Making Peace with Persistent Depressive Disorder

by Vincent M. Wales

Persistent depressive disorder (formerly known as dysthymic disorder or dysthymia) is just what it sounds like: depression that persists. While the symptoms aren’t as severe as in major depressive disorder, they are ongoing, lasting years or even being lifelong. In some cases, PDD can be punctuated by episodes of major depression.

In early 1984, finishing my third year of college at Penn State, I knew none of this. I was at the school’s main campus, University Park, which had a student population alone that was roughly twenty times the size of the town where I grew up. Adding in a non-student population of about the same size made it a virtual metropolis; and it was a bit intimidating.

That first year at University Park was bad. I was overwhelmed, not just by the size of the population, but the size of my classes. In high school, I considered a large class to be thirty students. At PSU, one of my classrooms held more than three hundred. My grades were garbage. I felt isolated and alone, more than even an introvert should. I’d made a couple very close friends back at the satellite campus, one of whom was now my roommate. That was about the only positive part of the experience.

I’d occasionally go home to visit my family on weekends and, during one such visit, I bumped into a friend I hadn’t seen in years. I was really happy to see her and we chatted for a while, catching up. But, a few minutes into our talk, she asked, “Why are you so depressed?”

I don’t remember what shocked reply I managed to stammer out. I believed I was in a great mood, thrilled to be seeing her! If she thought I was depressed, I realized, something was seriously wrong.

A Dank and Suffocating Mustiness

When I looked recently at the writing I was producing around that time, one thing was clear: I was preoccupied with suicide. I wrote a term paper supporting “death with dignity.” I wrote short stories that “justified” suicide. I wrote poetry describing my brain as suffocating in a layer of mustiness, and wishing I could just crack open my skull, allowing fresh air in to blow away the cobwebs. And my journal? Dark. I wasn’t in denial about this darkness. I didn’t see this preoccupation with suicide as “normal,” nor did I believe everyone else felt the same. Even so, I regarded suicidal thinking as part of the natural progression of my life. I’d never been what you would really call “happy.” I was miserable through middle school and high school, withdrawn and lonely. I kept telling myself things would be better in college, but – three years in – nothing much had changed.

I never actually made an attempt to take my own life. There were, however, plenty of times when I’d see one of the public transit buses zooming toward me at an intersection and would think of how easy it would be to step out in front of it. A quick instant of pain and that would be it.

Something, though, kept preventing me from doing that. I had that “one thing” that kept me staying in the land of the breathing because I just knewit was going to turn my life around. This “one thing” was my first novel, which I’d been working on for a couple years at this point. I was convinced that I’d sell this book to a publisher, make a nice little sum up front, and live off royalties while writing more.

(Spoiler alert: that book has never been published.)

But even with that overconfident attitude, there were times when I’d be alone in my studio apartment and would imagine myself sitting in the middle of the floor, my handwritten manuscript in front of me, lighter in the other, and I’d tear out a page at a time and burn them. Then I’d have no excuse not to step in front of the bus.

My friend’s words in the mall, though, stayed with me. Eventually, I opened up to a classmate, telling her of my mall encounter where the word “depressed” was used. She urged me to visit the on-campus health center, which offered free psychological counseling sessions to students. I took her advice. I knew I was miserable. If this could help me, I was all for it.

So How Do I Get Rid of It?

At my intake appointment, I forced myself to open up about my feelings. This wasn’t easy for me to do, as such things weren’t really talked about thirty-odd years ago. But I poured out my heart to this woman, who listened politely and took notes.

At the end of our meeting, she surprised me by saying that I would be paired with a counselor who would be able to help me with my particular problems. I’d thought this woman was to be my counselor, and now I’d have to open up to yet another total stranger! I wasn’t thrilled with the idea.

But I did it.

I was offered up to ten sessions at no charge. I used them all. At the time, I didn’t feel they were particularly helpful. Part of the reason, I’m sure, was that it would take me quite a while to finally get talking during each session, and my time would be up just as I was really getting into it.

It was at the end of our initial session that I first heard the words that would stick with me: chronic depression.

I knew that, in a clinical sense, “depression” had a very different meaning than in common usage, but I didn’t really know what it meant. (Because 1984.) Even so, there was a sense of relief now that I had a name to put on these feelings. “Okay,” I said, “so how do I get rid of it?”

My counselor seemed surprised by the question and told me that I’d probably have this for the rest of my life. As my face fell, he said, “But we can reduce the severity of it.”

At the end of the free sessions, I was told that we could continue, but at cost. Being a poor college student, I couldn’t afford it. And I wasn’t about to ask my father to pay for it, since that would mean I’d have to explain what he was paying for and… well… that just wasn’t going to happen. It was too embarrassing to share.

