I Wish You Knew

I Wish You Knew

(written a few years ago for my family) 

I wish you understood depression and how it’s affected my life.

I wish you knew what it's like to want to die. To want to die when you have beautiful kids and grandkids who you know love you, to want to die in spite of knowing that you have a blessed life. To be thankful for so many things in your life, but to have no joy in them.

I wish you did understand but to understand you’d probably have to experience it, and I’m glad you haven’t for your sake. But still, sometimes I wish you knew what it felt like to be me.

I wish you knew how the pain inside makes life so hard … and my life is not that hard when you look at it from the outside…it’s just hard being on the inside.

I wish you could understand the strength and depth of the emotions in my life.

I wish you knew how hard I’ve tried to stop feeling like this. I wish you knew the research and the people I’ve talked to, to try to make this better. I wish you knew the meds and the side effects I’ve endured to help myself.

I wish you could see how I have worked hard to put in place actual strategies to stop myself ending my life… the photo of my kids on my car visor to deter me from driving into a tree, the hundreds of hours of soaking myself in worship music and the friends I have who I know will ask me honestly about how suicidal I am.

I wish you knew the deepness of the pain this depression causes, the physical-ness of the pain.

I wish you could understand how hard it has been at times to pull myself out of bed and to just function at a basic level.

I wish you knew that when you wonder about me and why I haven’t reached my full potential - why I haven’t really made much of my life, when I have so much ability - that I too am aware of this … that I see others doing and achieving things that I want and know I could do if I didn’t have to spend all my energy fighting the depression … and that sometimes when things are good I feel like I still can…until it hits again.

I wish you knew how hard it is for me sometimes just to LIVE, to do small talk, to look ‘normal’, to enjoy things. I wish you understood that when you see me I am usually putting in a huge effort to appear ‘normal’; that when you look at me, what you see is not really ‘me’…inside I’m in pain and sometimes just holding on…though you wouldn’t know it.

I wish you could understand that sometimes I have good days, yes even good months, but it always comes back. And those good times probably makes it harder for you to understand me…you see me doing things and you don’t understand why sometimes I can and other times I can’t.

I wish you knew the relief I felt when I swallowed those tablets, how I knew that it would be over, the pain was going to stop, that I would be with my Lord and that my family would be free from the burden that I am.

I wish you knew how I now work hard to fight the desire to end it all. How those thoughts come unbidden and when I am weak they seem to speak truth.

I wish you knew how much I wanted and tried to be close to you but felt so judged.

I wish you knew what its like to have your brain, your mind, your thinking, just stop working; to look at something and not be able to process thoughts about what it is and what to do. 

I wish you knew how tough it is to look at your child and to know you love them, but to feel nothing. And how sad that in itself makes you feel.

I wish you could understand how someone can be a devoted Christian with a deep love for their Father God, and still struggle with life; that a Christian can experience deep hopelessness while still having a strong faith.

I wish you understood that for a person with depression the ‘joy and hope’ of being a Christian is found in the knowledge that one day they will be with Him, and that being a Christian means you lose your fear of dying and that in fact it becomes even more desirable because you know that to be with Him is to be free from the pain and sorrow of the depression.

I wish you knew and could understand these things, but I’m kind of glad for your sake that you don’t, that you won't ever experience the depths of this depression….so I wish you knew these things but I’m glad you don’t.

I wrote this a few years ago when things were tough, when severe and chronic depression had been a part of my life for 9 years. I do not experience the depths of depression like this now, and haven't for 3 years. Yes sometimes it comes back when life gets hard, but it doesn't stay with me (I will write about my healing in another post). 

I've posted the above writing for 2 reasons: Firstly, to help people who haven't experienced anything like this to understand how it feels and how it can take over a life and debilitate a person. Secondly to show that even in a depression this bad and which may go on for many years, it can change. It can leave, with God there is hope where there is no hope.

If you feel like this or know someone who does, please write to me. I would love to hear from you...

My life story and personal experience with depression

This is my ‘life story’ as it relates to the depression I have experienced. I wrote it in 2009 as part of the introduction to the book on depression that I am writing. I’ve had a few people ask me about my personal story, so thought I’d include it as a post on this blog. . . here goes. . .

Another valentines day . . . just another day. I'm so sick of seeing red hearts! I guess it doesn't help that I am in one of Adelaide's most romantic tourist places, Victor Harbor. Couples come here to be romantic on a normal weekend let alone the once a year red hearts and chocolate day. So of course I'm feeling sorry for myself . . . who wouldn't! Especially as this is my 48^th valentines day [remember - this was written in 2009, when I was 48] and I'm not only spending it alone but I'm spending it homeless and sleeping in my car albeit with my laptop on which I’m writing this.

