be able to, and we don't want to.

I have thought repeatedly to myself over the years that I am not depressed. I don't sit around crying, I don't have days when I can't get out of my bed because I'm "sad" (although plenty of days where I have had to go back to bed, or that I've been just too tired to get out of bed) - I have friends, I have lots of things that I'm interested in, even if I can't find the energy to do any of them...all of these are features of what *I* think of as classic, clinical depression. And when therapists have asked me questions about depression, this is how I've answered them.

And I thought to myself...what if this is some kind of weird low level walking depression that no one really talks about? I actually know a LOT of people who...while they aren't clinically depressed, aren't especially happy or engaged in life either.

I asked someone, and they directed me to dysthymia.

"Dysthymia has a number of typical characteristics: low energy and drive, low self-esteem, and a low capacity for pleasure in everyday life. Mild degrees of dysthymia may result in people withdrawing from stress and avoiding opportunities for failure. In more severe cases of dysthymia, people may even withdraw from daily activities.[6] They will usually find little pleasure in usual activities and pastimes. Diagnosis of dysthymia can be difficult because of the subtle nature of the symptoms and patients can often hide them in social situations, making it challenging for others to detect symptoms. Additionally, dysthymia often occurs at the same time as other psychological disorders, which adds a level of complexity in determining the presence of dysthymia, particularly because there is often an overlap in the symptoms of disorders.[7] There is a high incidence of comorbid illness in those with dysthymia. Suicidal behavior is also a particular problem with persons with dysthymia. It is vital to look for signs of major depression, panic disorder, generalised anxiety disorder, alcohol and substance misuse and personality disorder.[8]"

Well then. When I'm really freaking honest with myself, that's me to a T.

And, doesn't it seem like dysthymia might be a major feature of c-ptsd? Except, I haven't come across it as a symptom. Has anyone else? Has anyone's therapist suggested it, or talked about it with them? Does anyone else feel like they struggle with this?

In addition there's this:
"Another study, which used fMRI techniques to assess the differences between individuals with dysthymia and other people, found additional support for neurological indicators of the disorder. This study found several areas of the brain that function differently. The amygdala (associated with processing negative emotions such as fear) was more activated in dysthymia patients. The study also observed increased activity in the insula (which is associated with sad emotions). Finally, there was increased activity in the cingulate gyrus (which serves as the bridge between attention and emotion)."

I have read a lot of stuff about the physiological effects of chronic stress and trauma on the brain. Those are the exact same brain structures that are affected by chronic stress. Everything from poverty, chronic bullying, domestic violence and abuse...and child abuse.

Very very interesting.
http://en.wikipedia.org/wiki/Dysthymia

******
The more I look into this, the more I question whether or not the kind of depression that I've been dealing with actually has a diagnosis. It doesn't quite fit Dysthymia, or even Atypical Depression, although it has features of both. What is becoming increasingly clear however is that there are many different kinds of depression other than major clinical which is all the intake questions that I've ever encountered focus on.

http://en.wikipedia.org/wiki/Atypical_depression

There are people who describe a "walking-depression" which doesn't sound diagnosable, but is a Thing that people struggle with.
http://www.gresik.ca/2012/03/10-signs-of-walking-depression/

^^That sounds very much like what I struggle with, including this:

We don't collapse and stay in bed all day. We keep working, keep writing, keep looking after our families. Keep blogging and tweeting and going out with friends. Keep taking our car to the service station. We just do it all while being profoundly unhappy.

Because we're strong-willed creatives. We are so strong that we endure unendurable situations far longer than we should. We are deeply committed and we want to do our best for others.

[spryte]

bheart - thanks for taking the time to look those up and share them with me!

I understand the emotional instability and everything just...being all mixed up.

I have to admit that "labeling" things and learning more about them is a coping mechanism of mine so I have to be careful how much of that I engage in. I have a tendency to run myself in circles trying to detangle all of this stuff and have really been trying hard lately to just...stay with my experience, whatever it is...and accept it for what it is.

I think I have to just accept that my definition of "depression" was too clinical, and that there are lots of kinds of low level depression that we deal with...and it just seems natural that it would be something that would go hand in hand with c-ptsd for all the reasons that your books described.

The trouble is that the questions that they ask in a clinical intake aren't specific enough, or don't cover enough of the permutations of depression. Atypical depression, for instance, features criteria like this:

"shares many of the typical symptoms of the psychiatric syndromes major depression or dysthymia but is characterized by improved mood in response to positive events."

I think I've had low mood for so long (since I was a teenager or tween) that it's just become normal to me - in addition to that, my mood DOES significantly improve in response to positive events...the combination of those two things means that when they're asking me questions about low mood, I'm answering in the negative, which then has them skipping a whole bunch of other questions about depression. (That's how those intake evals work)

So, I don't know. Label or not, I guess today it's just kind of eye opening for me that ..."Yes, I do deal with SOME kind of depression...it's been ongoing for a long long time, and is likely the cause of my tiredness, and probably a whole host of other somatic issues that I struggle with."

I guess now I need to decide what I'm going to do with that information.

[schrödinger's cat]

Is it okay if I put this in my list of flashback symptoms? Because holy sh*t, does that ever sound like something many of us might be struggling with. I am, for one. And over and over again, from what people say outright or from the tone of their posts, I'm getting this sense that they're quietly sad, low on energy, less able to enjoy themselves, etc etc. I'll put it as a suggestion in kizzie's thread on the glossary, too.

Thanks again for posting all this. I'm like you too, spryte - finding the right word for something helps me immensely. Once I've got a proper definition, I'm better able to get an overview of a problem, a bird's eye view, and I'm not stuck in a rut anymore, unable to see the wood for the trees. I always, always, always assumed I couldn't be depressed because I was able to pull myself together in social situations.

