I've been talking a lot about depression recently

[xiphias]

You know, since I declared war on depression at the end of January, one of my friends has gotten her doctor to change her meds to some that worked better, one friend has decided that he has had a depression problem all his life and is going to find a therapist to start working on it, and one has decided that she deserves to have Nice Things in her life and not have everyone dump on her all the time.

I'm kinda happy about that, y'know?

Anyway, because I've been talking about it, I decided I'd write a little about what depression is like for me.

The first thing I want to do is to distinguish between three things which can all be called "depression", may externally look similar, but which are fundamentally different.

They are sadness and melancholy, situational depression, and clinical depression.

When I talk about the thing which I have, which I consider my enemy, which I consider to be an evil and pernicious disease -- I'm referring ONLY to that third one.

"Sadness" is a normal and healthy part of life. In fact, I'd argue that, if you CAN'T feel sad when it's appropriate to feel sad, THAT is a problem. The lack of sadness may, sometimes, be a problem in itself. We people, we have emotions. And they are all part of being alive. Contentment is a good one, and I think that there are people who can feel that most of the time. It's a feeling of reasonable peace at the world, that there's nothing particularly going on bad. If your baseline emotion is "contentment", I think that would mean you have a pretty good life.

From that baseline, we can feel other things. There are all sorts of lists of emotions that people can feel -- when I was in kindergarten, I think we were given the idea of three emotions -- sadness, happiness, anger. I think that an emotionally healthy person can move out of their default "contentment" state when something happens to make them happy, or sad, or angry, and return back to contentment when it is appropriate to do so.

Some people list emotions including anger, disgust, surprise, fear, joy, and sadness. (Aristotle lists, as emotions, anger, calmness (an opposite of anger), friendship, enmity/hatred, fear, shame, kindness, pity, indignation, envy, and emulation -- but his list was made for a specific purpose: it consists of emotional states that an orator can excite in an audience in order to get them to do or not do things, so it's not really relevant here, which is why it's in parenthesis. Because it's cool, even if it is irrelevant.)

If a person feels sadness, that is not depression. It is sadness. If a person feels unreasonable sadness, overwhelming over a long period of time -- in my opinion, that may well be a condition that needs treatment -- but it's not the same thing as what I call depression.

Then we have "situational depression." And understanding situational depression is the first step to understanding what I consider clinical depression to be.

I think that situational depression is a necessary part of the human mind. I think that it is there for a reason. I think it's a circuit-breaker.

If you experience a deep, deep loss, something shocking, something that changes the entire landscape of your world, something will break. This loss could be a death of someone who was a deep part of your emotional life, a loss of a job which was a framework to how you lived, a disillusionment with a belief that you held and built ideas and ways of living around. A beloved pet who formed a great part of your emotional support, a community which you were entwined with.

If you lose something like that, something breaks. Your world has changed.

I believe that, when that happens, our emotions shut down for a while. We go off-line. The operating system crashes. Whatever analogy you use -- something in us dies to keep the rest of ourself from being destroyed by it.

We feel shock, which numbs us, and the numbness continues and shuts us down. We are empty inside, with nothing. After a while, we may gain some basic functioning, but we remain empty. And, eventually, we find a degree of stability in our new life, we can afford to feel again, and our emotions "wake up" again, or come to life, or are reborn, or come online -- however we want to look at it.

And that's situational depression. Something that our minds do to protect us from the abyss of having our world torn apart, until our world may be repaired. It is necessary, like a scab, or a scar. It is a form of "damage" that prevents worse damage.

Human societies develop rituals around this process. For instance, in the earliest stages of this situational depression, when the emotions have shut down, it may have taken most of our basic ability to care for ourselves with it. So we feed people. The vast flowering of casserole dishes that appear after a funeral are a healthy and necessary way in which a society helps an individual go through this process.

We Jews have a fairly involved ritual, which I rather like, and I feel works fairly well.

In the immediate aftermath of a death, the mourners stay at home, often with mirrors covered, often sitting on the floor, often in a darkened room. They do not bathe, they do not cook. People come by and sit with them, in silence unless the mourner WANTS to talk. And people bring food.

There is no expectation that a mourner will be able to manage even the most basic of tasks during this first stage . They are too empty, and too shocked by being empty. They may feel INTENSELY for short periods of time, and may then go back to basic emptiness.