How did my life come to this, I wonder? Fifteen years ago I had a nice home nearly paid off, a husband and three young children. I was a 'good-Christian-wife’ . . . well that was my aim anyway . . . I tried to do everything that we were told good Christian wives did. Since then I have had 2 divorces, worked overseas for 6 months, got myself an honors degree, raised 3 children to adulthood, lost my home, attempted suicide, and suffered from chronic and severe major depression.

But just telling you my life story is not why I'm writing this . . . I want others to know that you can go through desperate times with debilitating depression and that even when you don’t get the support from your church, or Christian loved ones, you can still come through with a strong faith. I still have depression, and I have come to realize that until God makes his healing visible in my life, I have a life to live through the symptoms of depression. It’s hard for anyone with this debilitating illness but I believe harder still for those who have the added guilt and misunderstanding surrounding depression that being a Christian brings (and in particular those of us who were brought up in 'Christian' homes).

So then, this will hopefully be an encouragement to those Christians suffering from depression. I also hope this helps those of you who have a loved one who needs your support. Everyone’s experience is different, but there are also many similarities, and maybe knowing someone else has gone through something like you may be going through will make a difference.

I'm guessing that a middle-aged woman with a car and a laptop doesn't really fit your idea of a typical homeless person, so perhaps I'd better explain how I got to be this way. . .

Me, aged about 10

I was the eldest of five children, brought up in a very strict Pentecostal home in the 60s and 70s in Adelaide. Although my parents lived together until my dad died 18 months ago [2007], my father only became an influence in my life in the last few years of his life. As a child I remember him as always sick (somewhat of a child's perspective perhaps) and unavailable to me.

My mother was a very controlling force in my life, and I don't remember her being happy very often. As a child I seemed to be always in trouble, receiving innumerable hidings. I don't remember feeling naughty or rebellious and my mum can't remember now why she smacked me so often, but I'm sure it affected me. I remember trying to please mum but always seeming to fall short. I failed at school, leaving at the beginning of year 11 to work in a shop. In hindsight I can see now that I actually suffered from depression in my teenage years.

My dad, 4 siblings and me (at the back, on the right)

I married at twenty, a very immature twenty. Looking back I know it was basically to escape my home. It was really the only Christian thing I could do that would still qualify me as a 'good Christian'. I determined that my marriage would be very different to my parents. I had seen what a dysfunctional marriage was like and in trying to be the opposite of that I acted like a doormat, thinking that I had no rights in the marriage. Because my only teaching had been from my parents and the church, which promoted that a wife is submissive at all costs, I knew nothing about being assertive. I guess I thought that you were either aggressive or passive. I didn't know that there was an in-between that is actually how the Bible wants us to be.  

My wedding day, 1981

My husband was a good man, but he was also operating out of a difficult family background and although we tried our best, things deteriorated, and by the twelfth year of our marriage he was ready to leave. We had three children by then . . . Tim was ten, Mike eight and Libby 5 when he left. I can't explain the devastation I felt. I was so confused. How could this happen when I had tried my best? Good Christians don't get divorced. All I had ever wanted was to be a wife and mother. I had failed at being a wife, and how could I be a good mother when I'd failed at my marriage and so was not providing a stable home for my children?

This was 1993 and at that time even though divorce was rife in the community I think people just didn't stay in the church when it happened to them. I certainly didn't know any people in this situation. I felt a huge failure, to my children foremost, but also to my parents, my siblings and to God. I didn't know where to turn. Nowadays some churches offer divorce support groups but back then that wasn't an option. So I kept going to church (a very large Pentecostal church), coming in just after the meeting started and sitting at the back, leaving just before it finished. I didn't want to talk to anyone. I felt so deeply ashamed. I couldn't see a purpose to my life, but knew that I had to keep going for my children's sake. I had been involved in leadership in women's home groups within the church. I ran a young mum's support group and we also had a youth home group at our home. I pulled out of all of these and I felt a huge responsibility towards those Christians who may have been negatively affected by my marriage failure.

About 2 years before we separated

I was stunned and bewildered about why my marriage had failed. The only tangible reason for my husband leaving that I could understand was that he was dissatisfied with me as a wife, which made me feel even more confused and of course I blamed myself. At that time in my life I felt as though I was hanging on by a thin thread. And that thin thread was Jesus. I journaled, but I didn't get help from doctors or counselors as I still held the belief that I should be able to work through this on my own. I believed that the way I was feeling was my own fault somehow. I was still under the assumption that if I was just 'right' with God, I would get rid of the depression.

