Depression (major depression)

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• February 7, 2012 1:47 a.m.

  Finally correctly diagnosed with dysthymia. On Pristiq. Big problem is I am in nursing school and can't kick this depression which started up again in 2009. I am post breast cancer treatment as well. I have a psychiatrist, therapist, and I go to an Adult Children of Alcoholics and other dysfunction group. I also work full-time. UGH! I am really afraid for not making it through school for second degree and a future for myself. Suggestions?????

  - Beth

• September 13, 2011 12:01 p.m.

  ALL this organized info on so many aspects of depression is very helpful. Thanks Mayo! Hadn't heard of dysthymia but it sounds like what I had -- often blue, pessimistic, overly worried, feeling hopeless. These symptoms really started when my children entered school. Six years ago I finally revealed my sometimes suidcidal thoughts and increasing perimenapausal moodiness to my internist and she put me on Effexor (75). Literally overnight I felt so stress and worry free. I couldn't believe I'd spent so many years so unhappy. Everyone remarked on how relaxed I'd become. Best of all, I never had any bad side effects--no weight gain, no loss of libido. However, I did suddenly develop high blood pressure several years ago, and I feel that my memory is really slipping. I'm more absent-minded. Though high BP runs in my family, I worry that it and the memory issues may be related to my long-term use of Effexor. My internist said they are not related and that I should just keep taking it as long as Effexor is working. Online accounts of people trying to stop having serious withdrawl are downright scary. (I think that my internist should have told me that Effexor was particularly hard to stop taking.) SO I HAVE ONE MAIN QUESTION TO WHICH I HAVEN'T FOUND ANY REAL DISCUSSION ONLINE: Can you take Effexor indefinitely as I've been told I can? What are the risks of doing so? Has anyone else ever found any serious answers to this question?

  - sonya

• August 29, 2011 9:00 p.m.

  Been on Paxil for several years (I am 48), but last few years have experienced the "poop-out" effect - the Paxil isn't working as well as it use to. Switched to Prozac and double the dose (40 mg) but it's been 2 months with no appreciable difference. I am in perimenopause, so I feel this may have a lot to do with it, as I'm having sleeping problems now as well. Also, about a year ago, started drinking alcohol to make up for the decrease in Paxil's effectiveness and to try and put myself to sleep. BAD idea. Started to drink more and more - felt like a switch had been turned off in my head that used to tell me when I'd had enough. So then I had THAT to deal with (which after taking time off work, and dealing with external stressors, has so far been successful). Was happy to read the blog re menopause - I'm hoping that things will get better after menopause.

  - Janine

• May 18, 2011 11:17 p.m.

  dear natalie: i'm glad u wrote back, there is another class of a.d.'s called maoi's, alot of the drs. use them as a "last resort" drug, i was on them 4 about 20 yrs. & they worked great, u may want to see if they r available in your country, r u happy with ur psychiatrist, if not u may want to look 4 another one, i no u said that u've been 2 four therapists, but i wasn't sure if u have a "good" psych. dr., sooo important, (my opinion), ck. out the drug "nardil", it's one of the maoi's that i was telling u about, i'm on ritalin 4 energy, abilify 4 depression & ativan 4 anxiety and/or sleep, have u tried any of those, my 1st signs of depression showed up when i was about your age, i'm now 55 yrs. old & have been dealing with this illness 4 all this time, hang in there, don't give up hope & write back-i'd like to know how ur doing

  - denise

• May 18, 2011 12:48 p.m.

  I really don't know who else to ask, maybe I thought I would get an objective opinion from a professional who might come across this site or the author of the blog, but as appreciative as I am of your advice Denise, unfortunately I'm not sure it's of much help to my situation. I've already seen 4 therapists, and the previous one who until last week I had seen for a year, I got along well with him and he put in a lot of effort in enquiring about things on my behalf etc. so that wasn't the problem, talk therapy just hasn't seemed to have helped me. He even said I'm one of the most dedicated patients he's had...yet nothing seems to help. As for antidepressants, no luck there either, not even slightly. Your suggestion of Deplin might have been useful if I had any improvement with another antidepressant (as is my understanding of how it works), but unfortunately I haven't. It seems like the only thing left that would be suggested to me is ECT and I just can't do that, for numerous reasons. I've wanted so badly for there to be another option, that I wouldn't just be left with the one thing I can't do, yet no one can suggest anything else. I'm sick of feeling so despeate and scared

  - Natalie

• May 14, 2011 12:07 a.m.

