Ep. 356 Living at 60%: A Raw Look at Persistent Depression
Terry [00:00:04] Hello and welcome to the Giving Voice to Depression podcast brought to you by Recovery.com, a free online resource created to make it easier to find addiction and mental health treatment and resources. Each week we profile a guest here who shares intimate details of their mental health journey. They share because they understand that when people don't talk about their depression or other mental health conditions, those of us who struggle with them can feel like we're the only ones, that there is something wrong with us, and that no one understands. We understand. I'm Terry, the creator and co-host of this podcast. You have my promise that we'll keep it real here. Depression is real and we're not going to sugarcoat our discussions about it. Hope is also real, and you'll get a dose of that here, too. Thanks for joining us. This episode was originally produced with sponsorship from the A.B. Korkor Foundation for Mental Health. We record a couple of new interviews each month and also replay some of our best ones from the archive so that newer listeners don't miss out on those. This episode is from when Dr. Anita Sanz was co-hosting. Hello, Anita.
Dr. Anita Sanz [00:01:19] Hi, Terry. When we talk about depression here, we mean all kinds. And we try to find guests who can speak to each kind. That includes major depressive disorder and bipolar disorder, seasonal and pregnancy-related depressions, and today's focus: persistent depressive disorder, PDD, or what used to be called dysthymia. PDD is a fairly new diagnosis characterized by chronic depression. Its symptoms are very similar to major depressive disorder. The distinction with persistent depressive disorder is its persistent or chronic nature. While people with major depressive disorders may have days or periods of time where they feel better, those with dysthymia or PDD have depressive symptoms almost all the time for a very long time.
Terry [00:02:13] It's worth noting that a person meeting the diagnostic criteria for PDD can also experience major depressive episodes. When the major depresive episode has ended, however, there is a return to the previous state of chronic depression. This co-occurrence of PDD and major depressive disorder is sometimes referred to as double depression. Today's guest, Lori — while not formally diagnosed with PDD — has lived with chronic depression for about nine years now. She has also experienced major depressive episodes and will describe how they differ. Here now is Lori, in the first of two episodes, giving her voice to depression.
Lori [00:03:02] I've heard it referred to, like, you know, when you have a major depression, it's like being in the pit. You've got just a dark, black pit, but then you ... you know that you are actually ... you're going to be able to climb out. It's going to take a while and it can take, it can be slow, but you know that you're going to be working your way out back up into like life with air and sunshine and things. But it happens very slowly. But there's times along the way when you kind of go, you know, I'm still not feeling great, but wow, I am up, or I did this thing today. I went and grocery shopped today. You know, you can look down and see where you were and see that there has been progress.
Terry [00:03:52] And Lori says that's how it went in her earlier, major depressive times. As hard and as slow as it was, she got back to solid ground. A place she felt, and was seen by others, as "normal". A place from which she could resume life, pretty much as she'd known it. So that's what she was expecting in 2014. But it just didn't happen.
Lori [00:04:17] And it feels like dysthymia, like it gets to that point where you're like, Hey, I'm functioning better. Okay, I can, I can do some of these things. I'm not, you know, laid out flat where I just can't function. But it feels like that's kind of where I stopped, but I've never truly regained the emotional feelings of what it feels like to be out in the sunshine like normal.
Terry [00:04:43] You described it as sort of living at a five or a six on a 10 point scale.
Lori [00:04:49] Yeah, I feel like I function at about perhaps 60 percent. You know, I mean, it ebbs and flows. There's times that maybe I can go a little better than that. There's times where I go less than that. So I can do things, but I still ... It's still really hard and I just have to push myself to keep going because I have to. I mean I don't have a choice.
Terry [00:05:17] And while she's functional, Lori says that stuck place is also a really risky one.
Lori [00:05:24] It's scary because you're closer to the bottom. You know, so if you're operating at your normal and really challenging circumstances or whatever it is and you kind of go into the blues. You know, maybe you're down to 80 or 90, okay. But then, you know, you don't go all the way down into the pit. You don't go all the way down to 0 or 10, but when you live at 60 and you go down ... You're still pretty getting pretty close. You don't start out as well. So you're closer to the bottom. So just maybe sometimes even a little swing can make a dramatic difference in how much I'm able to function because it's like starting out underwater.