I remember once hearing a senior pastor from my church on the radio. He spoke about how the statistics showed that children from a broken home are much more likely to become drug users and prostitutes. I can’t remember everything he said, but I know it left me feeling even more of a failure. But that was the view of the church back then – more to try to warn people off getting a divorce at all costs than to help those who were going through it.

My family were all involved in the church and my grandparents had been missionaries in India and were involved in the early years of the AOG church in South Australia many years ago. So I felt that I had a lot to live up to –  and I was glad my grandparents were not around to see my failures.

            My missionary grandparents - my mum is on the left aged about 12

It was a very difficult time in my life and the first time I felt suicidal thoughts. I wanted to die, but had such a strong belief that I had to be there for my children that I fortunately never did anything about it. I know that I was not there for the kids emotionally though. My ex husband and I were able to sort things out regarding the house amicably, and he had the children once a fortnight and also fortunately for me was very committed to paying his child support. So I got on with life. I felt sometimes like I was two people . . . one that was doing everything I was meant to be doing, and the other that was just looking on. I wavered between feeling numb and deep feelings of despair and overwhelming hopelessness. The depression for me meant I felt deeply sad, so sad that it hurt physically. I had no hope for any future. The feelings of failure were extreme. I had to force myself to get up in the morning, but I think the fact that I had children relying on me was what made me do things. I know I failed them at that time in the area of their emotional needs. But how can you be there for someone else emotionally when you are struggling in that area yourself? This may be hard to understand but I actually grew closer to God in this time. After all He was all I had left. Even my children were not enough for me to get through. I felt as though God was my only thin thread to sanity. I knew He loved me even though I couldn't feel it. I read the Psalms often as that was often my only small comfort.

I had experienced my first major depressive episode when I had my daughter, Libby. I had postnatal depression which lasted for about 6 months. I didn't see a doctor then as I guess I believed that I should be able to cope on my own. Time helped that pass. Looking back  I believe I was depressed for the couple of years before my marriage ended, and I'm sure it contributed to the ending of it. But when my husband moved out I found it so hard to cope. I struggled to do everyday things. I didn't want to go out, and stopped contacting my friends. It was just so difficult to make myself do anything. It took all my energy to go shopping. I had no reserves to pull from and absolutely no motivation to force myself to do things. At one stage my two lovely sisters, who were heavily involved in the church, wanted to do something to help me and they offered to come and pray with me every week. So they would come round and we would spend some time in prayer (mostly them praying). They were trying to help in the way that they knew. But we didn't talk about anything, and in fact they didn't even stay long after the praying. (I was probably not much company!) I felt as though they only cared about my spiritual side, so I asked them to stop coming round. I know looking back that they didn't know what else to do, but it made me feel even worse as it felt like they were only concerned about me spiritually and not in any other way. My depression made me very over sensitive and reactive.

This intense depression lasted for around twelve months. I didn't get help from a doctor, and looking back I wish I had as it would have been about 2 years before I felt 'normal' again. In fact, I can remember sitting outside one day and hearing a bird singing, and having a sense of peace come over me and thinking...wow I actually feel normal!

To make a long story short . . . After 18 months I began a university degree in primary school education. I actually don’t even know why I applied . . . it must have been a God thing! The funny thing about it was that I had always thought of myself as, well, just plain stupid! I didn't do well in high school averaging C’s and D's and leaving before finishing year 11. But as a mature age student I found I loved to study, and I got good marks. That was certainly a boost to my self-esteem. It took me 6 years to complete the 4 year degree and I think, even though it was hard work, probably helped the depression to lift.

So I studied, and did some part time work, and brought my children up. We moved to Aldinga, a seaside country community just under an hour from the city of Adelaide (where most of my family and the children's father lived). I bought a home there and things became more settled, although I did have an episode of mild depression a few years after moving to Aldinga. This time I sought professional help and the depression lifted a few weeks after starting antidepressants. After I obtained my degree I realized I didn't actually want to teach, I wanted to do research. So I began a PhD. I loved it. It was hard work as I had the three children who were by this time, 17, 15 and 12. I worked 37 hours a week on the PhD and also worked part time to supplement the single parent pension. However my life was about to change, and I was about to make the greatest mistake I have ever made.

I met a man who was an Associate Pastor. We began a relationship. He swept me off my feet. He was attentive, romantic, and he made me feel special. Just before we married and after completing 6 only months I gave up the PhD so that I could concentrate on helping him in his church community work and also do more paid work as this was what he felt I needed to do. And I did what he wanted because I thought that was what a good wife did – I thought giving up what I loved and was good at, was part of being a submissive Christian wife. Anyway we married. 