  dear natalie: i can't even imagine how awful it would be to have thoughts of suicide every day, has any of the a.d.'s even helped u @ all ?? if nothing has helped, have the drs. ever tried ect treatments 4 u ? have u tried getting a different dr. ? it makes all the difference when u have the right psych. dr., ck. out some of the other blog-sites that r on this web-site, some of the info. that i've written may help ? there's allways something else 2 try-don't ever give up hope, go on-line & research the drug "deplin", it enhances the effects of the other a.d.'s, it works great & alot of people call it their "miracle drug", i'm not sure if it's avail. in australia, there's a good web-site that tells u all about it, i know u must be feeling overwhelmed & frustrated, do u have family & friends that support u ? good luck 2 u don't give up hope & write back if it helps u

  - denise

• May 10, 2011 7:10 a.m.

  I'm commenting because basically I feel like I'm at my wit's end and I seriously wonder if treatment will ever help me in the slightest way. I know I'm only 24 but I don't know what it feels like to be happy and have had thoughts of suicide every day for 10 years. I've been getting treatment for 3 years, have seen 4 therapists, been on 8 antidepressants, done CBT and DBT (Dialectical Behaviour Therapy) have had my diagnosis clarified by a professor, and been in-patient, yet I have had NO improvements what-so-ever. I'm not even sure if I should be commenting here since I live in Australia and I don't know if any advice I might get on here would be available where I live, but I just don't know what else to do. I feel like even though I'm open and honest with every therapist I've seen that they never really seem to understand me fully and don't get how severe it feels (possibly due to Dysthymia being one of my diagnosis) I just feel like there aren't any options left for me. I'm desperate for someone to tell me otherwise because I'm scared of what I might eventually do. Any advice is greatly appreciated.

  - Natalie

• March 8, 2011 9:41 p.m.

  For susan, who asked about dysthymia near the menopausal years--been there, done that. Not realizing I even suffered from dysthymia until later in life, I found that dysthymia, at least for me, got far worse during the menopausal years. I have been taking Prozac for years, but during these years, the dose had to be increased. Also, Seroquel was added and it really made the Prozac work better. I did this for approx. 6 yrs. It seems that once the menopausal years progressed, I was able to have the Prozac decreased to minimal dosage. I stayed on the Seroquel for sleep purposes only. So far, this has been working very well and I feel no side affects now that everything is back down to minimal dose.

  - Helen

• February 28, 2011 7:52 p.m.

  I was diagnosed with dysthymia when I was around 13 and went through all sorts of medications for several years including medicine for ADD. I stopped taking medicine when I was about 18 and then started again at 21 when I had some trouble with alcohol and a girl and dropped out of school. I seemed to be happier when I wasn't on medicine. I often feel uninspired and have a pessimistic view on life. I have low self-esteem. I worry about what other people think about me alot. I used to smoke pot often but stopped at the recommendation of a therapist. In some ways I think I was better off when I wasn't on medicine and was using weed and alcohol

  - Jake

• January 11, 2011 9:40 p.m.

  I HAVE RECENTLY BEEN TESTED EXTENSIVELY BY A GOOD PSYCHOLOGIST D/T A CRISIS IN MY LIFE. I HAVE BEEN TAGGED AS BPD 2,MDD RECURRENT,ADD AND PROBABLY ONE IN THE MIX THAT I HAVE LONG FORGOTTEN ABOUT. MY RESULTS INDICATED A CHRONIC FORM OF DEPRESSION NOT SEVERE ENOUGH TO KEEP ME FROM FUNCTIONING,BUT RENDERING ME AS JUST A PERSON WHO HAS OFTEN FELT LIKE I WERE JUST GOING THROUGH THE MOTIONS AND JUST EXISTING.OFTEN CYNNICAL, WORRYSOME,PESSIMISTIC AND IRRITABLE AT TIMES WITHOUT GOOD REASON,AND OF COURSE,THAT USUALLY IS TOWARDS THOSE WHO CARE THE MOST ABOUT ME. THOUGH I PRIDE MYSELF ON BEING A STRONG PERSON AND NOT A WHINER,MY SYMPTOMS EVENTUALLY BECAME PROBLEMATIC IN MY RELATIONSHIPS WITH OTHERS.MY DOCTOR TOLD ME MY DX WAS MOST LIKELY BROUGHT ON BY EARLIER LIFE TRAUMATIC STRESSORS SUCH AS SEVERE PHYSICAL BEATINGS OF MY BROTHERS AND ON A COUPLE OF OCCASIONS MYSELF,MY MOTHER TRIED TO INTERVENE BUT WAS POWERLESS AND ON A FEW OCCASSIONS,I WATCHED HER BEING CHASED THROUGH THE HOUSE BEFORE BEING CORNERED.ALSO THE SUBSEQUENT ENVIRONMENT OF LIVING IN FEAR IN MY FORMATIVE YEARS WAS TRAUMATIC IN AND OF ITSELF. DAD WAS A HELL OF A PROVIDER FOR US SEVEN KIDS AND WE ALWAYS HAD WHAT WE NEEDED.I DESCRIBED MY COPING MECHANISM AS JUST "KEEPING IT IN" AND NOT BURDENING OTHERS OR ADMITTING TO SUCH A WEAKNESS.THIS PROBABLY JUST MADE THINGS WORSE.LOST MOTIVATION TO DO THINGS I LOVE TO DO,NOT THE INTEREST.ATLEAST I FEEL I'M ON THE RIGHT TRACK FINALLY AS MY MEDS HAVE CHANGED RECENTLY TO LESS S

