Am I depressed, or just screwed-up?

August 4, 2009 6:31 AM

So I’ve finally made up my mind to talk to my GP about the depression that I think I’m suffering from. I have a few days before my appointment and I’d like to get a clearer handle on things before I see him. Can you help me unpack some of this?

Some background : Mid 20s, male, English. Although I never sought help at the time I believe that I went through quite a serious depressive episode during the year after finishing university. I was unemployed at the time and remember feeling absolutely worthless, guilty all the time, regularly crying myself to sleep, imagining what people would say about me at my funeral, thinking it would be better for everyone if I were dead, and so on. It was awful beyond words. I felt destroyed. This episode was sort of ‘cured’ by travelling abroad for six months at a family member’s insistence.

Since then I’ve never dropped so low again, but I’ve been consistently underemployed, have no friends at all, still live with my parents, have only ever had one girlfriend (whom I was with for years and years from a stupidly young age), and generally feel like a failure. However, I’ve also taken some evening classes, then part of a Masters degree, and had fun doing them. I’ve also held down an admin job and done a reasonable job at it, though I felt ashamed to be so underemployed (not helped by colleagues and family saying things like ‘but you’re so intelligent, what are you doing here/there?’). So I have some work/social/family issues mixed up in all this too, but is there also a medical element?

I’ve now been unemployed for months (previous job died of natural causes – end of contract), though I’ve been consistently going to some classes, turning papers in on time, and getting excellent grades. I’ve been applying for jobs, but not nearly as many as I should be, and I’ve been procrastinating and ruminating to a ridiculous degree. I’ve been putting off applying for jobs until the deadline passes, and I’ve been spending more time torturing myself inside over my unemployment than trying to fix the situation. For the past few months I’ve been thinking to myself that I should really go and talk to a doctor because I’ve been having shades of the feelings I used to have during the Awful Year. I kept putting it off until the end of the academic year, and since then I’ve put it off for two months longer. More recently the negative thoughts and feelings have become much more potent and frequent, but not constant. Right now I feel at a relative low, but at the end of last week I remember thinking and feeling quite well and at peace. This shift has happened a few times over recent weeks and I’m not sure how much to make of it. Maybe I’m just fooling myself on good days. Another thing I sometimes ask myself is – what if I’m just used to being depressed all the time now – what if I never really got over it before and now I just have times that are relatively better and relatively worse, but never truly well? I’m not sure I believe that. I don’t know. The more I try to figure it out, the foggier it all seems, which is partly why I’m asking for advice.

Anyway, the ’symptoms’ that I’ve been having recently are:
- Reduced activity (going out, reading, doing) and increased web-surfing and time-killing.
- Suicidal thoughts – but not of a kind that seems dangerous – I really don’t think I’d ever do anything like that. More like, if I think about my future, my career, about how I should be filling in that application form I’ve had open for days, I very quickly and fleetingly think ‘I should just kill myself’. It’s been happening much more recently (several times a day) and I think it’s more a bad thought-habit than a desire to actually harm myself. Just to reiterate – I don’t need to phone the suicide hotline or whatever. The only way I’d ever really kill myself is if I’d been bitten by a zombie, but it can’t be right to have suicidal phrases running through my mind every day, can it? I’m sure this didn’t happen so much a year or eighteen months ago.
- Irritability/anger (this is very out of character for me, I get ticked off like anyone else, but at the moment everything seems to be ticking me off, other times though I feel quite full of love and peace, but those are in the minority).
- Some tiredness and lethargy.
- Feeling tearful but not crying. My breath sometimes rattles a bit as if I had been crying (that used to happen during the Awful Year).
- The voice in my head seems slower recently and my intellectual curiosity seems diminished.
- I’ve been speaking less. I’m a quiet person anyway, but much more so recently. This used to happen during the Awful Year.
- Sometimes I feel very hopeless about the future and seem to have an uncharacteristically pessimistic and cynical outlook. Sometimes everything I hear people say seems to be a coded metaphor for my own failings.
- More generally, I seem to try not to get to know people too well because I don’t want them to see me for the failure that I am. It’s hard to really describe this. Avoiding eye-contact used to be part of it I think, but I can bluff through that now.

So really, after almost 1000 words, I don’t know what my question is any more. I suppose what I’m looking for is some clarity – does any of the above sound familiar, does it fit a pattern? If I was going to see the doctor about a pain in my knee, I’d find out all that I could about knee problems before seeing him, I'd see if the pain in my opposite ankle was related, but this is all so foggy. What do you think?

