Don't let the terms, mild or moderate, fool you.

by John McManamy

THERE is a silent killer amongst us. With little fanfare it ruins lives and even ends them. At any given time, some three percent of the population is under its spell. The experts call it dysthymia. We know it as mild to moderate chronic depression.

If we think of major depression as a spectacular brain crash, milder depression can be compared to a form of mind-wearing water torture. Day in and day out it grinds us down, robbing us of our will to succeed in life, to interact with others, and to enjoy the things that others take for granted. The gloom that is generated in our tortured brains spills outward into the space that surrounds us and warns away all those who might otherwise be our friends and associates and loved ones. All too frequently we find ourselves alone, shunned by the world around us and lacking the strength to make our presence felt.The symptoms are similar to major depression, with feelings of despair and hopelessness, and low self-esteem, often accompanied by chronic fatigue. This can go on for years, day in, day out.

Still, we are able to function, a sort of death-in-life existence that gets us out into the world and to work and the duties of staying alive then back to our homes and the blessed relief of flopping into our unmade beds.

All too often, we are told to snap out of it. That the invisible water torture we carry in our heads is our own fault.

Some of us turn to the bottle or illegal drugs. Others seek a more permanent solution. Yes, even milder forms of depression can be lethal.



And, sooner or later, it happens, the brain crash. Major depression. That's how most of us wind up, according to the experts, sometimes with a double depression, a depression on top of a depression that never had to be. One that could have been stopped years before.

And that, perhaps, is the saddest news of all: None of this ever had to happen.

Individuals with dysthymia may respond well to two types of cognitive therapy and other talking therapies, without resorting to medications. There may also be some relief from the herb St John's Wort, though the study evidence is hardly unambiguous.




As I sit here writing this, the term mild to moderate depression mocks me. I won't even begin to estimate how many years I've lost to a disorder predicated by the modifiers mild to moderate. The least they could have done was assign the name of a Shakespeare character - Hamlet's disease, Lear's disease, anything, really. Just so long as it doesn't imply I was cut down in the prime of my youth by some invisible stupid nerf bat pounding against the inside of my brain.

For the rest of you: You can end it right now. You don't have to endure the mental water torture any longer.

And for friends and loved ones: Let them know - they can end it right now. The mental water torture can be a thing of the past. Starting today those you care for can win their lives back.



Update: June, 2016

I first wrote this article in 1999, not long after receiving my bipolar diagnosis. Looking back, I got the basic thrust right, but I missed a major component, which I go to into considerable depth in my book, NOT JUST UP AND DOWN.

This involves how mood and personality intersect. In the case of dysthymia and a depressive temperament, the two are impossible to distinguish. Technically, a mood disorder is distinct from our personality, but nature is never that clear-cut. In all likelihood, we are dealing with a subtle overlap.

The pioneer diagnostician Emil Kraepelin noted this back in his 1926 classic, Manic-Depressive Insanity. There, he reported that his patients with depressive temperaments were more likely to exhibit depressive mood states.

Basically, "state" may arise from "trait."

Current researchers such as Hagop Akiskal of UCSD have lent modern authority to Kraepelin.

Thus, for many of us, chronic "mild" depression may be our true "normal." The silver lining to this is people with depressive temperaments tend to display empathy and can be hard-headed realists and identify as deep-thinkers.

The downside, of course, is being constantly down.

The prospect of a depressive temperament may also explain the low success rates of antidepressants, which doctors hand out like candy. If there is any clinical benefit to antidepressants, it is in helping resolve a mood episode, not change one's personality.

Our doctors are not going to figure this out for us. Hence the pressing need to "know thyself." In the final analysis, we are our own true experts.

From a personality perspective, see: Depressed or Thinking Deep and What's in YOUR Depression?

Revised June 16, 2016


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