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How bad can moderate depression be?


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I had an assessment with a new pdoc a couple of weeks ago. I get copies of letters sent to my GP, and today I got one with a summary of the assessment. Most of it was not exactly news, given that it was stuff I said.

 

The pdoc's impression was that I was suffering from a moderate depressive episode. 

 

I'm finding it almost impossible to get university work done at the moment. I feel pretty bad physically - exhausted and aching. I don't want to eat. I'm so tired.

 

I guess I had thought I was just battling against bad depression. This doesn't feel moderate, this feels almost impossible. But maybe it's not that bad? I'm just lazy or not clever enough or I'm doing things the wrong way? How much of an impact does moderate depression have on ones ability to keep going from day to day?

 

If I have moderate depression I shouldn't be so crap. I should be able to do some work and muddle along somehow. it shouldn't be an achievement to eat three meals in a day or get a piece of work in on time.

I'm sorry. This is a bit muddled and confused.

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"moderate (for lack of a better word)" doesn't look overly professional

 

it can be pretty sucky, try not to stress over semantics

 

docs are good [for the most part] at treating things, but they often suck at giving them titles and categories.

 

titles, schmitles "i feel shit" will do 9 times out of ten IMO

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I have no idea how they delineate "levels" of depression, but I'm sure it wasn't the doctor's intent to downplay what's happening to you. Just a thought, maybe they reserve "severe" as a descriptor for depression when the sufferer is overtly suicidal? I have no idea if that's accurate, just grasping at straws as to how that may work. Don't let "moderate" get you down or think that it somehow reflects a flaw in your character- depression is hell and will suck the energy and life out of you regardless of its degree of intensity. I'm sorry you're struggling so hard, though. Does your doctor have any treatment options in mind for getting you out of this episode?

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Gah, I'm probably being really irrational. I'm not thinking very clearly today. Sorry, it's a stupid topic.

I'm not sure how they delineate severe. I don't want to kill myself because I don't want to hurt anyone.

I got an antidepressant increase almost two weeks ago so that's the treatment plan for now. I've been in this episode for almost two years now so I'm pretty doubtful that it'll help.

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I'm not sure how they delineate severe. I don't want to kill myself because I don't want to hurt anyone.

 

 

i hope people don't take this the wrong way, but there is decent logic behind certain groups hating psychiatry. there's a lot of wishy washy guess work, "close enough is good enough" on titles and paperwork. they are munters, but i do partly see the rationale

 

hope the meds work out, for a funk that long i'd set a two month date to assess the degree it has/hasn't helped, they can take a while

 

what hemisphere are you in? exercise and the usual stuff we all get lectured about does help, but if your doorstep is under 2 feet of ice i get that it's sometimes not an option. brain exercise too [but not too much reading about the specifics of what your pdoc meant by "moderate" or other stressful stuff if you can help it, that doesn't count]

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Gah, I'm probably being really irrational. I'm not thinking very clearly today. Sorry, it's a stupid topic.

I'm not sure how they delineate severe. I don't want to kill myself because I don't want to hurt anyone.

I got an antidepressant increase almost two weeks ago so that's the treatment plan for now. I've been in this episode for almost two years now so I'm pretty doubtful that it'll help.

I don't think you're being irrational. "Moderate/severe" seems arbitrary anyway.

Episodes that drag on forever are the worst. I'm BPI and had a nearly 2-year long depressive episode as well, that I just came out of last winter. I know it's really hard to keep any fragment of hope after suffering for so long, but it is possible for the ep to end. I really, really hope it does.

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My pdoc recently said I was going through "subclinical" depressive symptoms. Well... I have been to class a handful of times in a month, I haven't studied in a month, my grades went from A's to C's, and I can barely drag myself out of bed in the morning. I feel like I've been hit by a truck.

 

That does not seem subclinical to me.  :brooding:

 

I present really well though, so it's possible that she thought I was doing better than I really am because of that. Maybe you present well too? 

 

Either way, try not to worry about the label. There is no way to determine someone else's level of suffering, unless you walk in their shoes. You have been going through a terribly hard time, for a long time. Whether it's "moderate" or "severe" is pretty arbitrary. At this point, having been in this episode for two years, the focus should be on how to get you out of this damn episode! Also, you are not being irrational. It really hurts to have it implied that your illness isn't as bad as it really feels. 

 

Did the new pdoc suggest anything? Any new meds? I really worry about you, Squish. 

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Moderate doesn't mean mild. It's a very significant depression that likely means you're struggling to function and are impaired. A severe depression means you're basically unable to function period. So the fact that you're able to function to an extent, even while struggling, would point to a moderate depression.

