Chronic Depression: Why You’ve Felt Blue For So Long
Worldwide, millions of people suffer from depression. Recent assessments of depression by the World Health Organization estimate that roughly 300 million people, or 4% of the worldwide population, are currently experiencing symptoms of depression. Symptoms may be mild, moderate, or severe, and may last a few days or several years. For many of these individuals, symptoms of depression disappear on their own or with treatment after a short amount of time. However for some, depression can be a daily struggle that lasts for years.
This long-lasting form of depression is known by several names, including chronic depression, dysthymia, and persistent depressive disorder (PDD). Although each of these were previously categorized as separate disorders, chronic depression and dysthymia have been merged with PDD. In this article, we will refer to PDD as chronic depression since many people use the term 'chronic' to describe long-lasting depression. This article will give more information on chronic depression, including how it differs from major depressive disorder, its symptoms, causes, and treatment options.
What is Chronic Depression?
Chronic depression is the persistence of depressive symptoms for a long period of time, often years. If you are chronically depressed, you have likely lost interest in things you used to love, you feel hopeless, you have experienced changes in the amount of sleep you get, and/or you may have low self-esteem. Chronic depression sometimes refers to someone having episodes of major depressive disorder (MDD) for long periods of time, and might be referred to as chronic major depression. However, chronic depression is actually characterized by its own symptoms and is considered a separate condition. There are some similarities, however. For instance, like MDD, chronic depression is more likely to affect women compared to men. Additionally, the treatment methods of MDD and chronic depression, while not identical, are very similar.
The symptoms of chronic depression can be mild, moderate, or severe. Traditionally, the term dysthymia has been used to describe chronic mild symptoms. Dysthymia has now been wrapped up with chronic depression into a single classification, however many references on the web still refer to dysthymia as its own disorder.
Some people experience something called double depression. This occurs when a chronically depressed individual experiences an episode of major depression with symptoms that are more severe than what they typically experience. If you have experienced this and are seeking treatment, it is important to let your health care professional know about the episode in addition to the underlying chronic depression.
How is Chronic Depression Different from Depression?
Historically, many people did not distinguish between chronic depression and other types of episodic or shorter-term depression. However now, when most people speak of depression, they are generally referring major depressive disorder (MDD). Depressive symptoms that accompany MDD can occur once or fluctuate for short or long periods of times. These 'episodes' come and go, the symptoms themselves may be mild, moderate, or severe, and are thought to last more than 2 weeks, but less than 2 years. Individuals with chronic depression also experience mild, moderate, or severe symptoms, but the symptoms do not come and go in episodes. Symptoms are present more often than not for at least 2 years, and disappear for no longer than 2 months at a time.
To be diagnosed with chronic depression, the individual has to have experienced nearly continuous symptoms of depression for over 2 years. Although you may not meet the requirements to be officially diagnosed with chronic depression (for example, having persistent depressive symptoms for a year and a half), this does not necessarily mean that you are not chronically depressed. Unfortunately, the specific differences between different types of depression are not always clearly defined, and can be confusing. Speaking with a health professional is the best way to find out exactly what diagnosis best matches your symptoms, as well as what the best treatment options are.
Chronic Depression Symptoms
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is commonly used by therapists as a reference to help diagnose mental disorders and provide care to individuals in need. The chronic depression definition and symptoms according to the DSM-5 are listed below:
A depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents). The individual is symptom free for no more than 2 months.
During periods of depressed mood, at least two of the following six symptoms are present:
- Poor appetite or overeating
- Insomnia (not sleeping) or hypersomnia (oversleeping)
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
The symptoms of chronic depression can be mild, moderate, or severe. Many of these symptoms are present in non-chronic depression, such as major depressive disorder (MDD). However episodes that occur as part of MDD also include different symptoms such as feeling worthless or guilty, or having thoughts of death, suicidal ideation, or attempting suicide. The DSM-5 does not include suicidal thoughts or actions as part of the symptoms of chronic depression because it is less common. However, if you are having suicidal thoughts and think you are (or are not) chronically depressed, please speak with a health care professional, chat with someone who can help online, or call the suicide hotline right away: 1-800-273-TALK (8255).
Chronic Depression in Children and Teens
Unfortunately, some children and teens experience episodes of depression. As noted above, chronic depression may be present when depressive symptoms are present for a year or more. Although teens and children may experience similar symptoms compared with adults, the presence of irritability is often unique to members of this age group. Although depression is sometimes difficult to diagnose in teens, parents should be aware of their behavior, and note if depressive symptoms are present most of the time.
