Learning to Live with Major Depression

Depression is a common ailment in our ever more complicated world. You feel down and may weep for a few days until whatever triggered your depression is somewhat reconciled, and you move on.

This is not the case with major depressive disorder (MDD). People who have MDD are not able to “pull themselves up by their bootstraps and simply move on because they are suffering from a disorder that needs treatment.

This article will explore what major depression is, how it affects your body, the co-occurring diagnoses, including complex post-traumatic stress disorder, and ways to deal with it when major depression flares.

The 6 Types of Depression

Affecting more women than men, depression is much more than the blues as the person living with its effects feels trapped in a never-ending world of sadness and disconnection.

Let’s explore together the six types of depression.

Dysthymia. Otherwise known as persistent depressive disorder, dysthymia is a long-lasting and mild type of depression. People living with dysthymia experience less severe symptoms than those with major depressive disorder. When you have dysthymia you are always down, but it does not greatly impact your life.

You may have had dysthymia for so long that you think your ‘down’ feelings are normal. The symptoms of persistent depressive disorder are as follows:

  • Sadness, emptiness
  • Feeling blue or ‘down’
  • Loss of interest in normal daily activities
  • Feeling hopeless
  • Lack of energy and always feeling tired
  • Low self-esteem
  • Self-critical
  • Feeling incapable
  • Trouble concentrating
  • Trouble making decisions
  • Decreased activity and productivity
  • Sleep problems
  • Feeling guilty
  • Obsessing over the past

Children too form dysthymia, but their symptoms also possibly include depressed moodiness and irritability.

Bipolar Disorder. People who have bipolar disorder experience wild swings between times they experience depression and periods of abnormally high activity (mania). When the mania is extreme, it is called hyper mania.

Bipolar disorder can, without treatment, significantly impact the person who has its everyday life. Hyper mania sometimes requires hospitalization and can affect a person’s sense of reality when the person presents with psychotic symptoms.

During a depressive episode, the despair can become so prevalent that they too require hospitalization. Also, during a depressive episode, the person may experience any of the signs of dysthymia or major depressive disorder plus a few more, such as:

  • Feeling pessimistic
  • Having a great deal of self-doubt
  • Hallucinations or disturbed logical thinking
  • Suicidal thoughts or actions

During a mania presentation, the person may have:

The manic phase of bipolar disorder may include:

  • Feeling elated
  • Talking fast
  • Feeling like they have lots of energy
  • Feeling important
  • Easily irritated
  • Delusions or hallucinations
  • Disturbed and illogical thinking
  • Not needing sleep
  • Not eating
  • Doing or making decisions that have drastic consequences

Bipolar disorder is debilitating with the person living with it often having unstable relationships.

Seasonal affective disorder (SAD). This kind of depression usually follows a seasonal pattern, with most people experiencing it during the winter months when it is darker outside. Although it is most commonly felt in winter, it can also occur at other times, such as when the times change during daylight savings time and in spring when the weather gets warmer.

SAD affects as much as 10% of the population and has been linked to a lack of vitamin D, a substance normally manufactured when your skin is exposed to sunshine. Light therapy is used to counter this seasonal effect.

The symptoms of SAD are below.

  • Feeling listless and sad
  • Loss of interest in activities you once enjoyed
  • Feeling sluggish
  • Problems sleeping
  • Having cravings for carbohydrates causing weight gain
  • Feeling hopeless
  • Feeling guilty
  • Experiencing thoughts of not wanting to live

The symptoms of SAD start out mild and grow more severe with time.

For the sake of the length of this piece, the other three types of depression are psychotic depression, postpartum depression, and our topic for today, major depressive disorder.

What is Major Depression?

Major depressive disorder (MDD) is ranked as the third cause of disease worldwide by the World Health Organization with a prediction that it will rank number one by the year 2030.

Major depression often accompanies the diagnosis of dissociative identity disorder and complex post-traumatic stress disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that for a provider to diagnose someone with major depression they must meet the following criteria.

  • Depressed mood
  • Anhedonia (lack of pleasure in things)
  • Rule out a history of manic or hypomanic episodes

Other symptoms that are not noted in the DSM are:

  • Decreased interest in things that once brought pleasure
  • Poor concentration
  • Lack of energy
  • Poor concentration
  • Feeling worthless
  • Feeling guilty
  • Slowed bodily movements
  • Sleep disturbances
  • Lack of appetite or heightened appetite
  • Suicidal thoughts or actions

Major depressive disorder is a life-altering and often devastating diagnosis.

Co-occurring Diagnosis of Major Depressive Disorder

As if living with major depression weren’t bad enough, people who have MDD often have other diagnoses that are also life-altering. The following diagnoses that can accompany MDD and their explanations are given below.

