I am so glad I found your site. After several months of attempting to effectively deal with my issues, out of sheer desperation, and as a stab-in-the-dark, I goggled “what’s wrong with me” and came across another question and answer exchange on your site. I found it extremely useful and educational but it left me with some old and new concerns so I thought maybe this was my opportunity to get some answers (or at least ideas). Now I just have to try not to get my hopes up in waiting for a response! Of course I would certainly appreciate one soon, as much as any other individual that posts on your site I’m sure.

I am a 28-year-old married, working female. I have always been an emotional, anxious, awkward individual, but I owned that and I never let it really affect my life in any big negative way (I didn’t think). Recently, however, I’ve had more and more difficulty overcoming these challenges so that I am now to a point where I cry daily (sometimes multiple times daily) and have daily thoughts of anxiousness, sadness, frustration, uselessness, self-loathing, guilt (sometimes lasting all day).

I now feel like I’m not heading toward a “meltdown” or “breakdown”, but that I’m right in the middle of one. I’ve been here for months and I’m stuck. Just when I think I’m feeling better, once again I lose all feeling of control and rationality because of some often incidental event, making everything else seem to pile up. You should understand that I have always been an extremely organized, rational, well-meaning, even positive individual. And I believe I am an intelligent individual. So first of, it does not make sense to me that I can even be feeling this way. I have had no abnormal tragedy in my life, thank God. How should I be allowed to feel the selfishness of fear and vulnerability when I don’t really know what those terms mean compared to some people’s experiences?

So I guess I’m looking for any answers, explanations, thoughts or ideas as to how I got here… and how I get out. I do feel I have attempted various methods of managing my stress levels, with varying degrees of success. (I’ve tried to change my mood/outlook and be more positive and selfless. I’ve tried to give myself time off to “recoup”. I’ve even decided that maybe it’s not the best thing to keep it all inside and have confided in a couple of people about a couple of things – but I am a very inarticulate person, at least face-to-face, and have difficulty understanding my emotions let alone expressing them.) So in the end all my methods come down to me still feeling overwhelmed, empty, or even wronged in some way (“it’s unfair”) – except I have no-one to blame but myself, right??

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There is constantly a battle being waged in my head. Scratch that, make it MULTIPLE battles. I am exhausted every day after work. I am exhausted every morning and have to fight to get out of the house (sometimes knowing I have to see and be around people is the toughest thought). I’m exhausted from the mental difficulty, from the crying, from the lack of sleep, from the pain in my back and neck.  I used to be SO involved and have SO much more desire and energy! Theatre, choirs, sports, school, work, committees…  While attending university it was nothing for me to have a 16 hour day, every day. Now all I can say is “I need to do less”, “I want more time”. Which says a lot, because part of my attempt at feeling better has been to make the very tough decision to quit some responsibilities. I really only have work and a couple of other things now.

I can feel myself getting more emotional now and can see it in reading this back so I will leave it there – hopefully this gives you a good idea of what situation I find myself in. Can you help?

You’ve done a very nice job of describing some of the symptoms you are dealing with, and the weary, despondent tone of your letter helps color in some detail as well.  You are describing physical and cognitive symptoms consistent with a moderate severity unipolar mood disorder such as Major Depression.  Major depression is also frequently characterized by feelings of emptiness, worthlessness, guilt, self-loathing, and physical expressions including fatigue and sleep disturbance.  This doesn’t mean that you have Major Depression, but it is certainly something you and your doctor should be ruling out. 

I’ve used the word “moderate severity” here and I want to explain why.  You are describing yourself as deeply affected by these problems, but not incapacitated.  I don’t see you talking about suicide, or not being able muster the motivation to get out of bed, or even hallucinations of a morbid variety.  When diagnoses like Major Depression are really severe, these kinds of truly disabling symptoms may be present.  In no way am I trying to belittle the suffering you are describing yourself experiencing; it’s just that it can get worse than you are describing. 