After about a week, it is expected that the mourners may be able to get back to really basic level functioning -- but they are not expected to be able to feel pleasure, and so do not go to parties or other happy events. It's just considered to be not fair to them -- most likely, they're STILL basically empty inside.

After a month or so, though, it is expected that they will be able to feel again. At THAT time, they will be able to cry for their loss, and feel happiness when happy things happen, and anger, and all the other parts of emotional life.

And that is how situational depression is supposed to work, I think. You feel empty and unable to even care for yourself; you learn to care for yourself, but are still empty; and finally, your life is stable enough that you can feel again. Perhaps there might be medical ways to shorten the period of situational depression, but, even if there are, why would you want to? It's performing a useful function -- protecting people until their world can heal.

So.

What of clinical depression?

I think that there are four kinds of diseases: something is in your body that oughtn't be there, something is missing from your body that ought to be there, and your body is doing something that it is designed to do, but is Doing It Wrong, and your body is harming itself thereby.

Things that could be in your body could be parasites, or toxins. A virus, or a microbe, or a heavy metal of some sort. Things that could be lacking could be a vitamin, a hormone, or something like that. And then, of course, your body could Do Something Wrong -- as mild a thing as using its sneezing defenses against innocuous things, such as ragweed pollen, or as serious as deciding that your own internal organs are invading parasites and attacking them.

I think that clinical depression is this last.

I think that clinical depression is when your mind has decided to activate the "situational depression" kinds of defenses, but based on no loss. And since the activation was based on no loss, nothing you gain can get rid of it.

Depression, for me, has nothing to do with sadness. If I can feel sad, it is a sign to me that my bout of depression is passing. I relish the feeling of sadness -- it lets me know I am emotionally alive. Sadness is vastly preferable to depression.

Depression is the absence of feeling. It is the absence of the ability to feel. To the extent that I CAN feel anything, it's muted, far-off, like a feeling being felt by someone else.

When I'm depressed, I cannot feel happy, that is true -- but I also cannot feel sad, angry, disgusted, or afraid. Not much, anyway.

You know why more depressed people don't commit suicide? Because we can't be bothered. There may be no point in living, but there's no point in dying, either.

And we DO have physical feelings, like hunger, and cold, and so forth, although they're muted. We might not bother to put a blanket over ourselves if we're cold, but then again, we might. We might not bother to eat, but then, we might.

For me, as far as eating goes, if I ate sugar, the blood sugar spike as the glucose hit felt remarkably close to emotion, so that's what I do when I'm depressed -- I eat junk food, because it's as close as I can get to feeling an emotion.

Other people do self-injury, like cutting, or burning themselves. It doesn't really work, but it does come close. I've tried it; I think the "chocolate" thing works better. For me, the glucose hit works better than the adrenaline hit.

I suspect that there are other drugs which do similar things.

Alcohol, by the way, does the opposite: it doesn't make you feel anything, but it gives you an excuse for not feeling anything. You don't feel anything, but you can fool yourself into believing that you DO have emotions somewhere, but it's just that they are hiding behind the alcohol.

This is why I have such incomprehension when people ask questions like, "What do we lose when we medicate people out of depression?"

Answer: absolutely nothing. Clinical depression has absolutely no upside. Situational depression DOES have a purpose, and an upside, but that's not clinical depression. And sadness, and melancholy, are VERY important -- but they have no more to do with depression than happiness does. Depression is as far from sadness as it is from joy.

Hell, depression isn't even BLEAK. Bleakness is when you look at the world around you, and see no future. In depression, you can't even get THAT far. You're just hollow.

Comments

[redbird]

That's a good explanation of some significant distinctions.

Questions that might be reasonable are, Are we medicating people too soon, before sorting out that what they have is clinical depression? (rather than situational depression, or some other mental/psychological problem that depression meds won't help with) and In this case, are the benefits of this medication worth the side effects?

[xiphias.livejournal.com]

I'd say, yes, we are sometimes. And that, for instance, that recent report about an old study which showed that, unless people were actually depressed, antidepressants didn't help more than placebos, would be an example of that.