Yes, I was one of those who believed depression was some sort of weakness. And, since my counselor was not a psychiatrist, he couldn’t prescribe antidepressants. But, even if he had, I wouldn’t have taken them, for the same reason I wouldn’t tell my father about it. I didn’t need pharmaceutical help. I just needed to learn to tough it out.

Just Leave Me Alone

Looking back, I can see that the idea of “toughing it out” was ludicrous, but I sincerely believed it. Had this all taken place a decade later, I’d have gone online and done lots of research. But, lacking the convenience of the internet, I never made an effort to do so, either at the library or even by asking my counselor for more information. I stupidly thought there was nothing more I needed to know. I had depression. I’d get through it. End of story.

A decade later, I was married to my first wife. At some point, she asked what she needed to know and/or do about my depression. Continuing my stupidity, I said, “When you see me in a funk, just leave me alone. I’ll get through it on my own.” This was, of course, the exact opposite of what I needed. And I have no doubt that my untreated depression was one of the factors that led to our divorce.

By this time, I was beginning to learn more about depression and mental illness in general. But since I was frequently without health insurance at this stage of life, I didn’t pursue any treatment options.

Well, let’s be honest. Even with full coverage, I wouldn’t have done so because I was still in that arrogant state where I thought I could just tough it out. The fact that I hadn’t yet been able to do so didn’t seem to matter.

I want to stress that this attitude did not stem from any sort of “macho” self-image. All my life, I’ve hated my body. I’ve struggled with weight issues, have never been “fit,” let alone “strong.” All this resulted in terrible self-esteem. Except in one area: I was proud of my mind and its intelligence and creativity. I was unable to accept that this crucial part of me was so damaged that it required drugs to be well. Pride and denial prevented me from seeking the help I needed.

You Don’t Want to Pursue Meds?

By 2005, my second marriage was on the rocks and I entered counseling again. This time, I had insurance, but because it would literally take months to get a counselor through my insurance, I took the quicker option of using an employee assistance program. I could get in immediately, but it would only pay for a few sessions. Probably because of this limit, my therapist pulled no punches. She didn’t guide me toward self-discovery. She laid everything out in plain terms, explaining to me exactly why I was this way. And it made perfect sense. These sessions remain the most eye-opening therapy I’ve ever had, causing me to finally understand the basis for many of my “issues.”

However, as important as understanding is, it’s not a “fix.”

A couple years later, I was divorced again. I knew our separation was the right thing, but being alone after so many years of being in relationships was difficult, and my depression increased. This time, I went to my medical provider’s psychiatric department. After a mandatory class on depression, I had a now-familiar intake session. After reviewing my file, the psychiatrist said, “Okay, so you want to go on antidepressants.” It was a statement, not a question.

“No,” I said, causing the doctor to look at me in surprise.

“You don’t want to pursue meds?” he asked, and I explained that I just wanted counseling. I figured, now that I understood the “why” of my issues, I just needed therapy, not meds.

So, that’s what I got.

Six months later, I was making little progress in therapy. Even with the knowledge I’d gained in the short but eye-opening sessions, I still wasn’t any closer to reducing my depression. So, I concluded that counseling alone wasn’t going to cut it. In April of 2008, I started on an SSRI.

We Seem to Have Stopped Making Progress

The good news is that, within weeks of beginning on the antidepressant, I noticed a distinct improvement in my mental state. Of course, this could just be my depression’s natural cycle, I told myself. But when I didn’t cycle back into a deeper depression in the ensuing months, I had to give credit where it was due. Medication was clearly something I’d needed for decades.

The bad news is that, six months later, my therapist told me that we were no longer making any progress. (Translation: I wasn’t doing the hard work that therapy requires.) Thus ended my third round of counseling.

That was nearly nine years ago. I haven’t stayed on the same antidepressant this entire time. I changed to a different one due to the unpleasant side-effect of weight gain on the first one. My dosage has increased twice during that time, as well, since my depression becomes accustomed to the medications and gets worse.

My depression has never been as severe as it was in college, but it has never gone away. Because “chronic depression,” today known as Persistent Depressive Disorder, is characterized by that one word: chronic. It is a constant presence in my life, every single day. That’s never likely to change.

I’ve recently begun my fourth round of therapy. I don’t expect major improvement; I’ll settle for any at all. For me, “recovery” has always meant “survival.”

I’ve made my peace with that.

EDITOR IN CHIEF / EDITOR: Gabriel Nathan | DESIGN: Leah Alexandra Goldstein | PUBLISHER: Bud Clayman

See Related Recovery Stories: Depression, Mental Health First Person Essays