A bride, 2nd time around, 2003

Our wedding night was the worst night of my life. I saw his other side. He became very controlling, but often in a subtle way. He was abusive but as I still had the view that I needed to be submissive and believed that the problems we were having were all my fault, I probably perpetuated it. I had been so happy before we married, but after our wedding the depression returned as I tried to deal with the abuse. And I went down-hill emotionally, very quickly. My children left our home within 2 months of us being married. Tim had moved out before the marriage, but because they couldn't get on with my new husband, Mike actually went to live in his car, and Libby with her dad. That was very hard for me as for so long I had developed my self-esteem on being a mother . . . my identity was wrapped up in my kids and suddenly I was not in that role anymore. 

               

I loved being a mum

I felt lost without my children to look after. As with most blended families there were problems between my new husband and my children,  but I was encouraged by the leadership at the church we now attended to put my new husband first (before my children) so I felt pulled between him and my role as a mother. I had also moved churches to be with my husband and we'd moved out of the country community that I had made my home for 9 years. Without me realising what was happening my husband gradually isolated me from my friends and family.

The depression got steadily I worse. I saw counselors for my depression, we had some marriage counseling and I was on medications for the depression. But nothing seemed to help. After 18 months I left. I knew I wouldn't survive living with my abusive husband, although I loved him, and I wanted to be able to work on getting back together. So for another year or so, although we lived separately I hung on to trying to make our relationship work. Eventually things just got too much for me. I felt that I was doing everything I could, and that I had given all that I could. I had tried to follow what the bible says about being a good wife. I actually had a list of about 20 scriptures which say things along the lines of turning the other cheek, and I tried to live that out with my husband even though we were technically separated. I struggled with the guilt of letting Libby and Mike down and felt responsible for the pain they had suffered as a result of my decision to marry again. Things came to a head and I couldn’t face going on, I felt that there was no hope, there was no future, I felt that I was hopeless and a total failure. I didn't understand why I couldn't make the marriage work and totally believed that it was my fault.

One evening I decided I couldn’t go on. I was in too much pain, so I wrote a note to my husband and one to my children, then I took a heap of tablets and went to sleep. I just wanted to be with God and the hurting to end. People often don't realize that depression - severe depression, is actually like a physical pain. It’s like a great load that weighs you down until you just can't move or think clearly. It’s all encompassing. I just wanted the pain to end. It was not a 'cry for help' in my case. I really just wanted out.

I know people say that suicide is selfish, but I really did genuinely think that my kids would be better off without me, that I was a burden on them, and that they would just get over my death. I believed that because I was facing a 2^nd divorce my very religious family were ashamed of me and that their lives would be easier if I was not around to embarrass them. You see depression actually literally changes your thinking – you lose the ability to think rationally in certain areas. I totally and completely believed that alive I was a huge burden on my kids, and that with my death they would be released from that. How wrong this would have been. They have all told me separately how their lives would have been affected if I had succeeded and how it would have destroyed them. I thank God that He kept me alive. He had a future for me and He had a purpose for my life.

That happened in 2006 and I was in hospital for a few weeks. It was not the beginning of me feeling better though. I felt guilty and even more of a failure not only for attempting to end my life, but in failing to do it successfully. I started seeing a psychiatrist and we tried different medications. One of them even made my hair fall out - I used to have thick hair, but I lost about one third of it and it has not all grown back now! And what has grown back has become very curly...its quite weird really. By the end of that year I was on three different medications for the depression, two at very high doses, and also using strong sleeping tablets at night. I did not think that I’d try to commit suicide again, as I couldn't do that to my children, but I still felt as though my life had no meaning. I was a Christian and I had a relationship with God, but this didn't seem to reach my depression. I knew that the Bible said God loved me and I did believe that, but I didn't feel it.

The intense sadness seemed to take hold of my whole body. It was like a gut wrenching pain inside. Sometimes I would wake up and then all of a sudden it would hit me like a heavy cloud falling around me. A thick fog of uncertainty and confusion. I didn't know how to go on. Sometimes I had to take it hour by hour, minute by minute, even second by second. Going out was so difficult. I just wanted to sleep. I couldn't read for long, or watch movies (things I have always loved). I couldn't converse with my friends or family. I tried to act happy for my kids, but it took so much energy and I'm sure they saw through it anyway. I was in a deep, dark, frightening hole. And I didn't even have my children relying on me this time round. I had nothing to live for. No hope for a future. The future stretched way off in the distance, and I wondered how I could spend the remaining years of my life in this much pain. 