Are the benefits worth the side effects? Well, the CERTAINLY are when that's actually what's going on. . . and they certainly AREN'T when that's not. Diagnosis needs to be better. *shrug*

[plumtreeblossom.livejournal.com]

This was an EXCELLENT explaination of that which is called depression, and that which really is. I don't have clinical depression, but I certainly do respond with situational depression when circumstances are horrible and I need to self-protect by shutting down temporarily.I've tried to understand and organize the difference in my head, but you've articulated it perfectly. I'm adding it to memories so I can refer back to it.Thank you for taking the time to write this.

[xiphias.livejournal.com]

You're welcome. It was important to me to get it out onto paper -- well, photons -- where I could read it, too.

[bkwrrm-tx.livejournal.com]

As a person with screwed up brain chemistry, I'm applauding this post. May I print it out?

[xiphias.livejournal.com]

Absolutely. If this can be useful to you, print it out, staple it to telephone poles, show it to your doctor, use it as toilet paper -- whatever way this can be useful to you, use it.

I only request that, if you're showing it around, you mention my name with it, too.

That's a good post

[dakiwiboid.livejournal.com]

I do feel most of the time when my depression's at its worst, but that's me and not you. I cry, I have suicidal ideas, I have obsessive thought patterns that go around and around. I don't always just go numb. There are different forms of clinical depression.

I do agree that the world loses nothing by medicating depression. If I weren't medicated I might as well not exist. Medicated, I hold down a regular job, function pretty well under stress, and handle my life rather efficiently. Without that medication, I collapse like a bunch of broccoli, to quote a certain sage.

Re: That's a good post

[xiphias.livejournal.com]

I wish we had better language for this stuff.

I bet that there's some sort of difference between the depression you have, and the depression I have. Just as there are vast, vast differences between cancers, but we call them all "cancer". And yet, the treatments for ONE kind of cancer are absolutely useless, or even harmful, when treating ANOTHER kind of cancer.

I bet that "depression" is the same way.

[roozle.livejournal.com]

I think you are using the words "situational depression" interchangeably with with the emotion that I call "grief". And I agree with you, grieving is a natural process and tends to terminate on their own. I'd go further and say that medicalizing that natural process does it a disservice .

I'm curious how you'd distinguish between situational depression and grief, particularly given your shiva analogy.

[xiphias.livejournal.com]

I don't know if I WOULD distinguish them that much. I think they're interrelated.

But I think that the situational depression stuff is only the first part of grief -- I think the process of grieving continues on after the situational depression is finished. Still, I think that, yes, situational depression is part of it.

[nancylebov.livejournal.com]

I think you're talking about severe depression. Mild-to-moderate seems to be a different beast.

There's a version where a person can enjoy low-effort pleasures, but finds it difficult or impossible to take care of themself which doesn't seem to fit your model.

[ron_newman]

This book has been getting a lot of attention lately: The End of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Have you read it (or reviews of it)?

[xiphias.livejournal.com]

I've heard of it, but not read it. One of the reasons why I wanted to write this up is to have a description of depression as I experience it, and how that's different from sadness.

While I'm willing to entertain the hypothesis that depression is over-diagnosed, I don't want people to jump to the conclusion that depression doesn't EXIST, or isn't worth treating.

[kalmn.livejournal.com]

And that is how situational depression is supposed to work, I think. You feel empty and unable to even care for yourself; you learn to care for yourself, but are still empty; and finally, your life is stable enough that you can feel again. Perhaps there might be medical ways to shorten the period of situational depression, but, even if there are, why would you want to? It's performing a useful function -- protecting people until their world can heal.

what i get is situational depression, not clinical. and while i agree with you in principle, here, in practice, i disagree. i think the difference is how long we think that period is, and how severe the wound has to be to kick it off. for me, the answers to those are months of my life, and not very severe on an absolute basis. so i take celexa daily, and if i'm having a bad spot, i go in and talk to my therapist about it, so that i can get out of it, or at least so that i can see that i will get out of it eventually.

i am sick and stressed and underslept; i don't feel like i'm writing very well here. if i'm not making sense, please ask questions.

[xiphias.livejournal.com]

Language is only an approximation of reality. I say "situation depression is THIS, and clinical depression is THAT", and I make these definitional categories and stuff.

Of course, real life doesn't fit neatly into boxes. And there can be all sorts of stuff that's in between the two categories.

