My Mental Health: Persistent Depressive Disorder

That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.

Elizabeth Wurtzel
Hello, Readers! Welcome to my first ever blog series, The My Mental Health Series. My hope over the next five weeks is to educate, advocate, and to let people know that they are not alone. For 38 years, I did not know or understand myself because I didn't have the knowledge that I needed. I decided that I wanted to share what I've learned in the hopes that maybe I can help someone else recognize themselves in my words. 

Be sure to check out the first installment, My Mental Health: ADHD and stayed tuned every Tuesday for a new installment. Also, you can reference the My Mental Health: A Glossary and the My Mental Health: Busting ADHD Myths post for more information. Thanks for stopping by!

Depression

red figurine with a tear in his eye, holding out a broken heart
persistent depressive disorder

I have a long and storied history with depression, as many people do. According to the WHO website, depression affects over 264 million people around the world and is the leading cause of disability. Close to 800,000 people die by suicide every year. If you are depressed or feeling suicidal, please reach out to someone. You can reach the National Suicide Hotline (800-273-8255) at this number.

There are many types of depression and their symptoms and causes vary widely.

  • Major depression/Major Depressive Disorder
  • Persistent Depressive Disorder
  • Postpartum Depression
  • Psychotic Depression
  • Seasonal Affective Disorder
  • Bipolar Depression

I started showing signs of depression and emotional dysregulation as a small child, though we didn’t know it back then. I wasn’t a sullen kid, by any means, but I felt things strongly and deeply. I can remember a deep sadness in my very earliest memories. By the time I was a teenager, life circumstances had exacerbated my mental health issues and depression became a normal part of my life. Still, my family and medical professionals likened it to hormones, defiance, and attention-seeking and called it a day.

Major Depressive Disorder

The year I turned 20, I had what I would consider my first, severe episode of major depression. Major Depressive Disorder can be defined as persistent and intense feelings of sadness and hopelessness that last for extended periods. I think that the definition doesn’t do well in explaining it’s perilous nature. It swallowed up years of my life; always living with a sadness, loneliness, and longing so deep and so thorough that it often seemed it was stealing my breath away.

Major depression is also known as clinical depression. It impacts mood, behavior, executive functioning, sleep patterns, appetite, and some physical functions. It is one of the most common mental health conditions in the United States.

Clinical depression has debilitated me, at times. It has seen me in bed for days and sometimes weeks on end; not showering or brushing my teeth. I was the friend in my group whom everyone would find in a room alone, inconsolable for no reason that I could articulate to them. The best friends that I’ve ever had are the ones that would find me, hug me, and just be with me for a few minutes until it passed. Most people don’t understand that you don’t have to do anything for a loved one who is depressed. We simply need you to be there, with no expectations, in our time of need. And so they were.

A crushing failure

I was lucky in my 20s. I had a huge support system. I was surrounded by friends and family who knew me and loved me and stood by me through my darkest times. When I was about 24, I became suicidal; obsessed with thoughts of ending my life. I couldn’t do it anymore; I couldn’t carry the pain and anger. I was tired and, though this wasn’t the first time these thoughts had invaded my brain, I was getting more and more serious by the day.

I called my mom and my dad and explained that I was frightened of myself; I was losing control of the situation. They were able to find me a resource in the National Suicide Hotline (800-273-8255) who told me to go to any emergency room and ask for Mobile Crisis. They would come to me and they would be able to get me the help I needed. That is not what happened. This topic is probably for another blog but, for the sake of finishing the story, I will continue.

I woke up the next morning and I headed to the nearest emergency room with my aunt and my best friend in tow. I was scared. I knew that I needed help and I was willing to accept any help that I was given, but I knew there was a chance that meant inpatient treatment and I was afraid of that experience; the stigma and all that came with it. I did as I was told and informed the lady at the front desk that I needed the services of Mobile Crisis.

They took me into an exam room, allowing my safety net of women to come with me…and then they drug tested me and left me there for 6 hours. Granted, in that time, my emotions swung widely. I had little control. I was scared and I was impatient. I felt like I was hanging in the balance in this sterile room. I remember being irrationally angry that they were keeping me for so long. Eventually, they came and told me that it would be better if I went directly to the Mobile Crisis offices, so we headed that way. The emergency room later sent me a $200 bill, which I couldn’t pay…so they sued me for it.

At the Mobile Crisis center, things did not lookup. We were again put in a room and a woman came in to interview me. She demanded that my support system leave the room, even though I assured her that we could talk freely in front of them. She then told me that I needed to go to drug treatment because I had pot and Xanex in my system when the hospital drug tested me (the Xanex was prescribed by a doctor and I always took it as prescribed). Then she told me, “We can’t keep you here because you don’t have insurance.” She made me sign a contract saying that I wouldn’t hurt myself over the weekend and she sent me on my way. No one ever called to check on me; to make sure that I didn’t take my own life that weekend.

