<strong>Depression itself is not a disease: It's a complex emotion</strong>, one that mostly-healthy people can go through due to a variety of factors. It's normal to be depressed for a day sometimes, or for longer in response to getting dumped or losing your job, or even for a really long shitty while after some major trauma in your life. <strong>Depression sucks, but it's like having a cold: to an extent, all or most of us know "what it's like"...</strong>
BUT. Having a cold is WAY different from sneezing your ass off every day for years. Think of having a cold versus having something like HIV, which makes cold-symptoms potentially uncurable or deadly: The latter wears away at you in unexpected directions, gradually deforming and breaking other pieces of your health; we were never meant to suffer under depression (or rhinovirus) for months and years on end. You sneeze for a week, your nose gets red; you sneeze for a year, you suddenly have to deal with bleeding and secondary infections and all kinds of things that would never be an issue with a normal cold. Etcetera.
A normal, complex emotion like depression can become a chronic illness that will follow and fuck with you for life. Or maybe end it. And that's when we call it a "disorder", but of course, there are degrees and kinds of those too. It can feel pretty confusing, but I think there are just a few terms that, if clarified, would really help us all talk about these things accurately and compassionately.
And while I think it'll help everyone to understand these terms, for their sake and their loved ones', this is also somewhat self-serving for me: It's great that people hear "depression" and think "oh, right; that sucks and I've been there! I was depressed just last week!" — but sometimes that stops them from listening when you need to add yes but, for me a cold is not just a cold; this one has almost killed me three times and I've had it almost every day for the last two decades.
So here's some clarification of what I think are the five most useful terms in depression-related clinical psychology. I'm not good for much else this morning, because Reasons. :P
1. Major Depression, or Major Depressive Disorder, is when you feel depressed for weeks on end (more than 2 weeks is the current clinical limit) and can't shake it. It's a sickness, but it's a fairly normal one in response to, say, losing a loved one or suffering any major stress. Think of it as depression flu: It probably won't kill you, though it can be dangerous to some people sometimes; and it sucks ass, but most of the time you'll be alright once you recover.
2. Bipolar Disorder is not a kind of depression (which is why it was renamed from "Manic Depression") — it's a mood disorder that involves both periods of nasty depression and periods of equally-damaging mania, which are extreme and switch unpredictably. While depression is a big negative part of bipolar disorder, the primary treatment focus in this case is on regulating the emotions so that they a) aren't turned to 11 all the time in ways that cause you to make bad decisions, and b) don't switch wildly at the drop of a hat. The depression part of bipolar disorder can still be dangerous (all depression can be dangerous), but so can the manic part (ever seen someone leap into a car and tear off at 95 miles an hour and not be able to tell you later why they did?), and the disorder is in the body's failure to regulate either emotion's "when" or "how much".
3. Atypical Depression is like the citrus flavor variety: The term doesn't refer to a disorder, or to how long or often you have to deal with depression; it's a label for a common "alternative" set of depression symptoms that people can suffer. Just like there's a respiratory flu and a stomach flu but they both suck and they're both flu, there's an atypical depression (which really isn't all that uncommon, so weird name) that involves insomnia rather than hypersomnia, restlessness rather than fatigue, and some other symptoms that don't strictly *seem* like depression, but totally are, just in a different formulation. Before I knew this term, I called depressions "A-type" and "B-type" to try and differentiate the symptom-sets I was experiencing. It's very weird to have different symptoms that you know are coming from the same thing, but I guess it's analogous to having a cold that makes you sneeze vs. one that makes you cough instead — not really uncommon behavior for an illness, and we understand pretty instinctively that both are "a cold".**
4. Psychotic Depression is as scary as it sounds, but not as complicated: It's really just what happens when you take depression (any depression, whether it's caused by a trauma, or just a bad day, or a lifelong disorder) and crank the gain as far as it'll go without (or with) breaking you. The intrusive negative thoughts become full-blown hallucinations and delusions; the suicidal urges become sleepwalking to the medicine-cabinet; crying in bed all day becomes screaming until you lose consciousness; decision-paralysis becomes actual paralysis and going mute because you can't connect with your body anymore — that kind of thing. It's sooooooo fun. ::shudder:: As you'd expect, people who have depression longer and more chronically are more likely to have the psychotic kind; as are people who are psychotic in other ways. When people freak out during depressive episodes and kill themselves suddenly or violently, they're often experiencing (or one could say, trying to escape) a psychotic depression.