  - Jeff

• March 17, 2010 2:56 a.m.

  what a lot of insight you guys have into this dysthymia. why should someone so intelligent be so sad? I feel we should all stop thinking so much and DO more with our bodies and time. we're as good as anyone else, just stop thinking so much all the time and having such high personal standards.

  - Andy

• January 29, 2010 9:47 p.m.

  It took a long time to learn what my problem was/is - I'm 66 and have suffered with this disease since I was aware that I had emotions - which means early childhood. the most effective treatment, after years of failed tries, has been a combination of Cognitive Behaviour Therapy with a good psychologist (not psychiatrist) and Effexor. I still have the occasional down mood but nothing like before and I would suspect I am close to the realm of "normal". The dose of Effexor is the bare minimum, hence no physical side effects. The most immediate and biggest effect of the drug is that it straightened out my thinking. The confusion, low self esteem and inability to feel at ease with life has for the most part left me. I am aware the disease is still there if I quit the drug and I will have to keep taking it, but the alternative is too bad to contemplate, the state of chronic depression was not a pleasant way to live. It is wonderful what medical science has enabled me to feel for the last six years. I am grateful and happier than I ever thought possible.

  - ann

• January 10, 2010 4:54 a.m.

  My symptoms of dysthymia began in adolescence, about 40 years ago. I am now 54. Since that time I have tried a variety of medications and behavioral and natural therapies. Medications tried include all major antidepressant types and varous combinations thereof. The only truly effective therapy for me has been the MAO inhibitor marplan(isocarboxazid), which I have used on-and-off for 30 years. It is much more effective for me than the other MAO inhibitors. Many people who have commented here might try it. There is however, a possible long delay(my first response was at 8 weeks) in action. Also,observe the dietary guidelines. Though Marplan is commonly used in the United Kingdom, and there it is recognized that some people with dysthymia respond only to Marplan, it can be difficult in the US to get a prescription strictly because of physician liability concerns. I am convinced there are many people in the US that could benefit from this medication, but are not receiving it due to physician liability fears. Please reply to the column if you try it --remember to stick with it to give it time to work. My first response to it was at 70 mg. at the 8 week mark, though I have found subsequently that such a large dose is unneeded, if I give it time to work. Maintenance dose then comes in at 20 or so mg.

  - Colin

• September 30, 2009 4:07 p.m.

  I first felt dysthymic symptoms in my early twenties following University grad & and the break up of a relationship. I am now 41 and would say I've had a about 3 -4 major depressive episodes in the past 20 years. I definitely see the same pattern in my parents (although they may be more major depressive) and my husband. I have tried therapy a few times in the past, mostly marital, but due to the expense dropped it once "crisis" was over. I absolutely refuse to take medication and instead try to exercise and have a drama-free existence. It's such a weird condition; mostly I feel "flat" emotionally and don't really have a constant zest for life. Once every few months I feel totally elated and amazing, but that will only last a day - would love to bottle that feeling! I have never resorted to any kind of substance abuse as I'm a bit of health nut. I can say that this condition has been one of the major reasons I have decided to not have children. I believe I had some major childhood trauma (possibly sexual?) which I've blocked. I've never had a close or loving relationship with my parents and suspect this is why. I have this deep-seated feeling that they failed to protect me in some way and often felt a sense of shame growing up. Did not know unconditional love in the family of origin; highly dysfunctional all around for all known generations; "adult children" if you know what I mean. Ready to try therapy again with a crisis in progr

  - Dagney

• September 20, 2009 7:58 p.m.