I kept a picture of my children on my car visor so that when I was driving and wanted to just crash I would have them there to remind me of their love and how I would hurt them if I did that. Death would have been so good. I'm ashamed to say that I prayed that God would give me cancer. God did not feel as close as He had in my last severe depression, after my first marriage broke up. I don't know why. I never left Him, but I felt that I had disappointed him so greatly. All the strong feelings of having been a disappointment to the many people in my life were there. The feelings of complete failure and purposelessness of my life were profound. To understand the depth of the pain depression can cause, think back to a time when you have been in immense physical pain and imagine that pain in your inner being. That’s severe depression.

I wanted to run away from all the pain, but knowing I couldn't do it by death, I looked into working somewhere away from my family and friends, so that I wouldn't be a burden on them. If I was going to be like this for the rest of life, well I didn't want to bring others down. I found an advert for teachers in Korea. After investigating it further, I easily procured a position in the country of South Korea as an English teacher on a 12 month contract. People have said to me how amazing and brave I was to go. But it wasn't like that at all. I just wanted to get away from being a burden, and I felt a kind of numbness. I also didn't actually care at all what happened to me, as I still just wanted to die – I just knew I couldn’t do it by my own hand. I had felt the worst I could ever feel so it didn't matter what I did or where I went, whatever happened could not be worse than what I had been through, and was still going through.

So, I went to Korea. And it’s true that God uses everything for our good. He began a healing in me there. I had very little pressure as I didn't have anyone's expectations to live up to and the work was easy. I just had to follow the curriculum. Anything I did that was, well, a bit dumb, they just put down to the fact that I was a Westerner. So I felt very little pressure. I couldn't find a church that I wanted to go to, but God met me in my tiny little room there. He became very close to me – or is it that I became close to him?

I ended up coming back to Australia after 6 months due to my dad’s failing health and his subsequent death. That was 18 months ago. [Remember that I wrote this in 2009 – my dad died in 2007] So how did I end up sleeping in my car? Well, when I was a single mum I had been buying my own home, but due to things that happened during and after the second marriage I ended up having to sell the home without much profit. So when I came back from Korea I stayed with friends. I became involved in a relationship with a man and as I was feeling better I started to decrease my medication. It was not the right thing to do as the symptoms started to return. I felt sad and cried easily. I started sleeping longer hours and found my energy levels dropping. I had a part time job as a school Chaplin, but had to give this up as I was finding it hard to manage. Then the man I was seeing decided he couldn't cope with the depression part of me. So we broke up and that sent me spiraling further downwards. I began some prayer and inner healing ministry, increased my meds and had regular counseling from both a psychiatrist and a psychologist. In an amazing provision from God I was able to go on the disability pension and He also provided a unique way of me getting accommodation. I had previously house-sat for friends at different times, and so I joined a house-sitting agency. My depression has slowly improved and I am on my way to feeling normal again.

The house-sitting has worked out really well and in the last twelve months I have had only five weeks in total of no houses to sit. And now is one of those times. I have been staying with friends, but I have a weekend to fill in and I just feel bad about staying with people all the time, so I thought I'd give sleeping in my car a go. After all its what my son did for a while. It’s a bit like camping really! Tomorrow I am starting a new house-sit that goes for seven months. God has been so good to me. I don't know where I will be living after these seven months are up, but I have no doubt that God will have somewhere for me.

For many years I have kept detailed notes and journals about my experiences with depression with the vague thought of one day putting it into a book. Recently I asked God to show me if this was what He wanted or if it was just to benefit me personally. Just after I prayed that, I was at my GP’s (who is not a Christian) talking about the depression. I have known her for several years,  although she didn’t know that I had an interest in writing, but she suggested to me that one day maybe I could write a book about depression. I nearly fell of my chair! It was so clear to me that that was God’s way of saying He wanted me to write that book.  

Me in 2013, at my son's wedding

And so I am using this time as I slowly heal from the depression, to write. I may never be able to function as I used to. I don't know, but I do know that I believe in God's healing power. I believe He died for my salvation and he suffered on the cross for my healing. I don't know why I still suffer the symptoms. But I believe it’s in His hands. I have a new understanding of God's healing power and of the way God looks at depression.  

I have realized that Christians experience added difficulties when they have depression. They have to cope with the judgment and misinformation that the church has encouraged in the past with regard to mental illnesses. While the general community is becoming more informed the church is moving slowly behind in this area. We need to be more educated, less judgmental and basically more loving and supportive to those with this illness. I want this book to help those Christians who don’t understand depression (because, thankfully they’ve never experienced it) to realize it is not any worse spiritually than diabetes or asthma.  I want people to know that God doesn’t change just because you have the illness of depression. His grace covers you and that when other Christians don’t understand He totally understands.  I want the church to know that just because you may have depression as a part of your life, you are not a write-off as a Christian.

