A Spectrum of Depression


Blank.

Each time I go to write, I get a blank.  Is it a blank, because I feel as if I don’t have anything important to say.  Or is it a blank, because if I make a certain statement, then it is real.  It becomes something tangible in this world, not only for me, but for others, and I will eventually have to come nose to nose with it.

I’ve grappled with this before.  Making certain admissions.  I do not lie as much as I turn a blind eye.  I rationalize.  I attempt to will it out of existence.  But, it is just not that easy.

Simply – I am in the midst of a depressive episode.

Why was that so hard?

There is a certain hesitation for me to use the word depression.  It is not a word that I use loosely; others use it as a part of their regular vernacular to describe sadness.  Depression is not sadness.  Depression has a depth beyond that of sadness, loneliness, isolation, self-loathing, or any other word.  No amount of words arranged in any way can accurately depict depression, and do it any kind of justice.

The hesitation to term it as depression stems from the idea that, if it doesn’t feel like the worst I’ve ever felt, then it’s not depression.  I have faced more gruesome depressions than this one.  With the admission comes a certain fear.  If I am to term it as a depressive episode, then it really will be such, in the worst sense of that word.  It could worsen the episode itself by acknowledging it.

Blank.  Again.

I have found it so interesting that Bipolar Disorder has this grandiose spectrum to encompass so many different types and symptoms.  However, they are exclusive to mania.  Depression is just depression, and it by itself is MDD, or unipolar depression.  Except, now psychologists are starting to recognize symptoms that are related to atypical depression.  However, by reading through these symptoms, it seems as if it may be exclusive to unipolar depression.

How much research has been done to distinguish unipolar depression from bipolar depression?  So far, the only thing that separates the two is the existence of hypomania / mania.  In theory, there wouldn’t be a difference.  I get the feeling that there is, and it is significant enough to have a separation between the two.

So far, the mood spectrum looks like this:

But, I really think that’s being too broad about it.  I fall smack dab in the middle of Bipolar II, no full on psychosis equals no full on mania, even if I have delusions.  I wouldn’t even suspect that I have full on mania, anyway.  Even with delusional thinking, I can honestly say that there has never been a time where I have been hypomanic where I lost touch with reality.

People with mood disorders are familiar with the depressive symptoms.  But, I’ll sum them up:

Sadness, anxiety, irritability,  Loss of energy,  Feelings of guilt, hopelessness, or worthlessness,  Loss of interest or enjoyment from things that were once pleasurable,  Difficulty concentrating,  Uncontrollable crying,  Difficulty making decisions,  Increased need for sleep,  Insomnia, Change in appetite causing weight loss or gain, Suicidal ideation, and / or Attempting suicide.

Symptoms of atypical depression:

Increased appetite, Unintentional weight gain. Increased desire to sleep. Heavy, leaden feeling in the arms and legs, Sensitivity to rejection or criticism that interferes with your social life or job, Relationship conflicts. Trouble maintaining long-lasting relationships, Fear of rejection that leads to avoiding relationships, Having depression that temporarily lifts with good news or positive events but returns later

These are all familiar.  I’ve bolded the ones that I’m experiencing at the moment.  It seems that I’m bordering on the more atypical part of depression.  This is the kind of depression that no one really tells you about.

I had mentioned my diagnosis of Bipolar II, resulting from non-psychotic “manias” clinically termed “hypomania”.  Fair enough.  Let me put a question out there.  Has anyone ever experienced a psychotic depressive episode?

I have.  And I have mentioned this to doctors on several occasions.  I will have breaks with reality when I am depressed.  I have severe delusions, almost completely the opposite of delusions of grandeur.  I will have severe paranoid episodes – in fact, I just had one.  I can have myself convinced that everyone hates me and is out to destroy my life.  It makes me combative.  I will sometimes invent conversations that never happened, just because my brain contorts a criticism.

Mayo Clinic appended this in fine print below their list of classical depressive symptoms:

When a person with psychosis is depressed, there may be delusions of guilt or worthlessness — perhaps there is an inaccurate belief of being ruined and penniless, or having committed a terrible crime.

Perhaps?  I’m nearly positive that exists because not enough research on bipolar depression versus unipolar depression exists to accurately differentiate between the two.

There are a few questions that remain.  Again, not to just the bipolar population but the unipolar population as well, have you ever experienced a psychotic depressive episode?  Is this more commonly found in MDD, BP II, or BP I?