Terry [00:06:13] The word underwater reminds Lori of an experience she had that serves as a powerful metaphor for what living with chronic, even lower-intensity depression is like.
Lori [00:06:25] Yeah, I was taking a bath and I had some music playing. And I wanted to get my hair wet, so I kind of dunked myself under the water. And a song came on, like the song changed. And then I kind realized that I could hear the song enough to identify it, to know what it was, but I really couldn't hear the the song, itself. You know, and then I came out of the water, because this all happened in like ... a couple seconds — it wasn't like I was underwater contemplating life. (Didn't have a snorkel.) No. But when I came back up and I was thinking about it, because all of a sudden, I could just hear and experience the song. You know, I got all the feelings of like, oh, I really love this song, because I could hear all of it. And I just feel like that's kind of how it ... how I live a lot every day. I mean, every day is that I can function, I can do things. It takes an extreme amount of energy, but it's really hard to find true joy in things.
Terry [00:07:37] It's funny — or I guess interesting is probably a better word since it is not funny — how often we use the word joy in these conversations when many of us come nowhere near that benchmark and would be thrilled to experience something approaching contentment or even happiness. But all those feelings can just seem out of our reach. We're there, but we're not really there. We may be smiling but it seems more like muscle memory, or meeting an expectation, than an actual connection to the moment.
Lori [00:08:12] So, like, say something with my kids and I'm doing something. I can be like happy about it. I can know that I should be feeling joyful about it, like this is a joyous occasion. I know what it should be. I just can't get there.
Terry [00:08:28] If we were close, Lori, if we were family or friends, would I know that?
Lori [00:08:33] Well, I guess that would depend on how much I share with you about it, you know, how much I tell you about. Maybe if you've known me for a long time, long enough to know me back, you know, 15 years ago, when I was feeling like my normal self. You know, in between things, perhaps you would notice a difference. Or you might think, she seems blue today. But it would really depend on if I told you.
Terry [00:09:09] So you fake it well enough that someone who doesn't know you wouldn't know? (Yes.) Hm. Sounds flat. That's the word that keeps coming to mind — just flat.
Lori [00:09:21] Yes, that's a great word. Surprised I didn't think of that myself. Yeah, it's very flat. You just kind of feel like this is just what we're going to do today, every day.
Terry [00:09:33] Talk to me about mornings. I know there are a lot of people with all kinds of depressions for whom the mornings are really hard and you've shared that they are for you, as well. In what ways?
Lori [00:09:44] Because every single morning I wake up and I'm really disappointed that I woke up again. Because I just don't want to. Because when you have to just use so much energy just to do the normal things people do every day, you just don't, you don't just want to. Um, and so ...
Terry [00:10:06] Take your time.
Lori [00:10:14] Thinking about how to say this. Yeah. Yeah, I don't know how to explain to people that it's not like a lot of people might go well, yeah, of course, I struggle to get out of bed in the morning, you know. I struggle ... It's not that. It's not that. It's like you are immovable. Because almost every night I just pray, like, Lord, just can I just go? Can you just have me go? Because it's just too hard. It is so hard to stay, you know. Like I don't want to go, but I don't know how to stay. And it feels like, like, you know, I have like a beanbag chair full of lead on top of me. So I just, I just need people to realize that it's not just, oh, I struggle to get out of bed in the morning. It's not like, ugh I need more sleep. It's like, I'm awake and I can't ... I can't do anything.
Terry [00:11:17] It is hard to hear that. It is a lot harder to live it. And we've heard it from so many of our guests. It's sometimes called passive suicidal ideation. A desire to just be gone, done with it, without actually making a specific plan or having the intention to carry out those thoughts. Some of our guest have described it simply as a desire to disappear.
Lori [00:11:44] There's times where even, you know, I'll say, come on, Laura, we gotta get out of bed. And my body just doesn't even respond because there's just this being exhausted of life and going, no, I don't wanna do another day. I just don't. I don't wanna do this again. I think I say that every morning. I don't wanna do this again. Life is too long. It's too flat. I just don't wanna do this again.
Terry [00:12:13] Yeah, it would be really difficult to have hope if your ceiling is other people's floor. How do you continue when you say you don't experience hope?
Lori [00:12:22] What choice do I have? I just have to ... do it. It takes an enormous amount of energy, you know? I have one day a week where I work somewhere, and when I'm there, I can do it, and I come home and I just literally, I'm done. I can't do anything more. I mean, it's physical, but it's also mentally.