Causes of Chronic Depression
The root cause of depression can vary greatly depending on your genetic makeup, life experiences, and other factors. Episodes of major depression can be caused by the following factors:
- Genetic: A family history of depression increases the chance that an individual will have depression. Studies that have observed depression in identical twins have noted that depression is likely to occur in one twin if the other has depression. Genetic heritability of depression is likely higher for women than men.
- Situational: Certain life events like divorce, the loss of a loved one, or losing a job can cause a depressive episode
- Social: Prolonged loneliness or lack of social support has been found to lead to depressive symptoms.
- Physical Illness: Many types of physical illnesses can cause depression, such as suffering a heart attack (40-65% of heart attack sufferers experience depression), having cancer (25%), or diabetes (25%).
The factors that cause major depression and chronic depression to occur are very similar, however some factors may be more or less likely to contribute to chronic depression. For instance, depression caused by situational factors like divorce is often short-term, and does not often lead to chronic depression for most individuals. Social factors, on the other hand, often lead to chronic depression if the individual's social situation does not change. Additionally, those who have depression often see having depression as a burden, which makes these individuals less likely to speak with others.
Chronic depression is also more likely to occur in individuals who have chronic physical illnesses. For example, chronic pain and depression have been found to co-occur in many individuals, particularly for older individuals. Although alleviation of pain may help these individuals, some research shows that depression can cause pain, particularly for those suffering from chronic depression.
Taking an online chronic depression test may help to answer additional questions you may have, and may give you a better idea of your symptoms before you speak with someone professionally. When browsing the web, be careful in choosing tests, as there are some that may give you an inaccurate picture of your symptoms. Also be wary of tests that aim to 'diagnose' you. A diagnosis should be left only to a health professional. Betterhelp.com has depression tests that may help you. Here is another test that was developed by a professional psychiatrist, and is quick and easy to take.
If you believe that you are chronically depressed, it is likely that you have already tried things to alleviate your symptoms. If not, here are some suggestions from betterhelp.com that might help to relieve your symptoms:
Work towards a healthy lifestyle through changes such as improved eating habits and exercise.
- Exercise, which helps produce hormones and chemicals that regulate mood.
- A healthy diet lets the entire body function better, including your mood.
Get appropriate sleep and practice good sleep habits.
- Get 7-9 hours of sleep each night.
- Go to bed at the same time and wake up the same time each day.
- Remove the television and screens from the bedroom.
- Do not have any caffeine after 2pm.
Reduce stressors through relaxation techniques such as:
- Deep breathing
- Progressive muscle relaxation
- Guided imagery
Learn to challenge and change negative thought patterns.
- Write down your worries.
- Set a daily timeframe where you are allowed to worry.
- Work to accept what you have control over.
Engage in social activities and/or support groups.
- Join an in person or online support group to connect with other people suffering with depression.
- Join local groups to participate in activities you might enjoy, and to make friends.
Learn to set healthy boundaries with those who impact your mood.
- Discuss what it would mean to set healthy boundaries and stick to them.
- Learn when you are taking on too much, and that it is ok to say no.
- Do not continue to do things that you do not want to do.
Learn coping and problem solving skills.
- You and your therapist can develop skills to meet your individual needs.
- You can develop coping skills for when you feel your depression worsening.
- You can learn to problem solve choices that are in the interest of reducing your depression
Remember, you are not alone in feeling this way. If you or a loved one has been depressed for years (or even weeks or months), it is never too late to seek help from a professional. If searching for, and speaking in person with, a health professional is intimidating or inconvenient, talking online with someone might be a better option for you. Speaking with a health professional will allow you to:
- Adjust to and cope with major life events
- Engage in positive thinking and coping strategies
- Regain control of your life and reduce negative thought processes
- Make a plan to change behaviors that make your depression worse
- Begin or continue to develop positive relationships with others and yourself
- Set realistic, achievable goals for your life
One common strategy suggested to alleviate chronic depression is to stick with speaking to a mental health professional for a long time. Often, individuals with chronic depression will seek treatment and find that this eases their symptoms temporarily, but then discontinue therapy and fall back into experiencing depression. Persistence is often the best medicine for alleviating long-term symptoms of depression.
By talking with a professional through BetterHelp.com, you will be able to talk confidentially about your symptoms with someone who is experienced, and can help you answer any questions you might have. Regardless of the resources you find online, speaking with someone else is sometimes the best option to really understand what your symptoms mean and how to get the best help.