Because if this is common amongst all populations, then the mood spectrum should look more like this:

Perhaps a more accurate model

Advertisements

44 thoughts on “A Spectrum of Depression

  1. Depression is such a waste of brilliant minds isn’t it? It seems to strip one of everything. i hate it.
    For myself, I don’t draw a blank when it comes to writing, I just don’t want to write at all… it is horrible. Then when I have pulled out of it, I have so much to catch up on. LOL
    Hope you feel better soon. ♥

    • For me, everything slows to a drip. Sometimes, if I hit the right valve, I can get a fantastic gush. Depression is where some of my best work has come from. But, it can never be something that is forced. That’s where I blank. Kind of like when someone holds a microphone to your face and says, “Say something.”

      Honestly, this was pretty forced. And it’s unclear. It started out as an admission or maybe surrender to bipolar depression. But, I thought, “Why hadn’t I recognized this sooner?” Ultradian cycling had a hand. But the true reason was because I wasn’t having my classical symptoms.

      Fatigue is always my first red flag. Usually, it comes with an inability to just do things. I can’t seem to get everything done, and everything turns into a huge problem. Neither of those were present. All I had was hypersensitivity, irritability, reactivity, and a vague feeling that something wasn’t right. Like when you think you left something behind, but you can’t put your finger on it.

      I let it get worse. Truthfully. Because I had the fanciful notion that it would go away. That it was just a passing mood, like I had been having during my stable state. And that’s something I want to talk about in another post. The trickery of “remission”.

  2. Very interesting post Luna. I had never really thought about atypical depression – but my depressions are usually more in line with those symptoms.

    I was a little confused with what you meant regarding you never experiencing full-blown mania because you don’t have psychotic manias. As far as I am aware, you can still have a full-blown mania without psychosis. I have never experienced a psychotic depression – although if a mixed mood is severe enough I do have various delusions and minor hallucinations.

    ‘The hesitation to term it as depression stems from the idea that, if it doesn’t feel like the worst I’ve ever felt, then it’s not depression.’ – I feel the same. I am very hesitant to use the word. It bothers me when people use it in a colloquial sense.

    You are having such a rough time at the moment. I sincerely hope things start improving for you soon.
    xx

    • Many thanks to you. I’m getting concerned. It is becoming apparent to co-workers. A few people asked me how I was feeling. No one ever asks that question. They usually ask how I’m doing. There was an emphasis on feeling, as if they know I’m ill.

      Or, I’m delusional.

      My diagnosing doctor might have been wrong. I don’t know. I had been informed that because I didn’t have “classical” symptoms, including mixed episodes and psychotic manias, then it’s not BP I. The ultradian cycling at it’s worst could be reported as mixed. But, I have never really had what they term a “severe” episode. I have never totally lost control. And I have never broken with reality. I still retain the ability to refrain from some impulsive behaviors.

      BP I, II, whatever. My current treatment is working, so I won’t poke at that. But, what about psychotic depression? Literally, a depressive state, full blown depression complete with typical and atypical symptoms as well. Except, the hypersensitivity feeds into this strange world where day is night, and night is day.

      I stood in front of the mirror the other day and took a hard look at myself. Why don’t I age like everyone else? I have always looked considerably younger. And, I got this idea in my head that my parents lied to me about my age. It would have been easy to pull off. They lived in a rural town when I was born. If I wasn’t actually born at the hospital, then my birth certificate could be forged.

      Ridiculous.

  3. I’ve been doing a similar tap dance lately, skirting around acknowledging I’ve been knee-deep in depression -and I think I do a similar dance because of that fear that looking it directly in the face might make it much worse, or might make me realize it is much worse than I thought. Part of me finds the notion absurd, like acknowledging it should help, but something about that just never feels right.

    I don’t know much about atypical depression but looking at the list, I almost exclusively gain weight unintentionally when in a big depressive episode.

    And I think I might have had a psychotic episode with depression, but it is unclear to me whether it was just depression or might have been a mixed episode. It was worlds more terrifying than any other sort of “manic” or mixed psychosis I’ve experienced, but if that was what happened it was partially a product of one of the medications I was taking at the time. I would say otherwise, delusions are commonplace for me, but not full out depressive psychosis.

    • I know what you mean. When more clear cut symptoms started showing up, hypersomnia, loss of motivation, etc, that was the last nail in that coffin. This is me, finally paying the piper after escaping it for three months.