Things worked out okay. I crawled out of that deep hole on my own, eventually. I found a level of depression that was manageable and I trekked on. That is the story of most of my 20s. Sometimes I was insured and was able to get medical attention and sometimes I wasn’t and I had to just soldier on like nothing was happening. That’s one of the weirdest parts of depression to me; people just expect you to keep going, keep living life like you aren’t dying slowly on the inside. And, as you can tell from my hospital story, even the medical community (the people tasked with being there for us in an emergency!) doesn’t always take it seriously or help the people who need it the most.

Persistent Depressive Disorder

Persistent Depressive Disorder (also known as Dysthymia) is a long-term and chronic or, most likely, continuous form of depression. It often lasts for years on end. There may be breaks in the depression, but even those rarely last longer than a month or two. Symptoms can cause significant impairment in work, relationships, and personal life. The intensity of Persistent Depressive Disorder can fluctuate from mild to severe. Some symptoms include:

  • tired/lack of energy
  • concentration issues
  • trouble making decisions
  • irritability
  • excessive anger
  • avoidance of social activity
  • feelings of guilt
  • apathy
  • poor appetite/over-eating
  • sleep issues
  • loss of interest
  • hopelessness
  • loss of productivity
  • low self-esteem/feelings of inadequacy
  • finding it hard to be upbeat, even during happy occasions
  • you are often described as gloomy or always complaining

Major depression can occur before or during Persistent Depressive Disorder, which is often called double depression. There are many causes for dysthymia; one of them, and the one that I believe triggered my Persistent Depressive Disorder, is trauma. The symptoms of my depression seemed to morph into something different after a severe trauma when I was 32. Afterward was when I first noticed that I couldn’t climb out of the ditch and then I had to sit and watch the years pass by. I didn’t understand what was happening at the time, other than I was dealing with trauma. I wouldn’t get an official diagnosis for six more years.

Last year, a few months after my 38th birthday, I got my official diagnosis’. It was a laundry list of items and included was Persistent Depressive Disorder. At the time, I read the basic gist of what it was and then I moved on to researching some of the other disorders that I didn’t understand. While preparing for this post, I realized that it, too, was affecting me in ways that I couldn’t imagine; causing behaviors that I didn’t know had a root cause. As I said before, I went through a traumatic experience in 2014 and once my brain started dealing with the trauma, I was still left unable to function in some cases. Major depression caused me to be inconsolably sad, but Persistent Depressive Disorder caused me to feel nothing, all of the time.

I was almost immediately swept over by a wave of apathy that was so complete I could feel no joy, no excitement…even feelings of love seemed to elude me. These periods of extreme aloofness were only broken by intense anger or soul-crushing sadness. As my life crumbled around me (the trauma was extremely metamorphic in my life), I could feel nothing besides rage and agony. I became very negative. I complained a lot.

Intrusive and obsessive thoughts caused me to fixate on the situations that injured me and it was often all I could talk about. I was increasingly isolated so when I was around people, I would talk one hundred miles a minute, almost exclusively about the bad things that had happened in my life. I often found myself apologizing at the end of each phone call to the people that I loved. “Thank you for listening to me talk about this…again.”

Thing is, I felt like the only way I could make sense of what happened was by talking about it. Talking over it with everyone I could think of; surely someone would be able to help me. The things that happened were consuming my every waking moment; sometimes even my dreams. I needed it out of my mind and my body, so I tried to lean on the people that I loved and who I believed loved me. Surely someone would offer me the one piece of advice that would somehow get me out of this joyless hellscape that had become my life. No such luck. In fact, some people took the opportunity to kick me while I was down. Eventually, my Persistent Depressive Disorder symptoms and behaviors caused me to lose some important friendships.

Friendships lost

In my post about how my mental health has affected my friendships, I talked about friendships that came to an end in what I believe was a direct result of my mental illnesses and how they were manifesting. When I started reading more about PDD during blog prep, I realize now how much it was affecting my brain and my behavior during that time. I knew I was sick and, much later, I would come to realize just how sick.

When my “friends” started attacking me for the way I was acting, they started using terms like “toxic” and “negative.” They told me that I sucked the joy out of a room; that I was selfish and self-centered. They said all I ever talked about was myself and my problems. They called me a “miserable person.” I tried to tell them I was sick. Other people tried to tell them that I was sick. I needed them. I loved them and I believed that they loved me, so I started to believe what they were saying. They were right, after all. I was negative. I was withdrawn and isolated. I didn’t rush over to all the birthday parties and family dinners. I wasn’t always good about calling or texting to check-in and, when I did come out and socialize, I was contrary and I complained a lot. I was angry with life and with the universe and made my disgust known regularly. Maybe all this time, everyone else saw a different version than the person I was always trying to be. Was I a bad friend?