5. Dysthemia (Dysthymia) I've saved for last, because it's the one I most hope people who read this article remember. The word could use more exposure, for one thing; dysthymia is technically "chronic depression", but that really doesn't do it justice. Dysthymia’s an old word (the new term is Persistent Depressive Disorder, but can we just agree that you never hear that phrase because it’s horrible and stupid to the point of uselessness). Before depression was understood as a potentially-deadly disorder, dysthymia used to be a very yeah-what-the-f-ever term to label and dismiss someone as “just sad all the time”. In modern psychiatry there’s a thin attempt to draw a line between long-term “mild” depression (dysthymia) and chronic major depression — but the line is outrageously imaginary, based on self-reporting and total wild guessing about “how often” and “how severe” the “two or more out of five” symptoms one experiences are. What’s NOT imaginary is the effects of depression and living with them for years on end, though. This kind of subjective judging is, in this case, only harmful: once you’re talking about being depressed for most of every day for more than two years, the word “mild” really doesn’t belong in the discussion. (Also, when I originally wrote this, I spelled it “Dysthemia”. That’s incorrect, but I did it because the “e” spelling immediately made more sense to me, and my brain latched onto it, and now, in retrospect, I still like it better. So after pondering, I’ve decided to go ahead and use my spelling, to go along with “my” definition here, which doesn’t DISagree with the DSM-5 (psychology’s diagnostics manaual), but spins it, as well as the old historic use, in a somewhat different, I think more useful, way).
The clinical definition of dysth(y)emia is having depression almost every day for two years or longer. In other words, dysthymia is depression being damn near, or actually, your normal state. Most people with dysthemia started getting diagnosed with major depression as a child or teenager (I was eleven). Many say things like “I’ve always been this way.” A lot of us don't make it to adulthood without at least one suicide attempt, and every one of "us" that I've ever spoken to lives in constant fear that something will trigger a particularly bad episode of depression that does us in for good — or fails to, and leaves us trying to rebuild from the ashes yet again. Dysthemia is usually considered impossible to "cure", only manage; like all chronic conditions, once you've been dealing with it for decades, there's not a lot of hope that things can actually be changed on the ground-level*; only hope that your quality of life can be preserved or improved. Dysthymia is, in effect, the boy-in-the-bubble, broken-immune-system version of depressive disorder: Like a cold that never goes away, that sticks around at a low level, deteriorating and stressing you in various papercut ways, and flares up, it can seem, every time you dare to think you're getting better.
With dysthemia, your whole life is symptom-management and using all your sick days at work and being really flinchy around things that might trigger a flare-up; and no matter how good you get at all this stuff (I consider myself pretty awesome at it!), you still know that it's your glass jaw and always will be; and the chances of it being the thing that kills you eventually, one way or another, are pretty high.
There's a lottttt of evidence that dysthemia is caused by, or related to, suffering extreme isolation or ostracization, and/or existing in a cultural mileiu that one doesn't belong in. Artists and inventors are famous for having it a lot. Being exposed to a depressed parent in the psychological formative years has also been linked. Some people consider dysthemia the symptomatic result of sensitive psychologies forced to exist in environments that damage them; cf. "Civilization and It's Discontents", and the many similar writings.
…And maybe all that is wrong, and I could speculate endlessly, but really I just wanted to write enough that hopefully the word "dysthemia" will stick in your head, and the next time someone talks about depression, you'll have it there to work with, to sharpen and aim your compassion.
**These metaphors are almost certainly influenced by the fact that I have a cold. ;)
*I perhaps disagree with this, but only because I am convinced that spirituality points to the possibility of a psychological reconfiguration that could, I suspect, eliminate depression, even for dysthemics. ….I may also be biased. :P