      Psychotic depression, for me, a lot like psychotic mania (I have had one, medicine induced episode). Except, there is zero energy involved. It’s not as much outward as it is focused inward. I can convince myself of all kinds of obviously fallacious thoughts. I imagine that I’ve done something terrible, but I can’t remember.

      So far, so good here. Regular symptoms.

  4. This is really interesting. I’d never actually thought about ‘psychotic’ depression and how some particular symptoms experienced may still relate to depression (psychotic) as opposed to a diagnosis of another spectrum. For me, it’s prompted doctors to re-diagnosis or add further additional diagnosis unrelated to depression. I’m this and then I’m that and then no, I’m this again, etc..

    Personally, I’ve always tried to ignore whatever diagnosis is being dished out to me. It has never been a sure thing – forever changing depending on the time and/or professional treating me. I don’t find any solace in that whatsoever. I think an accurate diagnosis is important though – sometimes for the person, to gain a better understanding of themselves and what they’re going through… and even to feel confident or hopeful that it can then be overcome, but also importantly for professionals themselves, to know what they’re working with and which treatment to apply (treatment that has been effectively proven). There is definitely a lot of research which needs to be done.

    It may not feel it at times, but you are strong (I know that I don’t know you. I’m just judging by what I know you’ve overcome in your past) and I have faith that you will pull through this again. It doesn’t necessarily make trudging through the thick smog any easier, but I hope it can help focus on that light right over there.

    • Normally, I’d agree with you. Shuffling diagnoses is never desirable. I’m not really even suggesting different diagnosis, really. Psychosis is serious business. If it is found to be relatively prevalent in just this small population, then psychotic depression may be something that needs to be investigated. The existence of it alone prompts a need for acknowledgment for treatment purposes.

      I have had multiple Pdocs tell me that my (self-described) “severely, delusional, paranoid depressions” were not psychotic, because there is no such thing as psychotic depression. And the issue was pretty much dropped. When I read about psychotic depression today, it was a relief. Because up until this point, my depressive episodes were treated like depression. And the psychosis was left behind, for me to think that was just me.

      Knowing is important for me. A diagnosis alone is not an antidote. It’s the treatment that comes with it. If I’m having psychotic depressive episodes, then maybe it doesn’t have anything to do with my antidepressant. Maybe it has something to do with my mood stabilizer. And knowing this now puts me in a position to consider antipsychotics.

      I do a lot of at-home DIY therapy. This knowledge is important for the way I handle the episodes. I now know that I need a touchstone for reality checks. People I can trust with my life. There are only about three people I could trust to be honest with me.

  5. I have had a few psychotic depressions but my diagnosis is schizoaffective-bipolar type. I was experiencing the depression when the psychotic episode happened, not mania, hypomania, or just my normal psychotic episodes with no mood disturbance. I think it is just rarer.

  6. So agree with what a waste of a brilliant mind depression is. So sorry that you have gone through and continue to go through these horrible pits and gulfs. if only we could find a happy place and stay there, by choice, not be at the whim of where our minds took us! I don’t know what is ‘normal’ but I wish we could just be ‘comfortable’ and ‘functional’.
    For such a ‘blank’ you have managed to write a brilliant post – thank you and *hugs* hoping you feel better asap xx

    • Thanks Fiona. It’s so nice to hear kind words of support and reassurance.

      I’m about to write a post today about my happy place. And how coming back from that is probably one of the more painful shifts than I’ve been through with this. I’m hoping that if I write it out, it will go away.

  7. I’ve read this book called The Bipolar Handbook and it describes bipolar depression as different than unipolar depression. A unipolar patient may describe depression as being sad, but “persons with bipolar depression usually feel a mix of anxiety, panic, pessimism, irritability, etc.” The author also says, “Bipolar depression brings with it an intense internal pain so strong that individuals often spend entire days crying.” I know this is true for me. I’ve had problems with hypervigilating but not with psychosis, per se. The symptoms you listed as related to atypical depression are very similar to the symptoms listed in this book for bipolar depression. Perhaps bipolar depression is the same thing as atypical depression?

    When it comes to bipolar, just throw the DSM-IV out the window. I don’t think it’s a simple straight line like a rainbow, but more like a sphere or something where all symptoms blend and overlap. The DSM-V is supposed to have a complete remodel of bipolar disorder. Maybe we will have more answers then.