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I've been struggling with the "WTF does moderate mean :glare: " thing too.  I felt increasingly "off" for almost a month, enough to clearly negatively impact my work.  Only about a week ago did I finally acknowledge, and have a doc acknowledge that it was "enough" (whatever that means) to warrant going back on Wellbutrin after almost a year off of ADs.

 

I had the same confusing thoughts you describe, like the worry that its just laziness (way low energy) or I'm just an unlikable bitch (irritability) or I'm an uninteresting idiot (apathy and brain fog).  I feel like I should know better the signs by now, but its hard.  

Edited by CirclesOfConfusion
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I suffer mostly from moderate depression and only 3 times fell in to major depression, was hospitalized once for it. Major depression is so bad you can not go to work or class, and you do not care about any thing. You could feel numb or complete apathy or suicidal. Nothing matters any more. It's the black hole that's strong enough to suck light in to it. Not trying to down play moderate, no depression is a picnic. My moderate tho I am able to go to work even though I am not really in to it. It can still be very painful and difficult. But at least I can eat and function some what.

Edited by IndieVisible
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Actually, indie, you're confusing major and severe depression. The severity specifiers "mild", "moderate" and "severe" all refer to major depression. So all three would fulfill the criteria for major depression. Which is confusing, I know. And I wouldn't really call a mild major depression a mild illness, it's just not as bad as a severe or moderate major depression.

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Actually, indie, you're confusing major and severe depression. The severity specifiers "mild", "moderate" and "severe" all refer to major depression. So all three would fulfill the criteria for major depression. Which is confusing, I know. And I wouldn't really call a mild major depression a mild illness, it's just not as bad as a severe or moderate major depression.

yes it can be confusing when pdocs add to the confusion instead of educating patients. I was originally diag major depression and the next year was changed to bipolar. More recent pdocs said I mostly suffer with "moderate" depression and moderate or hypomania. So yea, I just went by what I was told. But what you eay does make sense. It's all major because it comes and goes with various degrees of hurt.

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Thanks for the replies everyone.

Hume's doona, there isn't any snow where I live, although it's cold. I'm finding it difficult to exercise because I'm feeling physically fatigued but I could push myself to do more.

 

Thanks hagar. I'm leaning on CB a bit for support at the moment and I feel kind of bad about it because it's not even particularly bad depression and I should really be able to cope better by myself.

 

Thanks Para as well. Your "subclinical" symptoms don't sound sub-anything to me. I think I probably do present quite well. I don't how to not present well, if that makes any sense. I'm so used to putting on a brave face and pretending I'm fine that to do anything else feels false and almost like I'm faking. The pdoc increased the dose of the med I've been on for quite a while and said we can talk about augmenting if it doesn't work. 

I know the label isn't really important, what's important is treating the symptoms. It feels kind of important though. If I keep on not being able to do stuff and I can say, well that's because I've got X, so while I'm struggling with this thing I know I am doing my best at at the moment and I don't need to feel disappointed in myself.

 

kate, that is completely logical. I have been not functioning really at all in the past and I am better than that now. I don't think I was actually feeling any worse though. I wasn't really even trying to do things at that point whereas now I'm trying all the time, so that makes it harder.

 

Circles, I'm not great with the old self knowledge thing either. I hope Wellbutrin works well!

 

I get confused as well, Indie. I haven't been missing lectures so I guess that shows it could be worse.

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Thanks hagar. I'm leaning on CB a bit for support at the moment and I feel kind of bad about it because it's not even particularly bad depression and I should really be able to cope better by myself.

It's never easy to go it alone. Don't feel bad for wanting support or asking for it. When I've been in episodes and posted on here, even just a simple acknowledgement or a kind word made me feel better and less alone. 

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Thanks Para as well. Your "subclinical" symptoms don't sound sub-anything to me. I think I probably do present quite well. I don't how to not present well, if that makes any sense. I'm so used to putting on a brave face and pretending I'm fine that to do anything else feels false and almost like I'm faking. The pdoc increased the dose of the med I've been on for quite a while and said we can talk about augmenting if it doesn't work. 

I know the label isn't really important, what's important is treating the symptoms. It feels kind of important though. If I keep on not being able to do stuff and I can say, well that's because I've got X, so while I'm struggling with this thing I know I am doing my best at at the moment and I don't need to feel disappointed in myself.

 

I feel you on the label thing. It is important to me too to be able to say I'm struggling because I have X, not because I'm a complete loser and failure at life. So I can appreciate that. 