I don't claim to know it all of course but through my continuing journey I have learned many things which I hope, in sharing, will help others. If you have any questions you'd like looked at on this blog, or any comments please leave them in the comments section below. If you'd like to make contact with me my email address is ruthch31@gmail.com 

Facts About Depression – B. Types of Depression

Depression is really just feeling sad isn’t it? Well, yes . . .  and no. As my last post on the symptoms of depression explained, to be diagnosed with clinical depression (depression that is diagnosed by a doctor as opposed to ‘feeling depressed’) must have at its core, the combined symptoms of 1) feeling sad and/or 2) losing the ability to enjoy whatever was pleasurable in the past.  So yes depression has ‘feeling sad’ as a major factor, but no it isn’t JUST feeling sad. It’s much deeper than that.  As we saw in the last post, there are many symptoms of depression. There are also quite a few different types of depression. Different types sometimes produce different symptoms. Knowing what type of depression a person has is important as their treatment will vary depending on what kind it is.

Now, I’ve found that sometimes when talking about depression in detail, there are Christians who say (or think) that its focusing on the negative and that by learning more about it we are actually giving Satan power, or lessoning our faith. But this is another of those areas where if it was a physical ailment – say diabetes, asthma etc., there would be no problem with someone examining the facts about the illness in order to understand it and to better help themselves or their loved one.  There are at least two scriptures that talk about God’s people perishing for lack of knowledge - Isaiah 5:13, Hosea 4:6. So if God doesn’t have a problem with His people increasing their knowledge base, why do we?

However as there is a lot of information 'out there' on depression, and some of it seeming conflicting, I have spent much time researching from reliable sources and compiled the following in an easy-to-read/layman's style resource that you can use as a basis for understanding your, or a loved one's depressive illness.

The most common kind of clinical depression is  often just called ‘major depression’. But the symptoms can vary hugely depending on whether a person has it in a mild, moderate or severe form. As we will see when we look at treatment in an upcoming post, they are treated quite differently. For example, a person with mild depression may improve with only basic help (lifestyle & cognitive changes, etc.), while in someone with severe depression those treatments will have little or no effect. 

Below is a list of the different types of clinical depression and some basic information on each:

Major depressive disorder is also called major depression, unipolar depression, recurrent depressive disorder and sometimes just clinical depression. It may involve a single episode, may be recurrent or chronic. You can have mild, moderate or severe major depression depending upon the number, type and severity of the symptoms. Someone may experience a mild, moderate or severe depression only once in their life, or they may have several episodes. Sometimes especially if it is not dealt with promptly and correctly, a person may progress through from mild to severe over one or many episodes. The more times a person has an episode of depression, the harder it becomes to treat successfully (more on this in the post on treatment, coming up), which is why its important to get help early on.

o    Mild major depressive disorder. The symptoms impact on daily life but the person is still able to function. They may experience less motivation and may find it harder to keep up with normal life activities. There is usually a reduced loss of interest in things they used to enjoy. Often these symptoms are only noticed by those close to the person. Treatment usually consists of lifestyle changes and some form of psychotherapy/counseling, with medication added if necessary.

o    Moderate major depressive disorder. The loss of interest in normally enjoyed activities is noticeably worse. The depression interferes to a greater degree with social lives, work activities and relationships. Simple things seem difficult. Self-confidence and self-esteem take a dive. A person will often withdraw from social activities and their loved ones as they struggle to deal with their inner distress. Thoughts of death may be vague or may start to take a stronger hold. As well as lifestyle changes and psychotherapy, treatment will almost always involve some medication, and it may take several attempts to find the right one.

o    Severe major depressive disorder. It becomes impossible to continue as normal with work activities. Most social activities cease. Friends and family will be able to tell something is very wrong. Feelings of hopelessness and despair become overwhelming, as do guilt and lack of self esteem. Thoughts of wanting to die become very real and suicide is a very real danger. Although not common, severe depression may also involve:

•  psychotic features (may also be called psychotic depression) where the person may have hallucinations (seeing and hearing things that do not exist) or delusions (false beliefs) and there are often more severe psychomotor disturbances. The hallucinations or delusions are negative in nature and often involve a sense of ‘nothingness’.
•  catatonic features such as extreme disturbances or slowness in movements and speech.
•  melancholic features (see below)

Treatment may involve more than one medication. Electroconvulsive
therapy may be used. Lifestyle changes are not usually possible as the
person has sunk so low that they are not able to make the changes
necessary. Psychotherapy is often not helpful until the person starts their 
recovery as their cognition is so affected by the severity of the depression
that they are unable to be actively involved in any form of talk therapy.
Medication is usually the only way to begin to move forward for most
severe depressions. When the symptoms have improved the person can
then begin to implement lifestyle changes and psychotherapy.