  8. Thinking of you. I had this looooonnnngggg thing I had written up that sort of 1/2 made sense on this psychotic depression thing but…. It’s done but anyway. I was going to send it directly to you. I am embarrassed to post it, but can’t seem to send it to you. The link is not there or something. Any way. Yes, I think I have had some, but question it. There was some thoughts in there too about the possible use of an antipsychotic too. That’s what my unposted reply was about.

    Hang in there! You’ll make it, I know it sucks in the mean time, but you will come around. Try and ride it out.

  9. I just discovered your site … I appreciate this post, because it sounds so familiar: wanting to write something, anything, but not doing so because everything seems so trite and pointless and boring.

    Before being diagnosed with bipolar II, I was convinced that I had atypical depression because the symptoms fit me very well. I still think I have what I’ve seen described as “double depression”, meaning the bipolar depressive episodes interact negatively with the ongoing permanent depression. It was during one of these double episodes that I had something close to a psychotic episode, and I went in the hospital for a week. I was only on SSRIs at the time, and I’m sure they made the bipolar worse than ever before.

    • The reaction you had to SSRIs is very commonplace. Often, it is how a person with Bipolar II ends up getting diagnosed as such. I’m going to guess that they mistook it as MDD and threw some Prozac at you. Unfortunately, that’s commonplace, too.

      Trite, pointless, and boring are too shallow to describe the emotions that occur for me in deeper depressions. It’s more like futile, absurd, redundant, monotonous, and worse of all, inane. Inane nonsensical, irrelevant babble – yes, that is an intimidating idea, enough to stir paranoia and keep me avoiding writing. Except, that would be a horrible thing. Isolation is the worst of any symptom. That is one thing that paves the way for my sense of reality coming loose.

      Interestingly enough, a fellow blogger, James Claims, had talked about duels cycles – primary and secondary. It’s pretty interesting. I see what he says, but I can’t pinpoint the function within myself yet.

  10. I had coffee with a friend (one of us) today and we both agreed that we would rather be institutionalized in a padded cell than open our mouths and express our feelings. It made us laugh to the point of tears because it is so insane yet so rational. We both conceded that when in the thick of “it” we almost love it, or hate it so much, or fear it’s not real, or that we’ve lost our minds, or worse, found them, that we almost come to relish the tiny pocket of insanity. Like a pet. Knowing that other people get it, is a strange, surreal painfully liberating realization.
    Tipping my hat to your ability to verbalize this (waving from the padded cell.)
    xoxooxox
    The Cockroach

    • The problem was losing the ability to verbalize this whole depressive thing before this incident happened. I get to the same place you and your friend were talking about. Honestly. It comes with this dreaded feeling. “Oh, yeah, another super original piece about the effects of bipolar depression. *Sigh*”. And I discourage my own self from doing it. Add in the fact that I thought I could combat it by just avoiding it, and poof! Here we are.

      That really was the point to this piece. A person cannot avoid it and hope that this is just something in passing. It’s not. It needs treated. Or else it just gets worse.

  11. I think about that because my default is to keep things inside, say I am fine, sometimes I’ve dropped off the cliff way before I even realize it (I can even fool myself?) And sometimes, I am just hoping it will go away before I have to tell anyone? Sick. I know… But another part of me wonders if I almost can’t bear to hear “I get it, you’re not alone, I feel that way too.”
    A different kind of pain.
    xoxox
    TC

    • It’s not sick, it’s self preservational. I feel the same, and in this instance, I did the same. But, I realized that I should have brought it to light instead of just kind of mentioning it in passing. However, where do you find the words when they just won’t come?

      • Sometimes, I can’t…I have literally sat with my mouth open and no sounds coming out, even when doing something relatively simple, like talking to my boyfriend of 6 years. 6 years and I should be able to say how I feel, right? But it felt as though a bear trap was clamped over my lips…
        We just wade through it, I think, and try to conquer one little chunk at a time.
        xoxoxox
        TC

        • You’d think after seeing each other in various stages of nudity and inebriation for the last ten years, plus watching me have a child, there would be no shame or secrets.

          Sometimes, when I screw up, I am terrified to face him, kind of like a child is afraid to face their parent after doing something bad at school. We don’t have that kind of relationship; we are peers. But, I don’t know.

          It all eventually comes out in it’s good time anyway, right? *chuckle*

            • Even if we’re sitting in the car, and I’m like, “Hey remember six months ago when . . . ?” I guess at that point in time, it becomes irrelevant. I’m not sure that some things are even relevant to start with. If they were, then they’d be out there. I suppose.