  I've had dysthymia since early childhood and was just diagnosised with it this year. I knew I was depressed growing up because of not being loved or accepted by my family or other people. Things didn't get any better when I started using drugs at age 13. But now I know I took them because I felt so bad and isolated. I never understood why I could feel normal one day and then awful the next. I've recently learned that my thinking patterns are very negative and are causing me my most distress. I keep having to remind myself to stop thinking of painful past experiences. My mind automatically goes there and it's hard to make myself stop. Today is Sunday and I've spent my weekend at home alone cause I'm depressed. My head feels compressed and it is hard to focus on anything. Ever since getting on prozac I've stopped going to the gym and I need to go back but I haven't been able to. Before starting the medication I had to go there just to function at work. I needed the endorphines or I couldn't do my work. Now that I can work, thanks to the prozac, I'm not going to the gym. I just broke up with someone and realized I've been in a very unrequited love relationship. I just learned a few days ago what that means. I was treated so badly as a child that I am still trying to get others to accept and love me, to no avail. I feel so pathetic. I'm 48 and divorced. At least I'm looking and trying to help myself get better.

  - Sue

• September 13, 2009 1:30 a.m.

  As far as I can remember I've felt empty inside. Relationships were always difficult, because I was very argumentative and opionated. I only have one friend and not so positive relationships with family members. My life has been consumed (eventhough I suffer from depression) with taking care of others with mental issues. It had to be GOD who kept me from loosing my mind. Most days I feel lonely. I am determined not to let this depression take control over the rest of my life. I currently take high doses of B12, cod liver oil and 2000 IU of vitamin D. I have tried quite a few meds, and the side effects are concerning. I don't like the changes my brain experiences. I will be looking for another therapist. Prayer has been very helpful. Internal breathing helps when I feel anxious. I also plan on eliminating people who constantly bring stress into my LIFE. I want to know what happiness feels like. I deserve it!

  - Bernie

• August 19, 2009 1:22 p.m.

  I believe I have had SAD for the past few years. I am not looking forward to the next few weeks. I am hoping my symptoms do not appear this fall/winter. I would like to enjoy my daughter's September birthday and Thanksgiving, Christmas and the New Year. Depression is real. Sometimes I believe in medication sometimes I don't the past couple years I have stopped taking my medication because I feel better. I am not doing it this year. Also, although I am not an alcoholic, I have found that eliminating alcohol from my diet has helped. I find myself sleeping all the time in the Spring and Summer and then Fall and Winter I can't get to sleep. This may sound weird, but I almost have a fear of darkness when I have episodes of depression. I definetly cut people off socially too. I would prefer to be alone for 3 months out of the year. I know there is no cure, but hopefully this year with continuing with my medication and positive thinking I can make it through the SAD season a little easier.

  - Angie

• August 19, 2009 7:46 a.m.

  Thanks for your succinct description, Gabrielle. My (Australian) medicos haven't mentioned Dysthymia before but my current condition seems to fit. I have attempted to fight back against my father’s (and then my own) pessimism by adopting an analytical and positive attitude – plus nicotine. In middle age I was hit by a full blast anxiety and depression attack, and my defenses caved in. I used the medical profession’s full armory and my psychologist’s marvelous sense of humour to discover I’d been battling depression ever since I was aged 8. Worried that my perception of “reality” might be up the spout, I made dogged efforts to discover and validate the “facts”. That saved my life because I had to develop a new view on the world and try to find a less stressful place/environment. Unfortunately, another acute stressor has just arrived, so I’m back to square one again but armed with a new SSRI variant, some new knowledge, and a reminder of what I now need to do. Keep up the good work in broadening the knowledge and ability of sufferers to deal with this condition.

  - Mark

• August 1, 2009 3:52 p.m.

  Chuck, I read your comment...is this "learned helplessness"?? Can family members be "enablers"?? Any insight into this condition is most appreciated.

  - KC

• August 1, 2009 1:12 p.m.