The answer to that is…no. I am not, and I was not then, a bad friend. I was a sick friend. I was a friend who needed kindness, understanding, love, and support. I needed patience and someone willing to listen to my endless ramblings because they knew me well enough to know that who I really am was buried somewhere under my disease. Although this group of friends had known me since my early 20s and had walked similar paths with me before, they decided to ignore the signs that something was wrong and attack my character.

Let me be clear, I was not a perfect friend. I have my faults, just the same as anyone else, and relationships take two people. These friends, though…what they did to me in my darkest time was cruel and unnecessary. You see, I tried to end the friendship multiple times. I tried to tell them that they were hurting me and that I didn’t want to stand for it anymore. Every time, they would tell me how much they loved me and how they had no intention of letting me end the friendship.

Yet, it was still just more of the same. I wouldn’t hear from them for months on end and they eventually became very blatant about not inviting me to hang out with them anymore; often posting photos on social media the next morning of them all happily hanging out. It started to feel very contrived and pointed directly at me. At first, they said it was because I wouldn’t come anyway and they were probably right in most instances. But when the chips were down and they were called out on the carpet, it wasn’t because I wouldn’t come…it was because I cramped their style. My illness and my trauma harshed their mellow and they didn’t want to deal with it anymore. Yet, they still wouldn’t let me walk away.

This dragged on for several years. Eventually, the last straw was drawn and I made myself cut all ties. I haven’t spoken with any of them in more than a year. I still miss 2 of them. I think about them often and I wonder if they if they know it was wrong. They were once two of the closest people in my life and I can’t imagine that they are okay with themselves after what they did.

There was also a ringleader. The Regina George of the group. The mean girl. She was the one who said all of the horrible stuff about me, while the other two tried to scramble behind her and clean up the mess. The blame doesn’t lie solely on her shoulders, though. The others were grown women and they made their own decisions in the matter. It hurts that they are no longer part of my life, but it doesn’t hurt as much as being abused and gaslighted by people who purport to love you.

As I read through the list of PDD symptoms, I couldn’t deny that all of these things were happening to me during that time in my life. I have no doubt now that PDD gave those friends the ammunition they needed to bully and exclude me for all those years. Anxiety and trauma fed it and it was fat and happy for many years. But I got better, even just a little, and was able to take the steps that needed to be taken to ensure that it never happens again.

The beat goes on

Alas, time keeps marching forward. I’m much better nowadays. I still have low-lying depression. I like to joke that while major depression is a glitch in the operating system, persistent depression is the operating system. I was able to eventually find my feelings of joy and excitement again. I love the people who are left in my life with my whole heart; maybe more than ever because they stuck by my side when they didn’t have to and it’s one of the things that saved me.

My fight against depression is far from over; not two months ago, I found myself in the midst of one of the worst spirals I had experienced in a long time. Luckily, I was able to get the treatment that I needed right away and my doctors pulled me out before I went into mental free-fall. I just keep taking it one day at a time.

I have learned a lot from all of my experiences. The life concussion that I received in 2014 and the subsequent problems that I encountered with my friends left me raw, but wiser. I learned so much about myself and what I deserve. I look back at what I walked through, what I made it through, and I feel stronger than ever. For all the times that I reached out for a hand that wasn’t there, it was me who scratched and clawed my way out. Not just then, but every time that I had been engulfed by the darkness; it was always my hand in the void that pulled me back out. That knowledge gives me a never-before-felt confidence that I might actually pull off this life thing.

A calling

When I started to get better and I realized what had happened, I started to get angry. It wasn’t fair to be treated so badly for an illness that you have no control over and they were far from the only ones that ignored my illness so they could fit me into their narrative. It was this desperate desire to be truly understood that led me to start this blog, to get more involved in the mental health community, and to start speaking out about the truths of depression, ADHD, and my other brain disorders. We should never have to feel the way I felt then and I will fight for the rest of my life to give myself and my people a voice.

Depression is a wide-spread illness that affects every person in different ways and to varying degrees. No two people will have the same experience, but we all tend to understand each other’s pain. It very much shapes who we become. Just remember, depression is not a weakness. Many of us have hiked to hell and back and made it somehow. We are fighters and survivors. We face trauma and stigma and judgment. We’re called toxic and miserable and we’re kicked and cast out.

If you are feeling depressed or unwell mentally and you aren’t sure where to turn, please check out my Resources page for a list of phone numbers and websites of organizations that are there to help 24/7.

That’s it for this week’s installment of the My Mental Health blog series! Be sure to join us next Tuesday for, My Mental Health: Generalized Anxiety Disorder. I’ll be discussing anxiety, panic attacks, and how it relates to my brain health. Be sure to sign up by email so you never miss a post!

Love and light. Keep fighting the good fight!💜💜

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4 Comments

  1. Your old friends group didn’t deserve a warm, genuine, GOOD person like you anyway. I’m really glad you’re doing better – I happen to think rather highly of you and like having you around! <3

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