Question:
I am a 50 year old female, and I feel that I have never really experienced happiness. I think in some cases I’ve been able to hide my depressed state, but it is getting harder. I have always been overly emotional, and have always been a big crier. Some questionnaires ask the question, "do you no longer want to do something you previously enjoyed doing?” That’s part of the problem – I don’t really think there’s ever been anything that I’ve really loved doing – even as a child.
It’s not like I can’t function – I am intelligent and creative and have been fairly successful, but I do have a really hard time with criticism at work. In social situations I am shy, but I have a group of friends who are anything but shy. I have had relationships, but have never been married or even lived with a man. I don’t have any social life now, but did when I was younger. I didn’t get involved often, but when I did I became so resistant to rejection that I would hang on even after knew it was over. I would just set myself up for more rejection.
AdI have never been confident in my appearance or my body – even when I was younger and knew I wasn’t ugly or fat. I always look my best when going somewhere. I wish I would exercise and lose some weight (I’m not obese, but need to lose around 20 pounds), and I’ve started many programs but never stick with it. I do get excited when something exciting happens, but that fades quickly and I’m back to blah. When something sad or disappointing happens, I get so depressed that it takes over my life. I literally cry and cry and cry.
I have tried Prozac and Zoloft in the past and it stopped the crying, and all emotions, but made me numb and fat – I still felt depressed, but I didn’t care, which to me was worse than being depressed and wanting to get better. I recently lost my job due to a layoff and I am having a hard time getting over it and getting another job. I took Cymbalta for 9 months, but it just made me gain weight and sleep a lot (It was a nightmare to quit this drug). I’m currently on Wellbutrin and I can’t sleep at all. I switched to SR from extended release but I’m still up all night, and then I’m too tired to get anything done the next day. Not even sleeping pills work. Xanax will put me to sleep, but then I can’t seem to get up the next day. The inability to go to sleep is there with or without any of the drugs, but seems worse now. I am so tired all of the time.
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AdI guess my basic question is – is there a type of depression that is always slightly there, but allows a person to be functional, but the reaction to sadness, criticism, or rejection is over exaggerated? – Cry a lot, can’t get anything done because of procrastination or just too tired, can’t sleep, crave food (gain weight), and just feel totally lazy with no motivation to even get dressed. If so, is there a certain kind of anti-depressant that works best for this? My doctor seems like he’s running out of options.
By the way, my mother was always depressed (more severe than me), but would never get help. Also, I have two sisters who also have issues but they aren’t the same as mine. One sister has suffered with obesity for most of her life and has tried many antidepressants with no good results. She just started taking Lyrica and a sleeping medication that she says is working. Why would this work for depression? My other sister started taking ADHD drugs because of her inability to focus and get anything done. She’s never been able to keep a job or keep up with household chores, mostly due to lack of motivation. She’s always been snappy and overly critical (kind of a mean know-it-all attitude), but I think the Adderal makes her reactions worse. I adopted a foster child about 5 years ago who is now a teen, and I don’t want her to grow up with a depressed mom as I did. The older I get, it seems like the depression is more severe and difficult to hide from her. Are the problems my siblings and I have just due to being raised by a terribly depressed mother? Thanks for any advice you can give.
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Answer:
The first thing that has crossed my mind while reading your letter is that you are a strong woman despite how you may think to the contrary. Here you are someone who has more or less never known anything other than feeling over-sensitive and down and who has grown up in a family dominated (it sounds like) by negative emotion and self-centeredness. In spite of this, you have worked valiantly over the years to try to find a way to feel better, and though no medication treatment has seemed to work out all that well, your hope that something will ultimately prove effective has not flagged. Here you are taking on the responsibility of mothering a child in need of parenting, and thinking about the impact of your own mental state on your developing daughter; something your own family did not do for you. So, my first reaction to you is that you are a good person and I am impressed with your strength and thoughtfulness.
You ask if there is a sort of low level depression, and the answer is yes there is. Dysthymia is a low level depression that never really becomes disabling, but never really goes away either. This is by definition a chronic condition; you can’t even diagnose it until two years have gone by without significant relief from the low level chronic depressive mood state that is the core feature of this diagnosis. You can read about it in the Dysthymia page of our Depression topic center.
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Dysthymia and Major Depression can be treated with medications as you are well aware, but they can also be treated quite effectively with particular forms of psychotherapy such as Cognitive Therapy for Depression which has been shown to produce longer lasting relief from depression than medication can offer. If you’ve never before tried Cognitive Therapy as an approach to treating your ongoing low level depression, I recommend that you give it a try. It is relatively short term (lasting maybe 18 to 20 sessions total duration), has no side effects such as weight gain, and is today pretty widely available in most cities from therapists who specialize in the approach, which you should ask for by name.
You characterize your problem as a constant low level depression, but I can’t help but wonder if part of the problem isn’t a life-long social anxiety issue centering around what psychologists call a "fear of negative evaluation". It may be that your basic social anxiety and feelings of inadequacy are what have driven your chronic depression. I can’t know that for sure, but that is how your presentation feels on first impression.
If this is the case (that a basic layer of anxiety needs to be addressed as well as feelings of depression), Cognitive Therapy is still a very useful approach for addressing your problems, because this therapy is also very effective in helping to treat anxiety problems.
The basic idea to be found in Cognitive Therapy is that your thoughts and beliefs help shape your emotional reactions. If you believe that you are inadequate, this belief will shape your emotions, causing you to feel depressed, for example. The basic problem is that beliefs function to shape emotion independently of whether they are based on anything true or not. It is possible (and indeed often likely) that you believe you are inadequate even though the evidence suggests that it is not the case, but still you end up feeling depressed. Through a process known as cognitive restructuring, Cognitive Therapy teaches you to evaluate your beliefs to see if they are true or not. As you get better at evaluating and correcting your beliefs, you automatically stop feeling as bad because you end up becoming less self-critical.
You may be wondering where people pick up beliefs about themselves that could influence them to be anxious and depressed and if this might have anything to do with growing up in the sort of depressive household you describe. There probably is a relationship between some of your present day thinking habits and how you were treated while growing up. It doesn’t do too much good to focus on the past, however, as the past is not fixable. It is far more helpful to focus on what is in front of you today – the thoughts you are thinking these days that make it easy for you to feel inadequate, anxious and depressive. If you can address and correct these thoughts, which is what Cognitive Therapy teaches you to do, you are likely to experience some relief. Good luck to you in this enterprise.
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