So, I can say that "clinical depression is when nothing triggers it, and situational depression is when something serious triggers it," but, in reality, there are all sorts of things in the middle.

Like having depression triggered by actual stuff, but the kinds of actual stuff that happens several times a year, rather than several times in your life.

Is that situational? Yes. Is that clinical? Yes. It doesn't fit neatly into boxes, because life doesn't fit neatly into boxes. But if it fucks up your life, it's definitely worth treating until it DOESN'T fuck up your life.

[rebmommy.livejournal.com]

Thank you for this post - it is a very helpful explanation of an all-too-common human situation. I liked your disctinction between sadness, situational depression, and clinical depression. In my work as a chaplain, I meet people in all three emotional states. How I work with them is different depending on each case. My work is very intuitive - I have to figure out for myself when to help someone out of an emotional funk, when to help them deal with the situation, when to refer them to a doctor or therapist who is skilled in working with depression. And, of course, there are degrees of clinical depression - I let the therapist determine this with the patient. As a family member and as a friend with clinical depression, we can support someone in getting the right kind of help. Your post may help to sort through what is needed to help someone. It explains things pretty well, at least from my point of view as a chaplain. You are a wise and kind man. I raised you well and am proud of you.

[papersky.livejournal.com]

You're very wise.

[dancing-kiralee.livejournal.com]

This is mostly helpful, but also... incomplete... and, I think, incomplete in a way that could hurt people (and, generally, hurt people who have a hard time defending themselves because they are stigmatized).

You need to make it clear that situational depression isn't just grief or grieving (where I'm extending grief and grieving to include all loss, even, say , moving to a new house or losing a job).

To put it another way, situational depression can be caused by long standing environmental factors that are outside the control of person experiencing the emotion.

The most famous case of this is the large number of women in the 1950s who were unhappy in their role as wives and mothers; many of them believed they should be happy, and sought professional help in ridding themselves of this unwanted, irrational, and ineffective emotional reaction. They were usually diagnosed with depression, and given Valium (an addictive drug) to cure it.

Eventually Betty Friedman did a study (published as The Feminine Mystique) in which she revealed just how many of these women there were, and argued that their feelings were a "normal" reaction to their environmental situation. Thus did the feminist revolution of the 60's begin.

Unless you make it clear that situational depression can last over a long period of time, and occur in situations that other people would be perfectly happy in (many women are happy in the roles of wife and mother) you stigmatize, and shame, the people who experience this. That both hurts them, and makes it harder for them to defend themselves; and it means that people, like you, try to treat their problems as clinical depression and not situational depression, which usually makes it worse.

Kiralee

[ailbhe]

I'm crying because your post leaves out postnatal depression almost totally. It's neither situational nor chronic. And it's grossly underestimated.

[xiphias.livejournal.com]

I'm sorry. It's obviously something I never experienced. I'm, really, not trying to be exhaustive here -- I'm not saying this is EVERYTHING -- I'm saying "this is what I have experienced."

[eleanorb.livejournal.com]

This is great. I'd also add clinical depression does not have anything to do with low self esteem, no matter what therapists try to tell you. You don't care enough to be bothered about how others see you.

[xiphias.livejournal.com]

For me, that's not 100% true. It's true that low self esteem doesn't LEAD to depression -- but for me, it can be a result of it. Because you DO notice that OTHER people are doing things like, y'know, showering, holding down jobs. and feeding themselves, and you realize that there's something fucking wrong with you, and that it must be because you suck.

Fixing depression can fix low self esteem: fixing low self esteem does jack for depression.

types of depression

[baratron.livejournal.com]

I think it's a great post, but currently incomplete. For example, you haven't mentioned that there are two basic types of clinical depression with almost completely different symptom sets: melancholic and atypical. Melancholic depression looks like what you describe as grief or situational depression, but it goes on much longer and isn't necessarily caused by an external source. Melancholic depressives won't be able to get to sleep or stay asleep, and they'll have no appetite, energy or ability to think - yet have psychomotor agitation and will pace up and down for hours. They generally feel numb emotionally and won't feel better even if something fun happens (anhedonia, and failure of reactivity to pleasurable stimuli). Atypical depression, despite the name, is actually the most common, and it has the polar opposite features. Atypical depressives will overeat ("comfort" eating, especially of carbohydrates) and typically sleep 15-18 hours a day. But they can be cheered up temporarily - they have paradoxical anhedonia, and will feel better for a while when something good happens.

