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Mood

Mental Water Torture - "Mild" Depression

dysthymia

 

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

by John McManamy

 

Depression symptoms. 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.

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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. And shamed into thinking something is wrong with our attitudes, we fail to seek help. Or, if we do, it's our family physician who confuses a very real chemical imbalance in the brain with some imaginary defect in our personality. And so we are sent away with a stupid happy pill such as a tranquilizer (whose depressive effect only adds to our quiet misery).

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 (experts estimate anywhere from 3 to 12 percent of people with dysthymia cure themselves by suicide).

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. A review article appearing in the Jan 6, 2010 JAMA indicates that antidepressants are not likely to work for milder depressions - and this is the new conventional wisdom now in circulation - but the book is by no means closed on the issue.

Ironically, the herb St John's Wort - which had received a bad rap from psychiatry for only being good against milder depressions (an unproven assertion) - may be the pill tailor-made for this condition. But again, the 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 - Jan 5, 2011

The next edition to the DSM, due out in 2013, would fold dysthymia into "chronic depressive disorder," which would also accommodate major depression. The draft DSM-5 criteria for chronic depression is at least two years, as opposed to "recurrent" depressions, which come and go.

Published 2000, latest update Jan 5, 2011

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