Bonus questions:
- I’ve been trying to learn a musical instrument for the last couple of weeks. I think I’ve been enjoying it. Does that mean I’m not really depressed?
- I still laugh at jokes, hard. Does that mean I’m not really depressed?
- I’ve learned some new three-ball juggling tricks over the last few months. I’m really pleased with myself for learning them. Does that mean I’m not really depressed?
- I get out of the bed in the mornings, get showered, generally drive someone to their workplace, go to the supermarket, things like that. Does that mean I’m not really depressed?
- I never miss appointments, and I got my car repaired last week (which involved multiple visits to more than one mechanic). Does that mean I’m not really depressed?

Thank you so much for taking the time to read this mess. I’m really very grateful. Anything you could offer would be appreciated.

posted by anonymous to health & fitness (14 answers total)

No, unfortunately, it does not mean that you are not depressed because there is some enjoyment and order in your life. There are many degrees of depression and everyone's symptoms are different.

However, on the plus side, it is likely that you since you are not in immediate crisis mode, you *may* not need to be on an antidepressant. Therapy, while it takes longer to bring about consistent good feelings, will probably work well for you in the long term.

I am not sure how it works in the UK, but in the US, I would be wary of speaking to a GP because they are more equipped to provide medication than recommend therapy. When you speak to your GP, be insistent that you would like a recommendation for therapy, not medication. Medicating the problem can lead you down a better-in-the-short-term, worse-in-the-long-term path of avoiding underlying issues. I was on medication for years before I figured this out, and then on top of everything else, I had to deal with withdrawal symptoms. Plus, various medications often eliminated the few happy moments I once had.

Most importantly, you sound like an excellent candidate for cognitive behavioral therapy. You can learn how to redirect your thoughts (for example: when having suicidal thoughts makes you depressed, which makes you have suicidal thoughts, CBT can teach you to break this chain of thought)
posted by lesli212 at 6:46 AM on August 4, 2009

I wanted to add: good luck! I'm sure it will get better.
posted by lesli212 at 6:47 AM on August 4, 2009

You poor guy. this sounds like a pretty classic depression to me-- you're trapped in a circle where you're depressed, and you can't find a job because you're depressed, which makes you more depressed. Definitely go see a doctor.

Your questions about laughing, enjoying some activities, and being able to make appointments and keep to a schedule are good. The answer is that NONE of these things are dispositive of depression. Some people get such severe depression that they cannot get out of bed-- that's the stereotype. But a lot of other go about a superficially normal life, and even enjoy some things, while still struggling with depression.

You don't have to live like this!! You deserve to get help and feel better. You've taken the first step by asking this question. Now follow through, and see your doctor.
posted by miss tea at 6:51 AM on August 4, 2009

Yes, you do sound depressed, and discussing it with your GP is a good idea (especially since IANAD and IANYD). You can still enjoy things and laugh when you are depressed. Two things to keep in mind with depression:

1. There are multiple levels of depression. Even if you are on the lower end of the scale, it's better to treat it now, then wait for it to become worse.

2. Depression levels are not necessarily constant. Depressed people can have a "good" day, as easily as they can have a particularly "bad" day. The persistent sadness, lack of motivation, and withdrawing from the world are all consistent with signs of depression.

The suicidal thoughts you've described sound like suicidal ideation. It's best to address your issues before suicidal ideation progresses to actual attempts. I'm not saying it necessarily will, but why take that chance? Exploring your options and talking to a medical professional, are all important steps and will help you determine your level of depression and what you can try to make it better. Best of luck!
posted by katemcd at 6:56 AM on August 4, 2009

A month and a half ago I hit the place where I had to do something about my situation. Which was depression. I was having issues dealing with the world around me, to the point where I was mostly not-there at all for about a week. I got a kick in the ass that got me at least moving again.

I'm lucky - I have a good health care system, and work for a company that's got an employee program that let me get a quick intake into a therapy setup.

I think you should check in your area for a mental health clinic; if you're going to classes, the college you're going to may, in fact, have a free treatment area you can utilize.