And of course, real people aren't as simple as two little boxes. My depression is mostly atypical: I crave carbohydrates when depressed and can be cheered up temporarily (leading to me becoming addicted to video games as I feel happy while playing the game as it blocks out all the negative thoughts in my head). The problem is that during depression, my baseline mood has drifted downwards. So it's easy for me to feel bad because only a small surge of badness is enough to push my mood down to the troughs, the lowest possible mood - but it would take a VERY SERIOUSLY happy event for me to feel even mild contentment, due to starting so far below zero. And the positive mood doesn't last - I'll feel happy because I'm having fun with my friends, but as soon as my friends go away, I'm back to myself and my thoughts again. I have comorbid anxiety, which brings with it the irritable features more like melancholic depression, and anger. Like the melancholic depressive I'll have trouble getting to sleep and will still be awake at 4am worrying about stuff, but I have the atypical feature of sleeping for many, many hours once asleep. (Part of my trouble with falling asleep is "natural" insomnia that I've had my whole life, part is delayed sleep phase syndrome, the rest is due to the fact that I have nightmares when depressed and would rather like to avoid them by not going to sleep at all. I also tend to self-medicate with bright lights, which can reduce the body's ability to act on melatonin.) When depressed, I have times of not looking after myself because I don't have enough energy to do things like cook proper meals or wash, and times of not looking after myself as a form of self-punishment - "I'm a bad, weak person, and I don't deserve to be clean". Following therapy, the latter is now very rare for me - I've learned that my brain chemistry beats me up enough without needing to add to it :)

I also have a strong psychotic component from hormonal stuff. Every time I have ever intentionally self-harmed was on day 23 of my period, when my progesterone:oestrogen ratio is highest. And the majority of times I have unintentionally hurt myself (e.g. by falling off stepstools or down the stairs) have been during the window of day 22-day 25. In general, my ability to think, reason & co-ordinate my physical presence all get screwed up by the wonky brain chemistry that results from the hormone spike.

[comment too long, continued in next post]

Re: types of depression

[gingicat]

Wow, this sounds like me. I also had severe emotional issues during both pregnancies and am having issues now postpartum (Eva's not quite 3 months old).

about doctors and drugzzz

[baratron.livejournal.com]

A GOOD doctor will work out what sort of depression you have based on your answers to complicated mood surveys, and prescribe an antidepressant accordingly. Prozac is great for melancholic depressives, but it may do nothing at all for atypical depressives. All I experienced from it was occasional physical numbness and a bit of dizziness, it didn't help me sleep or stop worrying. Efexor is fantastic for me, because it works on norepinephrine as well as serotonin, so helps with the anxiety and gives you energy to DO THINGS. When I first went on it, it worked quite literally within days - at least until my body got used to the dose and went "uh, this isn't enough anymore". One of the first "symptoms" of me forgetting a dose is that I become irrationally and disproportionately bad-tempered. However, Efexor may be utterly lousy for some depressives, because it can give them the energy they're lacking without actually making them feel any better - which can cause them to have enough energy to seriously hurt or kill themselves. And of course, people are complicated and biochemistry isn't this simple.

A really good doctor will be able to tailor make a cocktail of psychoactive drugs to sort you out. At one point I was on Efexor, Fluanxol and Mirtazapine all at the same time, along with megadose folic acid (15 mg per day). Efexor (venlafaxine) is an SNRI, Fluanxol (flupenthixol/flupentixol) is an antipsychotic given in low dose to treat psychotic depression, and Zispin (mirtazapine) is a NASSA drug which works on noradrenaline as well as serotonin, used in combination with venlafaxine and duloxetine for treatment-resistant depression. Folic acid is a mood stabiliser which is much safer than lithium for monopolar depressives. I used to take it around the dangerous time of the month, and it stopped me going completely deranged.

