Dysthmia - moderate depression

[Penny4]

I have felt moderately depressed for much of my adult life, but always just told myself to suck it up, life is hard, life is not fair, etc. Well, you can imagine where that got me....earlier in this year, I had a major medical issue that I had to face alone (I am single and did not receive a lot of support from "friends" during this time). Everything turned out fine for me physically, but left me very depressed, as I felt I had no one to turn to in a major moment of crisis.

I finally went to see a psychiatrist and she put me on a low dose of an anti depressant (she has gradually increased the dosage). I am feeling better, but not exactly "happy". At my last appointment, as I was checking out, I saw the term "dysthmia" on my record. I went home and researched it and could not believe how accurately it described me...low self esteem, either over weight or underweight, fatigue, irritability, chronic MILD depression, trouble sleeping or sleeping too much.

I know that therapy along with medication is more effective than just meds alone in treating depression, but I have not taken that extra step yet. I went to a counselor 2x in the very beginning but was so overwhelmed wiht her approach of trying to make a plan for being more social, trying to meet someone, etc (i had told her I was lonely, etc). It makes sense that I wasn't ready for that given my low self esteem.

Just wondering if anyone has experiences with mild depression? How long does it take to feel "happy"? (not really expecting answer to that last question...it's just what I ask myself all the time)

[indysteel]

Yes. Mine has been episodic. I started cognitive therapy with licensed social worker about 10 years ago, mostly to deal with some family of origin issues. I won't lie; the first year was hard and emotionally draining. I saw her every other week if memory serves. It got easier in time. She was pretty upfront that it cam take several years for a patient to feel consistently better, and that was my experience. I see her once a month now. Frankly, I don't really need to see her, but I like having someone I can talk to without any editing or filter.

It is, hands down, the best thing I've ever done for myself, and I don't regret the money or time that it's taken to
become a better version me. Maybe you would benefit from talking to someone new. I, personally, would have been put off by someone who wanted to formulate a "plan" right off the bat. The first step in cognitive therapy is to identify your thoughts. From there, you work on changing those thoughts that are destructive or counterproductive, with the hope of changing outward behavior. It's harder to do the latter without first working on the former. Of course, not every therapist is cognitive, but that is the type of therapy that made the most sense to me.

Good luck in your journey. What you're doing is very brave.

[Kerry1976]

I have struggled with this for years. I especially struggle during the holidays, so lately things have been really hard. I hope and pray that your journey leads you to a better place and you find some inner peace.

[Crankin]

I see lots of people with Dysthymia; it's one of the more common issues, often untreated, as you say, because people often "get used" to it and don't realize there is very effective treatment.
I find it interesting you found a psychiatrist to prescribe you an antidepressant without being in counseling. Most psychiatrists that I have worked with only will prescribe as part of a total treatment program, or if the person has been in counseling, is doing well, and just needs a maintenance prescription.
You received from good advice here; try another therapist. Mild depression is one of the things that responds extremely well to cognitive behavioral therapy, as Indy said. It's an approach that requires active participation from the client. I use it a lot, combined with some sort of mindfulness/relaxation practice.

[OakLeaf]

I have "double depression," major depression superimposed on dysthymia. For me, meds only work on a very small subset of symptoms (and I've tried a lot of them) - an important enough subset of symptoms that I stay on the combination we found after a lot of trial and error, but nowhere near all of my symptoms. I really think "happy" is never going to come from meds.

I'd encourage you to try another therapist when you're ready. Searching for a therapist is VERY hard ... you have to keep making yourself vulnerable to strangers who may or may not have a personality that "clicks" with yours AND a skill set that matches your issues. Once you get to know your psychiatrist well, maybe she can recommend a therapist for you. After a long hiatus plus a couple of false starts with therapists who just didn't work for me, I just started seeing a therapist recommended by the psychiatrist I've been seeing for years, and man, I have more hope and good feelings surrounding this therapeutic relationship than I've had in decades.

((((((Penny))))))

[Penny4]

Thanks all. My psychiatrist has recommended therapy in addition to the meds. I just haven't taken that extra step yet.

My first attempt at getting help with all of this was going to the counselor. And in fairness to her, she is more about helping people set goals and finding ways to achieve them. She actually suggested that I start with a psychiatrist first because I pretty much cried my way through the first two sessions with her.

I think I need more of what you are all talking about, a cognitive therapist? Recommendations on how to find one?
Is this the same as a psychologist? Social Worker? Honestly before I started treatment this year, I didn't know the difference between a psychiatrist, psychologist, therapist, etc....

I'm grateful that there are folks like you who understand. I haven't told any of my friends or family.

EDIT - Oakleaf, our posts crossed. Thanks for your suggestions and you really summed it up perfectly....opening yourself up to strangers over and over...ugh!
I'll ask my Doc if she has suggestions.

[Crankin]

Therapists/counselors can be from different professions. Both licensed mental health counselors (called professional counselors in some states) and licensed social workers are masters level professionals who do therapy. Psychologists have to have a PhD to practice. And only psychiatrists can write scrips (they are MDs). All of these people do pretty much the same things, but in all of these professions, people specialize in working with different kinds of mental health issues or techniques. Cognitive behavior therapy is very common, but not all therapists may be proficient in it.
For example, most of my work with adults is around anxiety disorders, trauma, or depression. I use a lot of cognitive therapy, along with holistic techniques, such as art therapy, meditation, breath work.