I also agree with lesli212 - I'm going through CBT, and it's helping. I'm also on medication (Wellbutrin) to support it - to relieve the deeper parts of it to give me the space to work. Your case sounds a lot like mine, and I can tell you: it does get better. You need to start work on it, but the sooner you do, the sooner you can feel better.
posted by mephron at 7:00 AM on August 4, 2009

IANAD. I know that antidepressants are sometimes helpful and sometimes a godsend. However, the effort-requiring standbys are there as well: yoga, exercise, meditation, excellent eating, and talk-therapy. My advice fwiw is to be skeptical of the drugs. Research them for yourself. Don't take (if you/your doctor decide you must) w/o doing the therapy, etc too. Certainly your description of symptoms sounds sadly familiar to me, but I can also tell you that after 7 years on a variety of antidepressants (discontinuing now, and it is not pleasant), I am a shadow of my former self. In other words, my experience is that they obliterate the lows and the highs. Best of luck with whatever you choose. You are not alone; lots of us have been there/are there now. (On preview, yes CBT is the bomb: check out Feeling Good: The New Mood Therapy by David Burns)
posted by tingting at 7:04 AM on August 4, 2009

No, being able to laugh at jokes, get some things done, etc. does not mean you are not depressed. It's not a binary thing. For me, a moderately depressed period feels rather as you have described it: I'm not lying in bed crying all day - I go about my daily life and get things done and even occasionally do fun things - but my emotional and physical energy and my motivation are all pretty limited.

I'm glad that you've made an appointment with your doctor. However, please ask your doctor for help finding a therapist and possibly a psychiatrist. Your GP isn't extensively trained in the treatment of ongoing mental problems, and the most your average GP can do is give you a scrip for Lexapro, whether or not it's appropriate. A therapist can help you work on your negative thought patterns (via CBT or many other sorts of therapy); a psychiatrist can help figure out which sort of depression you have, rule out any connections to other medications or to physiological problems, and determine whether you might (or might not!) benefit from a trial period of any sort of medication.

I can also tell you that after 7 years on a variety of antidepressants (discontinuing now, and it is not pleasant), I am a shadow of my former self. In other words, my experience is that they obliterate the lows and the highs

Please do not believe that this is the case for everyone. Some people have this experience on anti-depressants. Others, like me, find that anti-depressants give us a life that actually has highs, not just various sorts of lows. It's only with medication that I have the mental and physical energy to regularly cook healthy food for myself, make it to therapy on a regular basis, get out of the house to exercise, and all the other "effort-requiring standbys" that people suggest as cures for depression. It is completely possible that medication will not be the answer for you. However, if your therapist and psychiatrist agree that it is worth a try in your particular case, do not refuse it because you believe it will automatically make you into a zombie.
posted by ubersturm at 7:18 AM on August 4, 2009

I've found getting the right treatment (a combination of medication and therapy) has turned my life around in ways I never thought possible. Reactions to medications are idiosyncratic; if they don't work, or make you feel shite, then go back to your GP.

Depression leaves you with far less energy to do things; it doesn't mean that you can't do anything. A lot of people can put on a 'happy face' for a few hours, then collapse when they're on their own. I got very high academic grades while I was so depressed I was having episodes where I was close on catatonic.

The Royal College of Psychiatrists have a checklist of questions to ask your psychiatrist (third one down). Some of them are a bit in-depth for a first visit to your GP, but it's worth considering taking that list, or one you write yourself so you can leave your GP with at least some of the answers you're obviously looking for.

Oh, and on a slightly different note - you might want to ring the surgery to see if you can get a double appointment with the GP. Whether they'll give you one depends on the practice, but if they will it will give you longer to talk.

Good luck!
posted by Coobeastie at 7:45 AM on August 4, 2009

You are the best-organized depressed person I've seen on MeFi. You are absolutely doing the best you can, and taking the right step of seeing the GP. You feel like a mess, but you are in fact accomplishing a fair amount. You don't need to beat up on yourself so much.

Please read How Not to Commit Suicide, and please don't hurt yourself. I've spent way too much time struggling with depression, but I tell you this: It will get better.
posted by theora55 at 10:02 AM on August 4, 2009

definitely keep your appointment, and lay out for your doctor everything you've said here.

depression doesn't mean that you are just completely void of any happy moments. rather, it is an ongoing thing, lasting weeks to months (or more) where your mood is generally depressed (which it seems to be). you will always have moments, even days of happiness, or normalcy. it's part of the ups and downs of depression.

and like coobeastie says, many of us with depression are quite adept at putting on a happy face, remaining functional, etc. for almost 20 years no one had any clue what was going on in my head, because i was so good at hiding it. it's a little like being a functional alcoholic.

it sounds like you are doing everything the best you can, and you've even found something that you enjoy, which is instrumental in helping depression. it's just that you probably need a little EXTRA help right now, and your doctor should be able to provide that, even if it's only in the form of a referral.
posted by unlucky.lisp at 10:39 AM on August 4, 2009

I was going to link you to one of the "am I depressed" checklists that doctors use, but Coobeastie's done that.

