Forever on and on I Continue Circling With Nothing but I Hate and the Paralyzing Agonizing

February 9, 2012 • Contributed by Cynthia W. Lubow, MS, MFT

Depression doesn't go away for everyone. For most people, depression is temporary and passes naturally or once the person has expressed the feelings and resolved the thoughts causing the depression. But there is a small percentage of people who can talk about their issues, express their feelings, take very good care of themselves emotionally, even take medication and have a great life, and still be depressed throughout their lives. They may have periods of feeling good, periods of feeling less bad, and periods of feeling horrible—for these people, the depression never goes away permanently.

Major depressive disorder is the medical term for repeated episodes of a very intense, deep depression that is disabling and enormously painful. People who are bipolar experience similar disabling depression during their depressive phases. Often, between episodes, people return to a functional, happy state. Sometimes people can also have a milder depression, even between episodes of major depression.

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There are also people with "atypical" depression who can be in a deep depressive episode and yet appear to come out of it long enough to laugh or enjoy something briefly before sinking back in, or can act normal for short periods. This can be confusing to both the depressed person and to other people. This isn't an indication that the person is any less depressed or any less in danger than someone in a major depressive episode who doesn't have those brief breaks. It's just a different form. Atypical depression is also characterized by feeling emotionally paralyzed, physically leaden—barely able to move or engage in any activity, and often overeating, oversleeping, and experiencing sensitivity to rejection.

It's difficult for most people to understand any kind of deep depression if they haven't experienced it. What people see with illnesses or injuries is a runny nose, blood, expressions of acute physical pain, or an x-ray of what hurts. What people see when someone is seriously depressed is a person who isn't doing anything; this person may be crying or snapping at them or sounding insecure and hopeless. These are behaviors we associate with personality and moral character—we think these are choices people are making, not an illness that has taken over their personality. Most people wonder why the unrelentingly depressed person doesn't just get over it and may even wonder if it's a manipulation or if the person is just lazy, weak, or giving in to something he or she could fight. It is difficult for the person who experiences it to describe because it is intensely painful, but not in any particular part of the body. It can be totally debilitating and sometimes even fatal.

People with chronic, severe depression are not indulging themselves, lazy, giving in, manipulating, or exaggerating their pain and dysfunction.

People with chronic, severe depression are not indulging themselves, lazy, giving in, manipulating, or exaggerating their pain and dysfunction. Taking this view is often destructive to them and the situation. While this kind of depression can be described as an illness, compared to other debilitating, painful, potentially fatal illnesses, it is pretty unique in the affect it has on people's minds, behavior, personality, and thought processes. When the mind is part of the illness, other people may not recognize the ill one as the person they love, and that makes it more difficult to be patient, to take care of the person, and to remember what they loved about the person, much like when a loved one has Alzheimer's.

Of course, this is all true for someone who has one episode of major depression, but it becomes much more complicated when it is recurring and takes over a person's life. We know that, statistically, every major depressive episode someone has makes additional episodes more likely. So once a person has had two or three such episodes, it's pretty clear that more of them will happen, and likely with increasing frequency. It's also likely that during significant hormonal events, such as menstruation, pregnancy, childbirth, perimenopause, and menopause, women with recurring major depressive episodes will be especially vulnerable to having another episode.

How does a person live with a chronic disability that can't be effectively described to those around them? How do people function? How do loved ones take care of them long-term? How do relationships survive?

References:

1. Depression In-Depth Report. (n.d.). The New York Times. Retrieved from http://www.nytimes.com/health/guides/symptoms/depression/print.html
2. Women and Depression: Discovering Hope. (n.d.). National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/index.shtml

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Cynthia W. Lubow, MS, MFT

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