Terry [00:12:53] And it's not just the hard thing. Sometimes doing something pleasant can be exhausting and depleting.
Lori [00:12:59] Yeah. Absolutely. And so many times if I am going to go do something, like I'll agree to do something because I know it's good for me to get out and do something. But when the time comes, I'm just like, why did I say I'd do that? Why? Ughhh. Let's just go get through this. And I'll tell you that it feels like I just can't get myself together. So you feel guilty. I feel guilty about it. I feel bad about it.
Terry [00:13:29] So now that we, through your story, have a better understanding of what persistent depression is, if we have someone in our lives who experiences it, I mean, there's no saying, just hold on, it'll get better because you're saying it doesn't. So what are some of the ways that somebody can be supportive?
Lori [00:13:47] I think you really have to ask that person because you can't really often see what the things they need help with are. You asked me what, what helps? And I'm like, well, I can tell you what doesn't help. There are things that, that show that there's not an understanding that this doesn't go away. So can I share some of those things? (Please, please.) Things people have said to me, and, you know, over the years, and some of these even by friends that know, or that I tried to explain before. Things like, you know, you mentioned that you're just really struggling or just experiencing depression and they, you know, "Still?! I thought you were better. Well, you look fine." People that want to try to fix things. "Well, maybe, have you had your meds adjusted? Maybe you need to see your counselor more." Or another one is, "Well, what happened?" And sometimes nothing happened. Just like you can go into a major depressive episode, and there's no reason. Depression is not ... It's not an equation. It's not like this plus this equals depression. So to try to fix things is just really, really hard to have people suggest that because the biggest thing is that if there was anything, anything that I could do, you know I would do it.
Terry [00:15:21] and would have done it a hundred times.
Lori [00:15:23] I am not choosing to live like this. (No.) You know, I'm not making it up. Who would choose to live like this?
Terry [00:15:30] So I want to make sure I understand what you're saying. If someone were to say instead, that sounds so hard Lori, because it does sound so hard. Props to you for getting up, for volunteering, for doing the things you are doing. Would you be more able to accept that and would it sound more understanding and realistic?
Lori [00:15:53] And, you know, emphasize endurance. Just validate that it's a chronic illness, you know. Just like somebody else, maybe with a physical chronic illness: you know, diabetes or lupus or something like that. You know, just emphasize that, and it's not because they're weak or just can't get their lives together —whatever. That, you know, the more I see it, I guess, as a medical ... or an illness, the less I blame myself, the less bad about myself I feel.
Terry [00:16:38] So Anita, to be honest, I did this interview several months ago and have sort of been sitting on it. I couldn't figure out how to produce this in a way that wouldn't make people who listen feel even worse, which is never our intention. But we also always want to be clear that this is a reality for a number of our listeners and we can't have them caught up in the "and it gets better" because it doesn't for everybody.
Dr. Anita Sanz [00:17:06] Mhm. No, that's absolutely true, and I'm really glad that we are doing this two-part piece on persistent depressive disorder, because that is the reality. And first of all, I just want to say thank you to Lori for coming forward and talking about this, and major props to everyone who is managing chronic depression. There's nothing to say that acute depressive, major depressive episodes are not also absolute hell, but a milder form that just goes on and on and on ... It's, you know, the slow grind. It is not milder in the sense of the impact on the person because it can just literally feel like you're being worn down on this daily, weekly, monthly, you know, sometimes yearly basis. And the suicide risk for persistent depressive disorder is also there. Not in the same way that it might be for somebody having a manic episode or a very, very severe depressive episode, but more in that sense that Lori was talking about, about just feeling worn down and just not wanting to get up and do this, you know, this grind again for another day. And I just think it's really important to ... To note that this chronic depression, the PDD, doesn't happen as a result of a failure to treat major depression correctly. You know, I think that's important to state. Like the person who has PDD didn't somehow fail or they're not doing something incorrectly. Their doctors, their therapists are not necessarily doing something incorrectly. It's why it deserves its own diagnosis. It is a reality, like it is its own thing. And having to come to terms with the fact that you're dealing with something chronic that isn't going to go away quickly is really important for being able to manage it. And when I think back to one of our guests, Wally, who had modified AA's 12 steps to manage his depression, which I think about it felt like it was more chronic. I really liked it because I think he said something similar about he gets up, he knows he's gonna deal with depressive thoughts every day, sometimes even suicidal thoughts every day. And so he came up with this, this protocol to manage it. And I think any person who deals with something chronic is going to have to have a way to manage It on a daily basis. Very similar to someone who's an alcoholic who cannot think about the rest of their life managing this, they just have to think one day at a time, "I'm going to get through today. How am I going to get through today?" and have that list of things that they're going to do to get through today. And I think it's very similar if you're dealing with chronic depression.