            • I KNOW. My boyfriend has no concept of hanging on to things, or sitting on them for months. It has taken me 6 years to get to the point where I can **see** he just doesn’t take things as seriously as I do. It’s so hard to let go of old patterns that no longer serve us…

            • And that’s the only reason I see symptoms of BP as being a maladaptive trait. Otherwise, I think it gives us a certain edge on humanity. We are the human experts by trade. We live this “super humanity” daily through our extremes.

              I feel like I have this static cling. But, I don’t pick up socks. I pick up emotions. Good, bad, and in between. I don’t even have to be “linked” with a person to get them. I just have to be in the same atmosphere. But, even when it’s cleared from the air, it lingers with me.

    • And that’s exactly what I’m talking about. When was the last time a doctor asked you about psychotic depression? My answer would be never. I’ve never had a doctor even consider it. And that creates a treatment issue.

      • Actually, the psych I am seeing now is the first one who told me that I did not seem to have “manic episodes” but I do have psychotic-like depressive episodes. He prescribed lithium to try and help during those times. But I could not stand the lithium. You know what he said to me, that actually made me feel better? “You deal with a lot of shit, young lady. I’m really sorry.” And he shrugged his shoulders. Not in a “sucks for you” kind of way but just like it’s a matter of fact. For whatever reason, perhaps because it wasn’t overly dramatized, I felt relief.
        We’ll get there. Exploring it and trial and error.
        xoxoxoxo
        TC

  12. Looking back, I think many times what I’ve had could be described as near psychotic or psychotic-like depressions, brief as they may be sometimes. Having insomnia–like going three, four, five days without sleep–can exacerbate that. I recall as young as my early teens, I’d wake up frantically searching for roaches because I KNEW they were crawling on me while I was asleep (or tying to fall asleep); I’d felt them even as I searched. I’d go as long as three hours searching for them in my room. Or hearing static, radio-like noises while staring at shadows until I begin to believe there’s a man there who snuck in the house. Or being fearful and guilty about wanting to hurt my mother, even believing I had already had killed her, or the opposite lying awake convinced she would kill me. Delusional thinking? Maladaptive defense mechanisms? I don’t know. Just weird things like that to the point of almost being funny. Then there’s the old usual, “everyone’s over there is laughing at me/out to get me” thing, kind of like what you described. I’ve never told any of the psychiatrists I’ve seen these things, except the first time I went in four years ago, I did tell the psychiatrist of an experience I had my senior year where everything began to glow and “sparkle,” in an almost enchanting and exhilarating way but I was very suicidal then. I believe I was really mixed then. It may be what got me the Dx that first time. It was terrible. Don’t know how anyone close to me (aka my family) didn’t note it or want to. Maybe I should bring it up the next time I have an appointment. I’m not sure how to go about it though.

    • For me, I know it’s not mixed. When I’m in a down, there is no up. Nothing of the sort. I am a pretty clear cut case of BP II, as far as I know. However, I do know that I have underlying anxiety things that the doctors and I have not worked out yet. From what I understand, people with PTSD can have psychotic episodes. I haven’t read up on it, but it may be the fit. At least now.

      I have always kind of had psychotic symptoms in depression. I remember being as young as 13. I see shadows. Literally, shadows around. It was always in depressive episodes. I was convinced that it was the shadow of death lurking around me, because I had invoked it so many times. When you pray for death, is it God who comes? Who exactly was I praying to, anyway? I was convinced that it was Death himself that came, making judgements, litigating with God and Satan as to whether I should be taken for judgement.

      It’s really something else. I could probably go on about it, but I don’t know. At the moment, it doesn’t really feel right. I just know that there is something amiss in my depressive episodes, something that goes above and beyond and doesn’t quite fit the description. Well, the most severe ones anyway, at the deepest, darkest times. I’d call it a 1 or even as low as a 0.5 on the mood scale, though there isn’t such a thing. I’d find myself slipping into these dark depressions where I would be paranoid, delusional, and have hallucinations about things that didn’t happen. My dreams bled into reality, and I couldn’t even really tell what was real and what wasn’t anymore. I’d split. I didn’t feel like me, like me had left completely and there was something else posing as me.

      Again, strange stuff. I haven’t gone this far in depth with doctors, because they have dismissed the notion entirely.

  13. Pingback: Depression – why it was never about sadness. « Halfway Between The Gutter And The Stars

  14. Pingback: Tag, I’m It! – Pittsburgh Edition « As the Pendulum Swings

Any thoughts to contibute?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s