Yes, you are depressed. Having some bright spots in an otherwise gray existence does not mean that you aren't depressed.

Your doctor may lean immediately toward either therapy or medication. Keep an open mind about both. Unfortunately, we use one word (depression) to mean a set of symptoms, which might have two different causes.

One cause is something bad's happened or your thinking's gone off track (someone died or life has handed you some bad cards recently, and so you are feeling low about those things; or your thinking is negative and so you need it to find new ways of thinking about things).

Another cause is a chemical problem in your brain; this is fixed by medicine, and to my experience counseling does little to fix it -- without the chemical, you simply cannot "pull yourself up by your bootstraps." Some people here disagree, and believe that you can just will yourself to get better, so I'm just sharing my experience.

For me, exercising like a fiend, taking vitamins, getting plenty of sleep, having a few drinks, reading A Guide to Rational Living, having plenty of sunshine, learning to "love myself," volunteering with the disadvantaged, praying, throwing myself into hobbies and activities, meditating... none of that was a substitute for the missing chemical. I liken this to a cholesterol problem: Some people can lower their cholesterol by eating less cholesterol, while others can eat zero cholesterol and still need medicine to get their numbers right.

If you are prescribed medicine, the first one you try may work well. For some people, they must try several before they find the right medicine and the right dosage. It may take several weeks before you see improvement, and it won't be immediately, suddenly noticeable. Suddenly one day, you'll look back and just realize that things have gotten better.

I think one of the most important things you can know right now is that it will get better.
posted by Houstonian at 10:42 AM on August 4, 2009

After many, many years of depression and one final year of major, debilitating depression before starting drugs, I can tell you that I did things I enjoyed sometimes, I laughed and even had fun but none of that was easy and often it came with consequences of a day or even a week in bed.

Since starting meds, it's like a humongous light stealing cloud that hung over me all the time has disappeared. Sure, a cloud passes through once in a while but on most days, I can get work done, I'm not wracked with guilt and anxiety, I enjoy the company of my husband and friends and I'm much more likely to take the initiative to get up in the morning and go. It's such a relief.

It didn't come overnight. I'm in therapy and I've been at it a few years but it is possible. I wish you the relief I have today.
posted by Sophie1 at 12:03 PM on August 4, 2009

Go to the doctor, answer his or her questions honestly, and he or she will most likely tell you that you're depressed, judging by what you've written here. You are doing the rational thing by going to the doctor. Make sure to ask about the pros and cons of different treatment options, and get a full list of what's available. Ask their opinion of effective long-term treatment. Make sure you know what to expect.

You are very much doing the right thing by asking a load of people - it's hard to step outside your own head and say "these thoughts I am having are not normal, not even in the normal range". Seeing an experienced professional is even better than asking a bunch of internet strangers.

Good luck!
posted by Wrinkled Stumpskin at 12:25 PM on August 4, 2009

No, none of those things mean you're not depressed. You're depressed, you know you're depressed, and your doctor will say you're depressed and he/she will probably give you an antidepressant. There's nothing wrong with antidepressants. I'm a mental health professional and I've seen too many people suffer needlessly in order to avoid taking a pill because they feel they should be able to pull themselves out of their depression on their own.

Sometimes depression is caused by a situation and sometimes it's caused by a chemical imbalance. I went on an antidepressant two months ago due to (in my opinion) my situation (health problems, work problems, family stress). I had gotten stressed to the point I was unable to continue functioning in my daily life. The antidepressant helped me get to a point I could return to work and continues to help me deal with my ongoing stresses that I can't make go away right now. It helps me not to break down in tears every day.

My husband, on the other hand, has a long history of poor self-image, lack of motivation, self-defeating behaviors, and irrational anger. It was complicated by recent health problems, but I think it was underlying all the time. He finally saw a psychiatrist who put him on an antidepressant and his life turned around immediately. Suddenly, he loves his job! Every day he has a good day! All the problems he thought he had have been neutralized by the change in his attitude that this pill has caused. Which is why I say he had an underlying problem.

So, with either situation, an antidepressant can be the best course of action, either short-term to help you deal with your current stressors, or long-term to combat a chemical imbalance. Good luck to you and take care of yourself.
posted by threeturtles at 1:03 PM on August 4, 2009