A few months back, I was reading a few pieces on The Mighty, one of my favorite websites. It’s a platform for first-hand posts about mental illness, disability, and chronic and rare illnesses (some of my blog posts also appear on there). As I clicked on various links related to mental illness, I came across a post about something called “double depression.” I had never heard the term before, and as I read, the tiny lightbulb in my brain began to flicker and glow, until it became so bright that I wanted to shout, “Eureka!” (or something equally melodramatic). I felt like I had finally figured out why I could sometimes live in the day-to-day of my depression, while other times the illness was knocking me on my rear end so hard that I couldn’t get back up for days.
Double depression occurs when a person who has dysthymia also experiences a major depressive episode. To help us all understand what the heck this means, I’m going to explain these two different types of depression. Then I’m going to give you a ridiculous metaphor for each of them. Then we can talk about how fun it is when they join forces.
Major depressive disorder (MDD), which is what I’ve always been told I have, is characterized by all the things I’ve covered in previous blog posts. It can be emotional: sadness, hopelessness, loneliness, wanting to die. It can be physical: aches and pains, stomach problems, headaches, weight gain or loss. There can be irritability, fatigue, loss of interest in previously-loved activities. Sleeping too much or too little. Typically, those who suffer from MDD experience episodes of acute depression, during which they may feel suicidal or not, may self-harm or not, may function in their daily lives or not. But the key to MDD is that the episodes do end. They may last days, weeks, months or even years, but at some point they stop, and the depression lifts.
The type of depression I did not know about, dysthymia, I would best describe as the mellower cousin of MDD. The symptoms are similar, but while episodes of major depression are likely to come to a more tangible end, the hopelessness, low self-esteem, and disinterest that characterize dysthymia do not. That’s right -- although dysthymia is considered a milder form of depression than MDD, it is chronic. As in, it does not go away. I think one of the best popular culture examples of dysthymia is probably Eeyore -- always plodding along, always pessimistic, every adventure met with a sigh. Eeyore never seems able to pull himself entirely out of the gloom that surrounds him. That’s kind of what it's like to live with dysthymia.
Now, as promised, an absurd metaphor.
Imagine, if you will, a 600-pound gorilla (yes, Wikipedia told me that they can weigh that much) who is determined to beat the living daylight out of you. He sees you as a threat and he is going to attack you with all the weight and strength he’s got. He’ll shake you and kick you and push you around and maybe even bite you. You’re getting the crap beat out of you, but hey -- it won’t last forever. Eventually the gorilla will get bored or feel satisfied that you are no longer a threat, and he will leave you alone. You’re left to lick your wounds and eventually get back on your feet. You’ll have a few scars, but the gorilla will be gone. That’s major depression.
In contrast, dysthymia is the much smaller, cuter-by-comparison monkey that sits on your shoulder. He won’t mortally wound you, but he won’t ever go away either -- he’s always picking at your hair, screeching in your ear, smelling up your house, making your life inconvenient and chaotic and unpredictable. It’s not pretty and it’s not fun. Sometimes it’s painful, but it’s not like you’ll end up in the hospital with any broken bones. The thing is, you will never be rid of the discomfort and exhaustion you feel from dealing with him every single day. That’s dysthymia.
So, what’s double depression? Double depression is when the monkey on your back wraps its arms tight around your neck to hold on, and the gorilla comes at you swinging. You might have learned to live with the little guy -- annoying though he is, he’s your monkey, and most of the time he’s not all that bad -- but now you have to carry his weight and fend off the gorilla who is trying with all his might to kick your ass. You’re less able to defend yourself because the stupid monkey won’t let go, and you’re tired from carrying him around all the time, so the gorilla has an easier shot at you than ever. And then, guess what? When the gorilla finally decides he’s done with you, the monkey doesn’t follow after him and leave you be. He clings on, just like always, so it’s just a little harder to heal and recover. You’re perpetually swatting at the monkey, who won’t leave you alone, and meanwhile, you never know when the gorilla might come back for round two (or three, or four…).
To get back to the real world for a moment: double depression is when a major depressive episode occurs in a person with existing dysthymia. The depressive symptoms you thought you were doing pretty well living with are suddenly compounded, and you are thrown into a deeper, darker place than any you’ve been to before. Your fatigue is no longer nagging, but all-consuming. The minor aches that fade with sleep start to keep you up all night. The passing thought that maybe not much in life really matters is replaced by an unrelenting thought pattern of pervasive hopelessness.
Once I realized that I may have been living all this time with dysthymia, and that my hardest times were the ones punctuated with major depressive episodes, I spoke with my therapist and my nurse practitioner, both of whom agreed that this was the most likely scenario. I can’t say I feel relief at the diagnosis -- it feels pretty awful to be told that my light at the end of the tunnel is likely a hazier, dimmer one than I’d like it to be -- but having a label helps me better understand what I need to do to take care of myself. On the very best days, the monkey on my back lets me put him down on the couch for awhile so I can take a break. I’m learning to love those moments and use them to enjoy life, all the while preparing to pick the monkey back up, and even to face the gorilla once in awhile -- hopefully mustering up more a little spunk and optimism than Eeyore.