Terry [00:20:01] And we mentioned that this is the first of a two-part series, because between our doing this interview and the one you're going to hear next week, Lori went to a three-week treatment facility and learned a lot of new ways of thinking, new tools for her toolbox ... A number of things. And while she still has what she has, it did affect a shift. She will tell us she no longer goes to bed dreading waking. And when she wakes, while it's still difficult physically and mentally to get up and get the day started, it's not because she wishes she hadn't waken. That's, you know, it's not for me to define whether that's a major shift or just a shift but it is something different. And so when we hear all the time, something can change, something can change, something can change. It can be so hard and I'm sure frustrating to hear when you feel as if you have in quotes, "tried everything" and nothing has changed. So what do you tell your clients? I mean, it must be really difficult to keep hope.
Dr. Anita Sanz [00:21:13] Yeah. It is, and honestly, we just never know what is going to cause the shift or the change. Sometimes it's time, not giving up, continuing to do all of the things that we know should be affecting depression in a positive way. Sometimes there are things that will happen and occur from the outside that none of us could predict. Sometimes we'll discover that there was something in the person's diet or the environment that was causing inflammation that none of us knew about. And once we can figure that out, that's a major piece, or, you know, something good can happen, some shift and change in the person's environment or family or friend group or work situation. There's just so much that's unpredictable about life. And, you know, that can be a source of stress a lot of times, the unpredictability, but I always also think of it as like the one reason we should always have hope is because we don't know what's going to happen in the next five minutes, five days, five months, five years. And because we don't know there could be something that we can't see now that's going improve the situation, that's going to happen and it will likely happen. So the focus is, how do we get through today? We use our mindfulness techniques, we practice self-compassion and self-care. We stay here in the moment, just getting through the moment because the moment might be the most difficult one, but if we can just get through that and then get through the next one, you know, all the next moments will sort of take care of themselves and we can do it the same way. And then whether it's time, whether it is cumulative effects of doing these little things, whether cumulative effects of being on medication, waiting for those things that will create the shift to happen ... we'll be around to be able to experience it and to see that shift occur. So again, the most important thing is to stay so that you're here to see the shift. And that's what we always come back to is, please stay, that's the most important thing. And then the next most important thing is, let's not make staying be so miserable because that's not okay either. I don't want you to stay and be miserable. I want you stay and have life be actually something worth feeling like it's worth living. And so then we go from there.
Terry [00:23:41] And I remember, I wish I could remember who it was, but it was years ago, a guest said, you don't have to be hopeful about your future, but try to be at least a little curious and that that was enough for him. And sometimes that's what we hold on to.
Dr. Anita Sanz [00:23:55] That's a great thing because I don't ... I think that's ... that's really ... that's a lot to ask of someone who, especially with chronic depression who's been depressed for years, to say "But you know you got to stay hopeful and optimistic." (Right.) They have a lot of data points, a lot evidence to say I've done a lot of things and nothing's working and you're still asking me to be hopeful. (Right.) So instead I would just say I think being curious let's stay let's not give up and let's see what can happen. And we do have, I think, enough personal stories of people who didn't give up and they waited, and the shift occurred, or something happened. You know, something just clicked and they're really glad they stayed. And those are the stories that we highlight and that's what I want people to remember.
Terry [00:24:38] Excellent. Thank you so much, Lori. Look forward to next week's episode as well. Thanks, Anita.
Dr. Anita Sanz [00:24:44] Thanks, Terry.
Terry [00:24:50] We truly hope this discussion helps you better understand your own depression or how to support someone else in your life who lives with it. We invite you to check out the hundreds of other episodes in our archive and to explore both the resource hub and treatment options on recovery.com. Depression is too dark a road to walk alone. We'll be back next week.