I’ve also used the word “unipolar”.  This means that based on your presentation, your mood is consistently down/sad and there is no evidence of periods where you are particularly upbeat and energetic.  The latter sort of episode is known as mania (or hypomania when it appears as less than a full mania).  It is not necessary that you feel happy during a manic or hypomanic episode, but it is necessary that you’d feel energetic.  If not happy, then you’d describe it as irritable or agitated.  You do describe irritability, but in the context of fatigue, so mania would appear to not be a problem here.  Depressions which vary between sadness and mania are known as bipolar depressions, while depressions that consist solely of sadness are unipolar. 

These symptoms are occurring for you seemingly without provocation.  You can’t identify any triggering incident and you really cannot make sense of them as a reaction to anything that has happened to you.  This suggests to me that what you are dealing with may be of medical origin rather than psychological origin.  Depression-like conditions can be caused by hormone problems, for instance.  The first thing that makes sense to do I would think would be to see your physician for a physical examination.  Tell your physician that you are experiencing chronic and semi-disabling mood symptoms and pain (as above) so that she understands what to look for.  You want to rule out any medical illnesses that may be contributing to your suffering before moving on to psychological or psychiatric interventions.  It is not necessarily the case that a depression which seems to have come from nowhere must be due to a physical problem, but that is the starting assumption you’d want to rule out, as to not proceed in this manner puts you at risk that you might miss something very treatable. 

Depressions can and do appear “out of the blue” in people’s lives.  There can be many reasons for this besides medical reasons, but perhaps the best simple way to think about it is to think about the idea that we are not always aware of everything that is happening in our mental (cognitive) and emotional lives.  Losses of important friends or family members who used to serve as a support can trigger depressions, for instance.  Some people understand that there is a connection between the loss and the mood, but others simply don’t make the connection due to the way their perceptions are oriented.  It’s not a matter of intelligence, so much as a matter of personality style.  Different people pay attention to different things and its surprisingly easy to fail to connect important dots sometimes.  In such cases, talking about the problem with a trusted and supportive other person (a therapist or family member or friend or clergy) can be of great assistance, because that person’s outsider perspective allows them to connect the dots in a different way than you would yourself and then feed that new perspective back to you so that you can use it to make sense of your situation. 

Another thing to consider is that, if you’ve always been, “an emotional, anxious, awkward individual” as you suggest that it is reasonably likely that you are predisposed in some fashion to be vulnerable to developing depression.  One of the major dimensions of personality is known variously as “neuroticism” or “emotional stability”.  People who are more neurotic by nature (in the personality trait sense; not in the Freudian sense) are simply more vulnerable to becoming anxious and/or depressed than are people who have less of this characteristic.  There is thought to be a genetic inheritance that predisposes people towards this temperament, but the fine details about how this all works are still not well understood.  Ask yourself: are there other people in your family who have had similar problems?  It is reasonably likely that the answer is yes if there is an inherited vulnerability working against you. 

If this is a depression which cannot be better accounted for by some other medical condition, then there are a variety of ways you can proceed regarding treatment.  Your primary choices are between a medical intervention, usually consisting of one or more antidepressant medications administered in pill form, and a psychological intervention.  In recent years, the trend in psychotherapy has been towards trying to standardize and validate specific psychotherapy interventions useful to treat specific problems.  While many people will benefit from any sort of psychotherapy, there are two specific therapy types that have been validated for unipolar depressive mood problems (last I looked): Cognitive Behavioral Therapy (CBT) for Depression, and Interpersonal Therapy for Depression.  In particular, CBT is now widely available in almost all major cities and outlying areas.  It is the type of therapy I’d suggest you search for if you decide that you want to do psychotherapy for mood symptoms such as you describe.

Medication treatments and (validated) psychotherapy treatments for depression might both be useful to you in helping you feel better.  They can be used independently or together, as advised by your doctor and as fits your needs and desires. 

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