 

I also don't know how to present "not well" either. Aside from when I was extremely depressed and at my worst, I always come to appointments appropriately dressed and ready to talk about anything and, dare I say, enthusiastically talk about my illness and medication. I'm a nursing student, so this kinda stuff is what I'm interested in. So, that contributes to me looking better than I really am. As well, I know what you mean about feeling like you're faking it. I actually just outright told my pdoc that I felt like I was faking it and, it was so nice to hear her say "I highly doubt you are faking it." It was such a load off. 

 

Anyway, we are here for you, Squish. I sincerely hope this med increase works. If not, I hope your docs will treat your depression aggressively.

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Thanks hagar. I'm leaning on CB a bit for support at the moment and I feel kind of bad about it because it's not even particularly bad depression and I should really be able to cope better by myself.

It's never easy to go it alone. Don't feel bad for wanting support or asking for it. When I've been in episodes and posted on here, even just a simple acknowledgement or a kind word made me feel better and less alone. 

 

 

Hagar's got the right of it.  CB is meant to be here for people to lean on, goodness knows I've done a lot of that myself, CB has helped me out so much.  That's a huge part of it being peer support, you get support! :)

 

I think the thing about the terminology when it comes to depression, in this case, is that the terms mild/moderate/severe are not meant to indicate that the depression is a minor illness, but rather that the terms refer to the type of episode and only make sense relative to each other.  Or, as you noticed, you've been worse with depression in the past, and this could be worse.  But just because it's not as bad... well that doesn't mean you should be capable of coping with everything on your own and just bootstrapping it through.  When I'm anhedonic, I'm not even sad, you could call it a mild/moderate depression for me, I have a really hard time even telling that I am depressed because I don't feel sad.  But I get the blunted/bored effect and my actions become a lot more like they are when depressed -- things still get difficult except I can't seem to place why that is (if I even notice.)  It's not something I can just tough out, and in fact it can lead to more severe depression if not addressed.

 

As well, depression clouds thinking, wants us to blame ourselves.  Even if we have insight into this it'll still do it, usually.  I suspect that a lot of the "feel like I should be able to do this on my own" is the depression talking.  I know that doesn't make things any better, but it's something I try to keep in mind when I'm having an episode.

 

I hear all of you on the presenting well thing.  Like, I can be in an episode and those who know me can tell right away, like my regular pdoc.  And I don't necessarily go in all dressed up nice in clean clothes.  But I am highly interested in mental health, and I'm my own test subject right?  So I spend a lot of time analyzing my behaviours, which tends to result in me speaking very openly and directly about my symptoms and medications and the like.  I've definitely had docs who don't know me think this indicates something other than what it actually is -- to the point that some of them have tried to send me home despite me trying to check myself IP after being instructed to do so by my pdoc.

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I have always wondered this myself, so I did a little digging.

 

It seems that the different diagnosis' of mild, moderate, and severe depression is type of treatment it requires.

 

For instance:

Mild depression generally indicates that the depression may subside on it's own without medications, while the treatment of moderate depression is seen as needing medication & possible behavioral therapy, while severe depression is most likely best treated with more intensified treatment like ECT CBT EDIT! NOT CBT BUT ECT!! A very simple acronym change with a very large definition difference and may require hospitalization.

 

A easy-to-read resource:

http://www.healthcentral.com/depression/c/4182/128686/mild-difference/

 

Also understand that diagnosing MI is not exactly a science, it's an art (as most medicine is). Doctors have to make their best guess in diagnosing the type & severity of MI with the symptoms presented visually, the symptoms presented orally, and the symptoms presented medically (how individuals react to medications, which we all know is different for each person) by the patient themselves. And as previously said, you may have presented better than you are (which many people do, myself included).

 

Depresion comes in so many types, severities, and flavors. The most important resource to know is that your doctor sees that you do need medication and proper treatment. I would try to focus on that :)

Edited by the girl
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Thanks Para. It's reassuring to know I'm not the only one who sometimes thinks like this. The docs I have now seem to be more aggressive about treating my depression, which is a huge relief.

I'm so glad CB is here for me! I'm not able to see a tdoc regularly at the moment, so CB is really helping with morale support and countering depression thoughts.

Mirazh, that makes a lot of sense. I intellectually know that depression makes me blame myself. But clearly I'm not doing well with translating that into making allowances for myself.

I've never needed to go IP but I'm terrified that if I did, no one would believe me. I tend to carry on putting on clean clothes and brushing my hair even at my worst and I carry on trying to engage in conversation with doctors.

Thanks for that, thegirl. I suppose that the difference between moderate and severe depression might be more visible as an objective difference in functioning to an outside observer, while one's subjective experience of struggling and suffering might not be that different. When I'm more depressed I don't really care that much at all, whereas what is do painful now is trying really hard to get things done as if I was well.

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