Often GPs are maligned for being allowed to prescribe antidepressants without the correct knowledge. I'll allow that GPs can be utterly bloody clueless - I ended up with treatment-resistant depression and suffered for four years because of the woman who only knew about melancholic type when mine was atypical, and said when Prozac didn't work "oh, then you don't have biochemical depression". And GPs may well not know which antidepressant is best for patients manifesting with a particular symptom set, or know how frequently patients need monitoring - "come back in 14 days" is NOT appropriate for someone who feels suicidal who's gone onto a new drug. The irony is, it was my own GP who worked out the treatment for me, and I've never seen a psychiatrist who I've trusted to know more about biochemistry and drugs than I myself do. (The last psychiatrist I saw actually argued with me that I'd made up one of my diagnoses for attention because she'd never heard of it. I pointed out that she had access to all of my medical notes and told her to make a quick phone call to my GP and confirm it with him. GAH!!!) The difference is that my GP is a medical researcher as well as a doctor, and reads all the psychiatry literature.

[comment STILL too long - continued in yet another post!]

what this means for me now

[baratron.livejournal.com]

I will be on Efexor for life or until it stops working (which is no longer a terrifying prospect now that it's not the only SNRI in existence - there is also Cymbalta (duloxetine)). I suspect I'll always be on a low dose of Mirtazapine, because I have quite literally tried EVERYTHING on the market that is supposed to help you get to sleep - every over-the-counter & herbal remedy, as well as zolpidem - even homeopathy (which I don't believe in). When I was still completely unable to sleep 5 hours after I took it, I took another pill, and another one, and it did NOTHING. I looked up the maximum safe dose - 4 tablets a day - took them all at once, and it did NOTHING. Mirtazapine mostly makes me get sleepy an hour after I take it, though it hasn't been working too well lately. I think I need to decrease the dose. (And yes, I meant decrease. Its sleep-inducing properties are strongest at the lowest doses. Many people who start off on 15 mg find they suddenly need to sleep for 12-15 hours a night and will be "comatose" if they try to wake before that.) I used to know about every psychiatric drug in existence, but am woefully out of date on anything after 2002 due to having been mostly stable since then. Now I manage my depression with cognitive behavioural therapy, which is an absolute LIFESAVER for atypical depressives, as it trains you to stop going round and round in negative thought spirals and break the cycle. Unfortunately, there are nowhere near enough psychologists trained in CBT for everyone who needs it, and waiting lists can exceed 2 years.

I'm now going to copy & paste all of this into a new post in my own journal, because I have EATEN your space.

[erin-c-1978.livejournal.com]

It's fascinating, seeing the differences in the individual depressions of the folks on your flist. For me, depression makes it much harder to do the things I need to do and significantly decreases my ability to feel happiness or pleasure, but it doesn't numb me completely. Mostly, I lose hope. Even the possibility of something good happening seems to fade away, and though I can sometimes enjoy things -- a visit, or a game, or a film -- I can't seem to hold onto it afterwards. Old, beloved media provide more comfort than anything new. My ability to take refuge in my imagination goes away. I dwell obsessively on all the bad places my life is inevitably going to go, and doing concrete things to try and improve it fills me with anxiety and a kind of sick horror that it's not working, that it will never work. Doing chores and regular life-upkeep sorts of things is possible but terribly difficult and terribly anxiety-provoking. I find myself procrastinating to shut out the stuff that scares me, a list that gets longer as I have anxiety spikes in more and more situations. Sometimes it feels like I'm breathing pain, and it's just a matter of getting through the slow, slow minutes until I can eat something -- I definitely have a problem with comfort eating -- or go to sleep.

When something cuts through the fog to make me feel something strongly -- a sad song in a public place, for example -- sometimes it's all I can do to keep myself from breaking down. When I saw the recent movie version of Charlotte's Web, I sobbed through the last quarter of the movie and the ending credits -- not just because of what happens to the characters, but because both the movie and the final song so strongly evoked for me how small things can be both infinitely beautiful and infinitely precious, and I could remember how it felt to feel that way but wasn't sure I'd ever feel that way in real time again.

As far as how my depression affects my outward behavior, it's not pretty. I'm irritable. I'm excessively critical of others and prone to inferring the worst about their motives. I latch onto stupid things and won't let go. At the same time I'm acting in ways that make me obnoxious and hard to be around, I get increasingly clingy and insecure.

I should probably note that a lot of my experience of depression is influenced as much by my anxiety disorder (OCD) as anything, so I'm not sure how close my experience comes to anyone whose depression doesn't accompany anxiety.