  I've suffered from Dysthymia all my life. I've become an expert regarding its onset and symptoms. What frustrates me the most is that conventional therapy is useless. They tip toe around the issues and don't address the feelings of helplessness, how to strengthen personal relationships, and how to strenghten coping strategies through effective problem solving. In addition, this exacerbates the problem and makes it much more difficult to deal with. Insurance frowns on this and in some cases has a limit of coverage or no coverage available. I realize it's no one's fault having this illness. Yet our culture still looks down on this as a weakness of character. There still exist a stigma. Most people who really need help find it extremely difficult finding professionals who have the skills or patience dealing with issues of pessimisim, self -worth, rejection, etc.. because they don't address the underlying belief at the core. Nor do they walk a frightened inner child through their hurt and frightend feelings. Many of us who suffer from this illness have difficulty are out of touch with our feelings and have low self esteem. Futhermore, the real solution to this epidemic is finding the right kind of help to address the attitudes, thought patterns, and activities at the root of chronic depression. Look for someone who will be active and willing to teach and guide you to overcome apathy, passivity, and helplessness. With is approach we will no longer feel like "VICTIMS".

  - Chuck

• August 1, 2009 12:56 p.m.

  My brother will be forty-five years old soon. He is bright, good looking, and a caring individual with a lot of potential. He has never been married but was in a committed relationship for over twenty years. That relationship permanently ended five years ago. He has feelings of hopelessness, extremely low self-esteem, and absolutely No initiative or energy. Sleeps all the time, unemployed and NOT due to laziness, and basically does not communicate with anyone or leave the house. I was able to get him under the care of a psychologist three years ago. He has taken meds for depression and been in therapy consistently over the past three years. Presently he is taking Wellbuterin and Lexapro but he still has NO ENERGY or INTEREST IN LIFE. He has been unemployed for more than one year and prior to that worked small jobs here and there. I too suffer from depression but I still function in society and work a demanding job. He is seeing his doctor again this upcoming week. This is his 2nd doctor and he has been seeing her for one year with NO improvement. Any ideas?? Thanks, KC

  - KC

• July 31, 2009 1:01 p.m.

  I too was diagnosed with dysthymia. Been on Zoloft, Welbutrin, Paxil, (which worked the best, but looses it's power after a couple of years and then the "brain zings" as othes put it comes. I take ambien CR every night because I can not sleep. I have been on that for a year. Now I am getting angry at everyting and everyone. I don't know what to do. If I should make a sooner appt with my pyschiatrist or just see if it goes away. I have no suiside thoughts but death thoughts. Like I hate life and would be better off dead. BUT would not do that to myself. It's good to say that to someone. Better days ahead

  - Betz

• July 3, 2009 6:29 p.m.

  This article (and website) is excellent, informative, comforting and accurate. However it requires some minor editing :) Just typos though, nothing serious. Thanks for this, Mayo Clinic and Dr. Melin.

  - Emily

• June 11, 2009 10:50 a.m.

  I've been suffering from some form of depression or other from round about age 12, I am now 32. I finally asked my doctor what the official term of my illness was, and Dysthymia is what I got. I've had major episodes of depression in the past .. suicide .. that kind of thing. Been on countless different meds and still am on at least 3 for this (not to count other pills I take for other illnesses.) I've learned a few things over the years: 1) you have to learn to live with it, accept your limitations but also embrace your worth. You've got to be good at something, surely? 2) regular talk therapy. You need outside perspective once in a while. 3) keep with the program. Just because you're feeling better doesn't mean you're cured. (I myself don't expect to be "cured" ever, and that's not necessarily a bad thing) Keep in touch with your doctors and therapists, and do *not* ever stop taking your meds on your own. This is not the same as quitting smoking! It's not my intention to preach. I can't even help myself sometimes. For example, I have not gone 100 meters from my house this whole week. It's one of those episodes. But nevermind. I just want to share my experience, and hope someone out there get something good from it.

  - chanin

• June 10, 2009 12:59 a.m.

  I have been depressed since I was in my teens. About 12 years ago I was diagnosed with Dysthymia. I used Zoloft for about a year. Started to get night sweats, dizzy. Went off for a couple years. Couldn't live with myself. Went on Paxil for a few years. My feelings were flat lined so weened my self off. Then tried Wellbutrin, had lots of energy, lost weight, and was so anxious all the time. Did nothing for my depression. I realized I was suffering from a few different things. Then went on Prozac. Have been on it ever since. It's been a few years, and I can't ever seeing myself getting off it. I still have episodes of depression, but can feel it coming on, I can get my dose upped when that happens. Then I ween down to my current dose. I found prozac seems to help my anxiety and other things like the thought patterns that are unhealthy. There are side affects but I'd rather feels mostly normal. I also am 49 and menopausal or peri, I am having sweats, the facial heat, inside out. I don't know if the prozac is helping or hindering, but I can live with it for now.

  - Dianne