"I'VE BEEN DEPRESSED MY WHOLE LIFE"
Dennis B. Kottler, MD
Westlake Village, CA
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This powerful statement points to a condition which has been called many things over the years:
"Depressive Personality Disorder"
Unfortunately, labels contribute almost nothing to understanding this complex, although not uncommon, condition.
Furthermore, not only does chronic depression plague the person who has it, it also leads to frustration and despair in significant others.
Common feelings in those emotionally involved with the chronically depressed person might be:
GUILT: "Am I the cause of my child's, spouse's, etc., misery?"
SELF-PITY: "Why did I choose someone who is so miserable?" (In the case of a spouse)
ANGER: "Why can't this person be like "everyone else?" or "This person has a good life, they have no reason to feel so unhappy."
For the person struggling with life-long unhappiness I suggest the following:
Get a comprehensive psychiatric assessment. See "Psychiatric Assessment."
The assessment should be with a psychiatrist skilled in both cognitive-behavioral and interpersonal psychotherapy as well as medication (psychopharmacology). I recommend against a separate therapist and psychiatrist.
Life-long depression is generally more challenging to treat than a depression which arises in the course of a generally "contented" life. However, this is not to imply that the condition is hopeless. Not at all. While no two situations are identical there are frequent themes which occur and which need to be assessed and explored:
1. Assess family history for indications of genetic loading.
2. Assess early interpersonal relationships.
3. Assess issues of trust and intimacy.
4. Assess for major disappointments at critical developmental stages.
5. Assess for styles of coping (defense mechanisms).
6. Assess for life-long poor self-image/self-esteem.
7. Assess for patterns of self-sabotage.
8. Assess secondary gain/effect on others.
9. Assess for substance abuse (may be long-term covert).
10. Assess possibility of undiagnosed physical condition.
11. Assess possibility of co-morbid psychiatric condition.
12. Assess for double depression (single episode depression superimposed on chronic depression).
13. Assess for Bipolar Spectrum Disorder
Has the person adopted a view of the world that expects the worst and protects against disappointment by constant pessimism?
Has the person forsaken (or not fully developed) the ability to trust significant others and thus, protectively, emotionally isolates? Is there major fear of LOSS?
Or is there some other dynamic at work?
Generally, life-long depressions require intensive psychotherapy as well as (possibly) medication. If the person is willing and motivated (at least a little) there is hope.
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