Even though the sort of depression I experience seems to be closer to baratron's than yours, I'm struck, now that I'm doing so much better, how much greater my range of emotion is. Listening to music, I can feel nuances beyond "soothing" and "makes me anxious." I can process the arguments in blog posts emotionally in a way that goes beyond threatening vs. non-threatening. It's incredibly freeing. I wish everyone who's depressed could find something that works for them as well as my current treatment is working for me (and that such treatments were more affordable and easier to find).

[ailbhe]

I've been thinking about this a lot.

Depression...

There's temporary depression and chronic depression, and situational depression and biochemical depression - so perhaps a sort of venn diagram thing, where people describe their depression as, eg TB depression (temporary biochemical) or CB, or CS (chronic situational, eg depressed because stuck in unbearable, unalterable life situation) etc? Would that be another useful place to start?

[baratron.livejournal.com]

I like that. How about this?



Notes:
1. All of the types of depression overlap to the extent possible within only 2 dimensions to show that each type of depression can change. For example, someone in chronic situational depression may become biochemically depressed and not notice until after they've escaped from the situation.

2. Premenstrual Syndrome & Dysphoric Disorder, Post Natal/Partum Depression and the Baby Blues are in pink to show that they affect women. They overlap to show that the situational depression called the Baby Blues might develop into biochemical depression called Post Natal Depression, and also to show that the women most at risk of PND/PPD are those with PMS.

3. Dysthymia is chronic "low grade" depression that will often be regarded as part of someone's personality - "Eeyore syndrome". People with dysthymia are however at risk of episodes of chronic depression. So I put it in the overlap between temporary and chronic biochemical.

4. Abuse survivors may be placed absolutely anywhere on the grid depending on whether they have managed to escape from the situation yet.

5. I'm not happy with where I put grief. It could do with being on the overlap between temporary situational and chronic biochemical, because a person who doesn't recover from their bereavement or loss properly is at risk of developing long-term biochemical depression. Really wasn't sure how to get it there, though.

6. I haven't even considered bipolar disorder. Mania & hypomania are somewhat different to depression, and there already exist Venn diagrams to show the overlap of monopolar depression, dysthymia, cyclothymia and bipolar disorder.

I am. A Geek.

[cogitationitis.livejournal.com]

For me, I don't know if I'm depressed; this is the way I've always felt. I know that I'm stressed far more than I should be, and that my sleep cycle is often screwed up, and I laugh when stressed but rarely when something is funny (though I do if it's hilarious). If all you've known is life at a four, is that depressed, even though 'normal' is life at a seven?

[xiphias.livejournal.com]

The definitions of "normal":

1. Referring to a force perpendicular to another force.
2. Referring to a concentration of 1 mole of atoms per liter
3. A college that trains teachers.
4. Usual.
5. Operating at its healthiest potential, with nothing wrong with it.

That definition #5 is a medical term. A "normal" heart is one that's perfect. I doubt many of us have those.

Me, I didn't know for sure whether I was depressed until it was treated. At that point, I was sure. The difference was as different as two things that you'd use as exemplars for different things if you were creating a simile to express a vast degree of difference.

[rubynye.livejournal.com]

I agree with the people who said this was incomplete; I know you do, too. I would disagree with anyone who said that because this was incomplete it was useless or unwise.

I'm glad I know you.

[stickylatex.livejournal.com]

sadness and melancholy, situational depression, and clinical depression.

When I talk about the thing which I have, which I consider my enemy, which I consider to be an evil and pernicious disease -- I'm referring ONLY to that third one.

Thank you for saying this. It should be obvious, if not to the general public, at least to anyone with medical and/or psychology training. I'm DEEPLY disturbed by the extent to which the other two states you mentioned are medicated in our society, and I blame the drug companies and their greed. Which is not to say that the drugs shouldn't exist, or that people with clinical depression shouldn't take them. But I don't think they should be advertised on TV. I think in the attempt to make depression less stigmatizing, and treatment more accessible (both laudable goals), we have done too far.

[xiphias.livejournal.com]

I don't think we should allow the advertisement of perscription drugs on TV at all, and I'd want a HELL of a lot stronger restrictions on how drug companies can market to doctors directly -- which they do partially as "doctor training seminars." Which happen on cruise ships and the like. I think that, yeah, a huge amount of that problem is from those things.