Dysthymia. This was described in the past as depressive personality disorder and is sometimes called chronic depression (although the term 'chronic depression' can also be applied to moderate and severe depression). It is a chronic, long lasting, mild form of depression where a low mood is experienced for most of the time with the overall disturbance less severe than with major depression. Dysthymia has less symptoms than major depression, and they are usually less intense. But they must be present for 2 years or more for it to be diagnosed as dysthymia. The person may have some good days at times, but the negative symptoms always come back. It can begin in childhood or early adulthood and often people do not even realize they are ill as it is the only way they have known and so may think it is just part of their character. Dysthymia often requires a longer treatment time than major depression and involves both medications and some form of psychotherapy. Medication alone is not enough as the person usually has ingrained thoughts and behavior patterns developed through years of depression. At least three quarters of people with dysthymia also have a chronic physical illness or other psychiatric disorder (i.e. anxiety disorder, alcoholism). People with dysthymia have a higher than average chance of developing major depression. Like major depression, it has a genetic component.

Atypical. This has many of the symptoms of major depression with over-eating, over-sleeping and fatigue being more pronounced. It may overwhelm a person so much that it causes a greater functional impairment in some areas than other forms of depression, sometimes to a point of emotional paralysis which sees them spending all their time in bed.  They may be more sensitive to rejection and may experience a feeling of being ‘weighed down’. The main difference with atypical depression is that the person’s mood responds to outside events. Often beginning in the teenage years, and more common in females, atypical depression is often present with other mental illnesses (i.e. avoidant personality disorder, social phobias). It is important to have this diagnosed by a professional, as people with atypical depression respond better to certain treatments than others.

Bipolar depression  This is the name given to the depression experienced by people who have bipolar disorder (previously called manic-depression, also referred to as bipolar affective disorder). The depression experienced as part of bipolar is generally of a melancholic (see below) or/and psychotic nature and can be very severe. The main features are a severely depressed mood and psychomotor disturbances (i.e. movements are slowed or agitated, hard to concentrate, physically hard to do every day things). It primarily responds best to drugs although counseling or psychotherapy will be helpful also. It is important to have a specific diagnosis of either unipolar (depression only, with no manic symptoms) or bipolar depression, because the management can be quite different. For example, some antidepressants given to someone with bipolar may cause a fast escalation to a manic state. Bipolar does have a strong genetic component and is often triggered by a stressful event. There are two main types of bipolar - bipolar I and bipolar II and a third less common form, cyclothymia.

o    Bipolar I This is the most common and is where the sufferer experiences episodes of mania (abnormally elevated energy levels, mood and cognition) and of depression.  They are usually separated by periods of ‘normal’ mood and behavior, although in some cases the mania and depression may alternate rapidly (rapid cycling) and may even merge, which is know as a ‘mixed state’.  In some cases the manic episodes may include symptoms such as delusions or hallucinations and the person’s self perception may be so deluded that they may act unsafely.

o    Bipolar II The sufferer experiences frequent or chronic severe depression with either very mild mania or short lasting mania called hypomania. This may be seen as irritability, racing thoughts, anxiety and/or sleeplessness and does not usually include euphoria. Because mania is often perceived only as an extreme elation in mood, an episode of hypomania may not even be recognized. It may just seem as though the person is having a ‘good day’. Rapid cycling, where someone experiences manic or depressive episodes more than 4 times in a 12 month period, is more common than with bipolar I. Bipolar II sufferers are at a higher risk of suicide than bipolar 1.

o    Cyclothymia This is a milder form of bipolar, where a person experiences some mood swings but remains connected to reality. It may develop over the course of a person’s lifetime to become bipolar disorder or recurrent depressive disorder.

Double depression This when a person with dysthymia (mild depression lasting more than 2 years) experiences an episode of major depression. Medications are almost always needed as the goal is to get the person not only to feel better than they did before the major depressive episode but also before they had the dysthymia. Psychotherapy is also essential in treating double depression. One distinguishing symptom of double depression seems to be hopelessness. People have a very bleak outlook on their life and have given up on hoping it could ever improve.

