Depression Part I

You have probably heard of Bipolar Disorder and Major Depression, but perhaps not Persistent Depressive Disorder (PDD). The symptoms in PDD tend to be quite subtle, compared to bipolar and major depression where symptoms are much more severe and dramatic. For instance, suicide attempts, psychiatric hospitalization, and the need for anti-depressant medication are much more common with major depression and bipolar disorder.

PDD is largely a cognitive condition, a way of perceiving and thinking about events in your life in a negative way. If you think negative thoughts, especially about yourself, you are going to feel pretty rotten – you are going to avoid challenges and become more likely to get depressed. Negative thoughts preclude positive actions, and without positive actions in your life you will never feel satisfied and productive. Imagine waking up feeling pretty good, but going through the day repeatedly telling yourself, “I’m incompetent; I’m going to fail; I can’t do anything worthwhile; I’m a disappointment to others; I’m such a klutz everyone feels sorry for me.” How do you think you will feel at the end of the day? Satisfied or kind of “down”?

If you feel you might suffer from depression but tend to write it off as just having some problems dealing with life, you could be one of the “silent sufferers” afflicted with PDD. You go to work or school, you care for your loved ones if necessary, and generally function in the normal range of activities. But you have this gnawing feeling that most people seem to enjoy life more than you do. You seem to have more than your share of pessimism, guilt, lack of interest, appetite fluctuations, low self-esteem, chronic fatigue, social withdrawal, and concentration difficulties. Whatever your particular profile, you have a chronic discontent with yourself, and your negative thinking has become a way of life. You can even learn to tolerate this depressive state and are not really convinced that you suffer from a psychological disorder.

The seeds of PDD are usually planted in childhood or adolescence, and result from poor development and guidance in developing social skills, optimistic thinking, and a belief that you can deal with challenges. The results are early beliefs that you are helpless, have a tendency to dwell on the negative, and experience a steady build-up of stress. These conditions often lead some folks to seek psychological help, and frequently the psychiatric diagnosis of depression results in a prescription for anti-depressant medication. Unfortunately, this medication, which can be effective with Major Depression and Bipolar Disorder, is usually ineffective for PDD. About the best that can be expected from the medication is a temporary “kick-start” to developing new thinking and action patterns with the help of psychological intervention.

PDD is primarily an avoidance issue, the sorts of things that we discuss in this blog. With PDD you have developed long-standing actions that allow you to avoid facing challenges and maintain your symptoms. You probably tend to avoid stressors, unfortunately the very stressors that helped cause and sustain your depression and other life problems; in other words, you avoid the very stressors that you must learn to confront. As a result, you are likely caught in a vicious cycle of action patterns that is difficult to exit, and unlikely to be affected by anti-depressant medications. Your depression is accompanied by actions that rob you of energy, motivation, and positive attitudes that are needed to break free of the avoidance vicious cycle. As a result, your depression probably creates problems in other areas, such as social interactions, concentration and focus, alcohol/drug issues, etc. Such co-existence of problems is known as co-morbidity and is not at all uncommon. So, do not despair. If you are willing to work you can learn to challenge and face your demons, and possibly without long-term medication use.