Patterns in Depression and Dysthymia

Once, a few years back while in a therapy session, my doctor mentioned to me that although she didn’t like to label, she had diagnosed me with dysthymia. At the time I didn’t think much of it, figuring it was just a particular diagnostic class of depression and that I didn’t need to know the details. But for a number of reasons recently, I decided to look into what it meant. In short, dysthymia (sometimes called chronic depression) is a form of mood disorder which has similar symptoms to depression, but they are often milder and last longer, for years. For me, the symptoms could be described as varying levels of hypersomnia, hopelessness, anxiety, guilt, loss of interest, sadness, and excessive crying, although many people experience it differently.

I’ve always felt that I was particularly sensitive to environment, in that in certain surroundings and social groups, the effort it would take to pull myself out of my self-critical thought patterns and incessant negative thoughts was more than I could manage. So I carefully considered the location of my university choice so as to put me in the place I felt most comfortable. For me, that place is a big city: a place so abundant with people that although I am surrounded by them, very few of us have the time to observe our neighbors closely, care about their choices, or actually express to them that we are uncomfortable with their differences. To me, this is the place where I can be me, find others like me, and find the inner strength to not worry about whether or not I fit in and am liked by the people I encounter each day. Living in this city filled with life and energy quells my anxious thoughts and helps me to be both carefree and driven. I feel at home here, and I love to show my acceptance of all the varied people who are my neighbors. And I can find any service that I need quickly, while not having to return to the car culture that my youth was so entrenched in. I firmly believe that this is both a great place to be and a great place for me.

Dysthymic people can also suffer from major depressive episodes, in this case termed “double depression.” I think I’m beginning to see some patterns to when my stronger depressive episodes develop. This last few months, there have been similarities to the depressed period which had originally brought me to my therapist in the first place. It seems that I am very sensitive to my social environment. When I was skating, it meant my home club and coaches. In school this meant my classmates and professors. At work it’s my coworkers and bosses. While some uneasiness may kick in right after a switch (new semester, new job, etc.), I’m often buoyed for the initial period by my love of new things. To me something new is something to learn from, and I love learning. But after the newness wears off, generally 3 to 6 months in, things get bumpier. I often start to really notice the people around me, and in many cases I start to fixate on the feeling that I don’t belong.

As I write this, I can remember so many times when this has happened. The first instance when I felt this way to the degree that I was not in control of my thoughts was when I was 17, and my training routine at the rink had changed. I was skating full-time at a club that I had rarely felt quite right at, and I was not able to spend much time at my favorite club, the place where I really felt at home. Many of my closest friends, skaters at that club, had moved on to other things. My coaches had decided to teach exclusively at this place that never felt as homey, and I found myself surrounded by ambitious young skaters. I was unable to value the maturity and strength that my skating had, and I only saw myself as a giant among little girls in a sport where smallness is an advantage. The bulimia that had began less than a year earlier spiraled out of control, and by the end of the summer I decided to quit, thinking that taking myself out of this environment, this competitive skating world, would help me heal. At the time, I didn’t realize how long that process would take.

Years later, when I was a junior in college, it was the beginning of classes with other driven students from my major field of study that led to this place. At first I did well enough, enjoying the challenge and the new things to learn. But as the semester wore on, the attitude of my professors and classmates wore me thin. By Christmas I couldn’t bear to attend the Holiday Party for fear that my professors would secretly be laughing at me for thinking I had a place in the department. By spring, I was missing classes and homework assignments because I couldn’t bear to turn in what I thought was such poor work or even to get out of bed and face the day. At some point I got low enough to feel that I was out of control and that my school success was in danger, and I wrote an emotional, pleading e-mail to my Dean. And so began that road to recovery.

Having been acutely aware of my environment, when I found myself struggling not long after having entered my first office job, I figured it was pretty normal. I was in a new environment, a foreign environment to me, and it would take me time to learn the ropes and find my place. But now I think it’s more than that, and I’m beginning to see the similarities to other situations that have led me to this emotional place.

This time, I was nervous about the new setting and lifestyle. But for the first 3 months, I was happily engrossed in a high priority, fast-paced project. I drew energy from this and didn’t concern myself much with the coworkers who weren’t on the project. There were many instances of a coworker’s statement or behavior being an unpleasant surprise to me, but the good parts outweighed the bad, and I could almost say that I was loving my job.

Then, in July, that project’s major deadline passed and I didn’t have much to do for it anymore. My work day slowed down, and I took on more varied tasks requiring interaction with more of my coworkers. And the feeling that I didn’t belong grew stronger.

Now, It’s been 6 months since I started this job, and I’ve been feeling somewhat out of control of my thoughts and emotions for the past couple of months. By the end of August it was pretty clear to me that I was having more difficulty than normal, healthy people do. This was compounded by my period of no health insurance (I had to wait 3 months after my job began to get health benefits) and the difficulty I had in obtaining my antidepressant prescription, which I’d been on for over 5 years. I managed to get the Rx, but not without significant stress, cost, frustration, and two hospital visits.

It was at the second of those emergency visits (I had tried but been unable to find a psychiatrist that would see me, a new patient, on short notice, and my therapist was out of town) that I realized that my struggle to adjust was outside the bounds of healthy behavior. I confided in the doctor that I had cried at work almost every day the prior week, and she said that sounded like the meds weren’t working. She let me go home with a prescription and the promise that I would go to my new psychiatrist appointment the next week¬† and come back in if I couldn’t make it until then. To top things off, this particular visit marked the first day of our “staycation,” and I spent the whole day in the hospital (the wait was over 7 hours!). I resolved to shake the feeling that I couldn’t even properly enjoy a vacation from work, and Husband and I made the best of the rest of our time off.

Since then it’s been a struggle, but I see the light at the end of the tunnel. My insurance has kicked in and I’ve found a psychiatrist that I feel comfortable with. We increased my dosage in September, and things have gotten only slightly more manageable. He said if things were still rough by this week, I should go back in and we’ll try a combination instead. So I will do that this week, and try it out for a while. Between him, my therapist, and the support of my husband and friends, I will get out of this rough patch too.

*Edited slightly from original posting