[spryte]

I think it would make a great addition - although, I am seeing it as more of an overall symptom of c-ptsd than hmmm...a result of an EF? How are you seeing this related to your EF's, or is it just that there are so many of them...maybe keeping you in that depressed state all the time?

I'd definitely like to see it added to the glossary.

quietly sad, low on energy, less able to enjoy themselves

I always, always, always assumed I couldn't be depressed because I was able to pull myself together in social situations.

Yes, yes exactly! And honestly, if it weren't for the fact that this soul deep exhaustion has started abating somewhat, I still might not have considered it as a factor. I know that extreme tiredness CAN be a factor in clinical depression...but since I didn't match any of the other symptoms, it seemed obvious that it was all physical...

[schrödinger's cat]

Hm, good point, spryte. I think it might be a form of Freezing or Dissociating, or something that accompanies those things. But it's maybe stretching things a little bit too far to just call this one long EF. Maybe it's an EF the way a penguin is a bird - a bit but not really?

But let's put it in the glossary, absolutely.

[spryte]

I'm going to start watching myself much more closely in regards to this. Because I'm not even sure that it's an all the time thing. There are times, like when I am with my boyfriend, that I am deeply happy, deeply joyful, and sincerely enjoying whatever it is that we are doing together.

And, I noticed a while back that for as much as I'd sit at work all day and engage online, have all these great thoughts and get all revved up about what I was going to do when I got home...between my office and my front door (which is about 15 minutes) I'd just...descend into this overwhelm state that included tiredness, mental confusion, anxiety and depressed mood. By the time I walked in door, I had just enough mental energy left to get to the couch and turn on Netflix. God help me if I had something I actually had to do...that required like...a major infusion of caffeine, and maybe a nap before hand.

So it's like...a not-all-the-time depression that's related to overwhelm that's related to FOG that's related to collapse??? 

[LilyITV]

OK I'm trying to resist my urge to bump old posts but finding so many golden oldies on this board.  I am wondering now if I have been suffering from dysthymia.  I too have suffered with fatigue over the years and from time to time have taken supplements.  There are many days when I don't have a reason to get up where I will stay in bed way too long.  I have small kids so I really dont' have a choice but to keep moving.  I've also blamed my fatigue on being a parent. 

Depression is such a hard illness to understand.  It sounds like with dysthymia, you live with it for so long you think the feeling is normal. 

I'm also noticing that after starting therapy changes in my energy levels--there are days when I feel really really good.  I'm wondering if these times when I'm feeling good are actually what for other people is actually "normal". 

[Blueberry]

LilyITV, as far as I'm concerned it's quite OK to bump old posts. There is a lot of worthwhile information in ones like these. When somebody like you bumps them, it gives others who've joined in the past couple of years the opportunity to see them too.

[LilyITV]

Glad to hear that you share my views on old posts.  I also like to get more responses from others and updates from the OPs. 

[Rainagain]

I've said this on here already but it might be helpful to someone:

Psychiatric diagnosis 1 was dysthymia and cptsd.

Psychiatric diagnosis 2 was PTSD and major depressive disorder (with an ongoing depressive episode).

Psychiatrist 1 read the diagnosis of psychiatrist 2 and told me 'Our opinions are basically similar'

I have posted about the help I got from professor sapolski's utube lecture, he describes depression using the same mechanism as the explanations I have read about PTSD and CPTSD.

They involve alterations in the same brain chemicals, they involve the same areas of the brain and the treatments for depression look exactly like the treatments for cptsd.

Also, C/PTSD has high rates of comorbidities. Often with depression.

These disorders are closely entwined, I'd say they could be one larger thing.

Not comorbid, just aspects of one thing that underlies all of the symptoms and causes them all.

Sapolski said in his lecture that depression often comes from bad childhood experiences and trauma, just like cptsd and PTSD.

Maybe I don't have two (or possibly 4) disorders, maybe I have one disorder that just fits 2 or more different DSMiv categories of disorder?

If I had a skin infection it would probably consist of several different types of bacteria, but it isn't classed as 2 or 4 concurrent simultaneous infections, you treat one skin infection with antibiotics and it all (hopefully) goes away.

[LilyITV]

Rainagain, that makes total sense.  I also loved the idea of treating several different types of bacteria with one set of antibiotics.  My therapist hasn't shared any of her diagnoses of me, but I would feel pretty deflated if  she rattled off a long list of disorders.  It gives me hope that even though I've suffered with C-PtSD for so many years that the treatment won't have to take years and years. 

[Rainagain]

I think if you work on the cptsd other possible issues will also improve, I hope that is the case for you.

If its all part of something larger then I think that could be right.

[LilyITV]

It looks like in my case, the depression has taken over.  My therapist has referred me to a psychiatrist to see if I need medication for depression.  She thinks that meds may give me the boost I need to continue working on my issues. 

[Rainagain]

I would give the meds a go if it's some form of SSRI, you will know if they are working in around 2 months, sometimes they work really well.

[LilyITV]

Rainagain, I was prescribed Zoloft and I've been taking it for about 2 weeks.  I seem to be responding well to it.  The first positive effect--which happened within hours of my first dose--my energy returned. 

I can't even put into words how much being on this drug has changed me already and I'm still in the early stages of recovery.  I realize that I have been depressed basically my whole life.  I thought feeling this way was normal and now I realize I haven't even been living for the past 35 years. 

I was trying so hard to overcome my C-PTSD for the past year, but I realize I never would have had a shot without medication.   I am rereading your post about how C-PTSD, depression and how they all might be intertwined in one and understanding it in a different way.    My early life experiences changed my brain chemistry in a measurable way. 

I know I'm not making complete sense.  Still trying to wrap my head around it all.