[indysteel]

Mild depression is one of the things that responds extremely well to cognitive behavioral therapy, as Indy said. It's an approach that requires active participation from the client. I use it a lot, combined with some sort of mindfulness/relaxation practice.

Interestingly, while I gained a lot from talk therapy, I achieved some significant breakthroughs when I started a regular yoga practice about 5 years into my work with my therapist. I'm not sure why, but a lot of things started to click for me--in terms of changing my thought patterns--at that time.

[Irulan]

I've been through similar. I initially went into counseling for PTSD related issues left,over from childhood abuse, treated primarily through counseling. After we got through all that, there were still some underlying depressive issues that just wouldn't go away. Back into counseling for more "here and now" (vs past) stuff. What ultimately was right for me was a dysthymia diagnosis, and medication. I've been on antidepressants for over ten years now, and it changed my life so much for the better. Don't be afraid of them. Sometimes there's biochemical stuff going on that needs to be adjusted that no amount of therapy or or other tools will fix. At least, that's my experience. I'm a little bit jealous when I hear of people that can manage dysthymia with meditation, yoga, or exercise. When I've tried to be med free, using a combination of diet, exercise, mindfulness and other tools, it's been a disaster. I function really well: years of counseling and recovery work did me a lot of good, but with my MD we made the determination that we aren't going to try and get off them until I'm well through menopause.

Good luck

[Irulan]

(continuation after reading OP again)

I don't know if its worthwhile to discuss "feeling better" vs "happy". For me, happy has to do with finding joy and contentment with my life, and really being in the moment. I still have plenty of days when I'm anxious, really sad, pissed off about something, or other strong emotions, which i believe is as it should be - that's real life. With untreated depression, these and other strong, "negative" emotions can really take over and be crippling. With treatment, whether its meds or other tools, you can handle them in a healthy manner, as a part of the life experience. Anyone that is expecting life's downs to go away with treatment of depression is fooling themselves; it's how the downs are handled that changes.

Before my dysthymia was treated, I felt like I functioned veiled with a shadow. It's hard to describe exactly, but that's the best I can come up with. Tasks went uncompleted, I lacked focus, and had a lot of anxiety and fear. Counseling, 12 step work, and medication changed my life for the better. For me, happy is a feeling of general contentment in my life and day to day choices, not an "up" or "high" feeling, at least not all the time. I do have long moements now where I feel so good that it takes my breath away and fills me with gratitude, but I don't expect to have that all the time. Having a really solid marriage ( we've done a ton of work) has helped immensely....I don't know where I'd be without that.

[Crankin]

Irulan, I wish I could bottle up what you said and quote it to some of my clients. Therapy is called "work" for a reason.
One of the things I am thinking of doing is getting certified as a yoga therapist. While I occasionally show people poses for relaxation, I'd like to use it more as a way to treat trauma and other anxiety disorders. The reason it works is that we store a lot of feelings and memories in the physical body and yoga can release them in a very powerful way. There is some very exciting research going on about this, at BU/Boston Medical Center. Hopefully, it will be an empirically accepted treatment soon.

[Penny4]

(continuation after reading OP again)

I don't know if its worthwhile to discuss "feeling better" vs "happy". For me, happy has to do with finding joy and contentment with my life, and really being in the moment. I still have plenty of days when I'm anxious, really sad, pissed off about something, or other strong emotions, which i believe is as it should be - that's real life. With untreated depression, these and other strong, "negative" emotions can really take over and be crippling. With treatment, whether its meds or other tools, you can handle them in a healthy manner, as a part of the life experience. Anyone that is expecting life's downs to go away with treatment of depression is fooling themselves; it's how the downs are handled that changes.

Before my dysthymia was treated, I felt like I functioned veiled with a shadow. It's hard to describe exactly, but that's the best I can come up with. Tasks went uncompleted, I lacked focus, and had a lot of anxiety and fear. Counseling, 12 step work, and medication changed my life for the better. For me, happy is a feeling of general contentment in my life and day to day choices, not an "up" or "high" feeling, at least not all the time. I do have long moements now where I feel so good that it takes my breath away and fills me with gratitude, but I don't expect to have that all the time. Having a really solid marriage ( we've done a ton of work) has helped immensely....I don't know where I'd be without that.

I understand. Before I started the meds, on most days I was just so down on myself. After my medical crisis last year, that really threw me into a new level of depression. The fatigue was unbearable (but I assumed was a residual physical effect from my surgery, 2 months later), I was bursting into tears at work and running into the bathroom to hide. I never really felt anxiety, but I would say I felt "down" all the time. After starting the meds, i feel stabilized. No more bursting into tears, fatigue is better. But I would still not classify myself as happy, or content. I'm just kinda going through the motions. I need to figure out why I think so little of myself...work on improving that. I know i have work to do.....

[Irulan]

+++ on adding therapy to the mix. I don't have any advice on how to find a good one. I was extremely lucky in that my primary care MD pointed me to exactly the right person I needed to be seeing initially, and then she was able to connect with other good professionals as needed. In my youth, I did spend time with what I now deem to be worthless/poorly matched therapists, and the difference when you connect with someone is huge. It's never easy, even with the right therapist, and it's not quick. But, if you can stick it out, the end results are well worth it. hugs from me too.