Chronic Depression for Over Ten Years…What Do I Do?

Reader’s Question

According to my research (and I am honest about these things) I have had at least a medium level of depression for over a decade, along with a few very serious major depressive episodes and panic disorder. At this point, I am recently married, living on my own, and generally doing what I thought I wanted in my life…that is, after about three tries as to what I want in my life. However, I still have no motivation for what I assume my passion is, although it’s been so long since I felt passion for any of my own accomplishments that I might not even know anymore. I only feel satisfaction from food and sex, and since my husband is not as sexual as I am, I generally go for food. Even then, the satisfaction comes more from quantity than quality, and as a result, my weight is getting out of control. I guess my biggest problem is that I feel like I’m fine. I’m happier than I’ve been in a long time, I feel like I’m a fairly attractive person, like I’m smart and likeable. At the same time, I’d be infinitely more attractive if I wasn’t so fat, I’m smart and have done nothing with my life, and I’m likeable but so unmotivated and unreliable that I have no regular social interactions with anyone other than my husband and family. Also, I know for a fact that if my husband were not around anymore, for any reason, that I would kill myself.

That is not mental wellness.

But I’ve been unwell for so long now, I’m used to it. I don’t know any other way to live. What am I supposed to do?

Psychologist’s Reply

As you describe, millions of people live for many years and even decades with moderate, chronic depression. How can this happen? It typically starts with an episode of severe/major depression. From that point:

• The major depression may be untreated or marginally treated (ineffective use of antidepressants, stressors lower, etc.). The individual seems to improve a little.
• As moderate depression stabilizes, the individual develops maladaptive strategies to deal with the depressive symptoms such as: 1) using alcohol/drugs to help sleep, 2) finding something that elevates their mood somewhat such as eating, 3) avoids stressful situations, etc.
• As months pass, a depressive lifestyle develops that includes no energy, social withdrawal, few friends, no outside interests, etc. The individual retreats from life.
• When stress increases, the individuals has panic episodes or increased emotional distress. As those symptoms go away, the individual feels relief that they no longer have panic attacks, and feels somewhat better, but the depression lingers.
• Family and friends gradually accept the depressive lifestyle and compensate for the depressed individual, lowering expectations and responsibilities.
• From an emotional standpoint, the product is a life of unhappiness but compensations for the depression that allow a lifestyle that is tolerable. After several years, the individual loses sight of what their original pre-depression life felt like.

Acute/Sudden and chronic depression have similar neurobiological components. Both respond to antidepressant medications. Chronic depression however, has additional issues that must be considered in treatment. In chronic depression we must address the depressive lifestyle and near-total loss of self-confidence and self-esteem. In a sudden depression, the patient knows they felt better only six months prior to the episode so they have an idea of where they want to be in treatment. In chronic depression, they have experienced these feelings for years. For this reason, a community-based treatment plan often includes:

• individual therapy/counseling,
• a gradual return to social activity,
• rebuilding relationships and hobbies,
• confidence building activities,
• relationship damage repair, etc.

With effective and aggressive treatment, the original or “old” you can return. However, you and your family may not recognize that person at first as they haven’t been around for many years. Several years ago I worked with an individual who had been moderately depressed for over seven years. In one session as her treatment continued, she mentioned a funny incident in which she was cooking and her teenage daughter interrupted her to say “Mom…you’re singing. I’ve never heard you sing!”

It’s possible to bring the old you back. Enlist the help of a physician, psychiatrist, and therapist and start the process. You’ll be singing…or painting, jogging, cooking, etc. before you know it.