  • Anxiety disorders
  • Complex post-traumatic stress disorder
  • Dissociative identity disorder

Anxiety disorders. The National Institute of Mental Health states that 18% of adults living in the United States have an anxiety disorder. Anxiety forms from a combination of factors, including genetic and environmental factors.

There are basically four types of anxiety disorders: generalized anxiety disorder, panic disorder, specific phobias, and social anxiety disorder. All four kinds of anxiety disorders are devastating to those who have them, especially when they accompany complex post-traumatic stress disorder.

Complex Post-Traumatic Stress Disorder and MDD

Complex post-traumatic stress disorder (CPTSD) is a mental health condition that is formed out of ongoing, inescapable trauma. Usually forming in childhood, CPTSD is estimated to affect 70% of adults or 223 million people in the United States. The National Council for Behavioral Health (NCBH) states that 90% of those experiencing CPTSD were victims of childhood sexual abuse, and 33% were exposed to community violence as children.

The effect of complex post-traumatic stress disorder is to leave adults who grew up in dysfunctional homes struggling to feel safe and having great difficulty forming and maintaining healthy relationships.

Research has found that approximately half of the people who experience complex post-traumatic stress disorder also have major depression and they share overlapping symptoms (Flory & Yehuda, 2022). However, it is believed that having both CPTSD and MDD represents perhaps a subtype of PTSD and might include a biological component.

Healing from both CPTSD and MDD requires changing daily habits while in psychotherapy to reclaim one’s sense of agency, sense of self-worth, and self-esteem.

Tips for Living with Major Depressive Disorder

The Substance Abuse and Mental Health Service Administration (SAMHSA) offers some tips that will help you heal besides medication or therapy. I quoted these tips directly from their website.

“Focus on self-care. Control stress with activities such as meditation or tai chi. Eat healthy, exercise, and get enough sleep. Most adults need 7–9 hours of sleep per night. Avoid using alcohol and recreational drugs, which can worsen symptoms and make depression harder to treat.

Set small, achievable goals. Set realistic goals to build confidence and motivation. A goal at the beginning of treatment may be to make your bed, have lunch with a friend, or take a walk. Build up to bigger goals as you feel better.

Know the warning signs. Recognize your depression triggers and talk to your doctor and/or mental health professional if you notice unusual changes in how you feel, think or act. If needed, your doctor can safely adjust your medication. Write down how you feel day-to-day (moods, feelings, reactions) to spot patterns and understand your depression triggers.

Educate family and friends about major depression. They can help you notice warning signs that your depression may be returning.

Seek support. Whether you find encouragement from family members or a support group, maintaining relationships with others is important, especially in times of crisis or rough spells.

Stick to your treatment plan. Even if you feel better, don’t stop going to therapy or taking your medication. Abruptly stopping medication can cause withdrawal symptoms and a return to depression. Work with a doctor to adjust your doses or medication, if needed, to continue a treatment plan.”

Ending Our Time Together

Major depression, especially when accompanied by complex post-traumatic stress disorder, can make life a living hell. Between the daily fear and the feelings of hopelessness and helplessness felt by both diagnoses, there are constant messages playing in your head telling you that you are a loser and should never have been born.

This author has lived with both diagnoses for many years and has only recently, within the past five years, begun to see improvement due to new medications and psychotherapy.

Although I still have breakthrough depression, I currently am stable and my depression is in remission thanks to a good therapist and a great psychiatrist who has given me the right combination of medications.

My final thought for you is that although major depression is not curable, it also is not a life sentence. Major depression is only part of who you are and not your entire identity. With work and help from a mental health professional, you too can experience a remission of your symptoms and feel much better.

The CPTSD Foundation understands your needs and hopes you seek help and that your therapies help you quickly.

“A positive mindset can be beneficial to your present and future self.”- Angel Moreira

“This all raises the question of whether depression is something you can control by simply sucking it up. My answer is no, I don’t think you can overcome it with willpower, but I believe that dealing with depression is a choice that needs to be made. You must choose to stand up every day and keep going. To reject your default settings.” — David Chang

References

Bains, N., & Abdijadid, S. (2021). Major depressive disorder. In StatPearls [Internet]. StatPearls Publishing. Retrieved 11/22/2022 from: https://www.ncbi.nlm.nih.gov/books/NBK559078/

Flory, J. D., & Yehuda, R. (2022). Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations. Dialogues in clinical neuroscience. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518698/

Originally published at https://cptsdfoundation.org.

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Successfully equipping complex trauma survivors and practitioners with compassionate support, skills, and trauma-informed education since 2014.