Gradual Onset of My Major Depressive Disorder

  Earlier this week, I posted about my visit at the doctor’s office and my latest diagnosis of Major Depressive Disorder secondary to chronic illness.   I have now had three full days of time to reflect, and to try and catch up on sleep, and as I think back, I can slowly see now the gradual onset of the MDD over the past four months. 

I’m not ashamed of what is happening to me because it is something that is beyond my control.  As a chronically ill patient, there are so many things physically wrong with me on a daily basis I’m amazed that my brain and body didn’t succumb to MDD a long time ago.  I had dealt with depression before on a very minor scale from time to time related to my illnesses but this is by far the worst that I have ever experienced in my entire life.  I would say this is even worse than the crying spells and emotional feelings I was having after I gave birth to my son due to the hormonal changes us women usually experience postpartum. 

I think the stress around the holidays with my husband losing his job was the beginning and having all of that mess to deal with.  I often times will feel that I am alone when having to deal with these situations because my husband is the type who doesn’t like to deal with the negative things in life, so for him, he just goes about and does his normal routine and life doesn’t change.  For me, however, I’m left to try and put the pieces back together and to make things work when I have no idea how to make it happen at the time. 

I also started getting sick with my sinuses and having other flares and issues but I realize now when I look back that I had completely lost my desire to participate in things and I still feel that way.  Normally, I LOVE getting on my computer, writing, keeping my blog updated, and socializing on Facebook & Twitter and lately, I may go 3 – 4 days without even getting on the computer.  I have no desire to do the one thing that has kept me going all of these years. 

I also have still been on my dieting plan but I stopped losing weight after the beginning of the year.  I have been struggling with trying to rotate how I’m eating my food, change my exercises, drinking more water – everything I can think of but nothing.  Now I know that it is because of the MDD that I have not been able to lose anymore weight.  There is another symptom that helps complete the puzzle.

With the CFS & Fibromyalgia flares, I will still have the want and the desire to do things – it’s just that I physically am not able to.  I have been losing the want and desire to do everything that was important to me.  Everything has become forced, if I can get myself to do it at all.  Work is where I have really noticed this change because I’m the type to look for something to do to keep busy when there aren’t any customers.  Lately I have found that I have even lost that drive. 

The fatigue has also been different.  To be honest, it kind of feels like the fatigue I felt when I first found out I was pregnant with Logan – it’s that fatigue where you can just sleep and sleep.  At night, however, I feel my insides going what feels like 100 MPH.  I’m used to not sleeping from the CFS & Fibro, but I think it is just making the depression worse.   Today I had the house to myself the whole day – no one was here at all  – and I was able to get caught up on some sleep finally. 

Another indicator that I now know I can probably attribute to the MDD is my increase in pain that I have been experiencing.  My doctor noted that I started complaining to her about an increase in pain around the middle of January and every apppointment since then, she has noted that my pain levels have not improved. 

I have been on my increase of Prozac since Wednesday, but unfortunately, it is going to take a lot longer than a few days for me to notice any difference – or so the doctor says.  I want this feeling to go away so badly.  I hate feeling like this.  I feel like my insides are so heavy.  It feels like there is a brick setting in the bottom of my stomach and I have to hold back the tears when my husband and son are around.  I feel like crying all of the time and I don’t even know why. 

I knew something was different with my body and that something was not right.  Normally this time of year I start feeling better and have a lot more energy.  This is so unlike me.  I am trying to put on a brave front and a happy front around my family because my husband told me last week that I “bring him down”.  I wonder if he feels bad about saying that now that he knows I have a chemical imbalance and can’t control it? 

I attribute some of the MDD to the pressure I have been feeling lately by him to “get well”.  He wants the Sandy back that was able to go and do a lot of things last summer but I can’t always be like that.  I tried to tell him that.  I feel lost – like I have lost my support system, my best friend in a sense.  I want to be well more than anything in this world.  But the illnesses are not going to go away and pressuring me to “get well” is only going to make it harder for me to improve. 

What is Major Depressive Disorder? (Source:  Wikipedia)

Major depressive disorder (MDD) (also known as recurrent depressive disorder, clinical depression, major depression, unipolar depression, or unipolar disorder) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. This cluster of symptoms (syndrome) was named, described and classified as one of the mood disorders in the 1980 edition of the American Psychiatric Association’s diagnostic manual. The term “depression” is ambiguous. It is often used to denote this syndrome but may refer to any or all of the mood disorders. Major depressive disorder is a disabling condition which adversely affects a person’s family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide, and up to 60% of people who committed suicide had depression or another mood disorder.[1]

The diagnosis of major depressive disorder is based on the patient’s self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. If depressive disorder is not detected in the early stages it may result in a slow recovery and affect or worsen the person’s physical health. Standardized screening tools such as Major Depression Inventory can be used to detect major depressive disorder.[2][3] The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years.[4]

Typically, patients are treated with antidepressant medication and, in many cases, also receive psychotherapy or counseling although the effectiveness of medication for mild or moderate cases is questionable. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT), under a short-acting general anaesthetic. The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized.

The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Certain types of long-term drug use can both cause and worsen depressive symptoms. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells.

Symptoms & Signs

Major depression significantly affects a person’s family and personal relationships, work or school life, sleeping and eating habits, and general health.[5] Its impact on functioning and well-being has been equated to that of chronic medical conditions such as diabetes.[6]

A person having a major depressive episode usually exhibits a very low mood, which pervades all aspects of life, and an inability to experience pleasure in activities that were formerly enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.[7] In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually unpleasant.[8] Other symptoms of depression include poor concentration and memory (especially in those with melancholic or psychotic features),[9] withdrawal from social situations and activities, reduced sex drive, and thoughts of death or suicide.

Insomnia is common among the depressed. In the typical pattern, a person wakes very early and cannot get back to sleep,[10] but insomnia can also include difficulty falling asleep.[11] Insomnia affects at least 80% of depressed people.[11] Hypersomnia, or oversleeping, can also happen,[10] affecting 15% of depressed people.[11] Some antidepressants may also cause insomnia due to their stimulating effect.[12]

A depressed person may report multiple physical symptoms such as fatigue, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the World Health Organization’s criteria for depression.[13] Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur.[7] Family and friends may notice that the person’s behavior is either agitated or lethargic.