Perinatal. Also called postnatal/postpartum if after the birth of a baby, or antenatal if during the pregnancy. This affects almost 16% of women giving birth in Australia. It’s not the same as the ‘baby blues’ which is often experienced a few days after a birth. Postnatal depression occurs in the months following birth and can become quite severe. A woman is 7 times more vulnerable to depression after childbirth than at any other time in her life. Unfortunately a woman who has had postnatal depression has an increased risk of it recurring with subsequent pregnancies and of developing bi-polar disorder.

SAD – seasonal affective disorder This refers to episodes of depression that occur every year usually during autumn and winter. It often begins in the teenage years or early adulthood and is found more in women than men. Exercise and increased outdoor activity may improve symptoms.

Depressive Disorder Not Otherwise Specified is a term used to describe a mood disorder that does not fully meet the criteria for any of the other categories. It covers

o    premenstrual dysphoric disorder - having depressive symptoms for a period of at least 1 year, in the 2 week period surrounding menstruation that are severe enough to interfere with everyday life activities.

o    minor depressive disorder - episodes of longer than 2 weeks' duration with more than 2 of the symptoms of major depressive disorder

o    recurrent brief depressive disorder - episodes of between 2 days to 2 weeks of symptoms of major depressive disorder, not related to menstruation, but present at least once a month for a year

o    schizophrenia related depression

o    when a there is a definite depressive disorder, but it is unclear if it is related to a medical condition or the effects of drugs or medication

Grief. I have included this here as a ‘type’ of depression as depression  is considered ‘normal’ for those who grieve a loss - be it the death of a loved one or the loss of a job - to go through a phase of depression. This is not classified as clinical or major depression and should dissipate with time. For some people though, it may well become more serious and if not resolved may be the beginning of a depressive episode.

There is a difference between grief and depression, although both contain similar elements. With depression  the predominant mood is sadness mingled with hopelessness and despair. The severely depressed person often feels that this will go on forever and that their future is bleak. Their thoughts are usually very self focused, in a self-negating way with self-loathing and very low self-esteem and they will withdraw from their loved ones. The sadness is constant and does not change. Usually a depressed person cannot be consoled or ‘cheered up’. Nothing can penetrate the despair, and suicide may be thought about and seen as the only option to end their emotional pain.

In contrast a person going through a sense of depression as part of their grieving will find that their feelings of sadness often coming in ‘waves’ in response to a reminder of the deceased and will be intermittent, mixed with positive thoughts and memories. They are more likely to see that one day their life will get back to ‘normal’ and are able to respond and be encouraged and uplifted by the love shown to them from others others. Their self esteem and emotional connection to loved ones are usually intact. Although sometimes a grieving person may fantasize about joining their departed loved one, they do not seriously contemplate suicide.

When a person is recovering from major depression they may go through a time of mixed symptoms of depression - having some good days and some bad, which may look similar to the 'grieving depression'.

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There are also some other commonly used terms which you may come across:

Melancholic and non-melancholic depression  Melancholic (sometimes called endogenous or biological depression) describes a type of moderate to severe major depression with a strong biological and genetic component. It's symptoms involve psychomotor disturbances, becoming physically slowed down, slowed thinking, sleep and appetite disturbances and/or feeling agitated. It only affects 1- 2 % of the population, affecting men and women equally. It very rarely goes away on its own and responds best to medication and only minimally to counseling or psychotherapy. Mood and low energy are often worse in the morning with improvement at night. Non-melancholic (sometimes called reactive depression) means that the depression is not primarily biological, but has to do with how a person copes with stressful events and/or their personality style. It is the most common type of depression. The symptoms are typified by worry and anxiety. People with this type can sometimes be cheered up to some degree. It has a high rate of spontaneous remission and responds well to a combination of treatments (i.e., counseling, psychotherapy, medications) and affects more women than men.

Smiling depression (also called concealed or hidden depression) is a term used when a person is depressed but hides it from others. They appear to be active and social when with others, but inside are suffering the sadness or numbness of depression. They are able to function to a certain level on the surface but are suffering inside.

Anxiety is not the same as depression but is often associated with it. While they do have a lot in common they are separate conditions and may require different treatments. Both can contribute to the development of each other, sometimes with an overlap of symptoms. The key features to anxiety are worry, fear and panic usually about things that may happen in the future, while depression has sadness, hopelessness and despair as it’s main factors and is more focused on negatives about the person while seeing the future as hopeless. Depression exacerbated by anxiety has a much higher suicide rate than depression alone. 

So you can see that depression is not simple . . . there are many different types as well as many different symptoms of depression. There are also varying causes of depression, with factors which affect the risk of, and resilience to, developing depression. If you can pinpoint the cause or risk factors at play in your or your loved one’s depression, its more likely you will be able to work on getting the appropriate treatment. We’ll look at the causes of depression in my next post.