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300.4

depression

Alone, in the front seat of a roller coaster, the mechanism steadily ratcheting the cars to the pinnacle — the fog thins and I’m briefly in hazy sun as the clicking slows. Briefly horizontal, the car teeters over the top and gravity assumes control, pulling me downward with increasing speed as I hurtle back into the mist. The track disappears and gives no hint of a bottom.

That was a metaphor for my periodic descent into depression. I have no idea how long the downward plunge will last nor when the sun might shine on me again.

I cannot recall a time without depression as my fellow traveler. In fact, so much familiarity breeds a comfort level where my malady and I are on intimate terms. There are days I’m actually grateful for the company.

My diagnosis in the old DSM-IV was 300.4 or Dysthymic Disorder. In the revised DSM it’s been combined with another condition and rechristened Persistent Depressive Disorder, not nearly so satisfying as labels go. We dysthymics wear the diagnosis proudly, though, so I’m unlikely to give it up. I sometimes compare notes with another dysthymic of my acquaintance.

Dysthymia

Simply put, this is a general low-level depression that has persisted for at least two years though most of us can trace it back to childhood; mine has been with me since I was about eight. It’s treated with medication (anti-depressants) and talk therapy — in my cases, seven years with Dr Bob, during which I learned more about the condition and myself than I had in the previous sixty years, plus or minus. The list of medications is long but familiar: Prozac™ (which will also take care of those loose bowels), Zoloft™ (“There’s someone else in here with me!”), Imipramine™ (“When was my brain removed and replaced with a wet and swollen roll of toilet paper?”), and now Wellbutrin™, which seems, for me, to be the best of the lot.

Another issue for dysthymics is called Double Depression, because a bout of run-of-the-mill depression can pile on top of the low-grade type and yank whatever rug might have been beneath your feet, simulating traction. That’s where I am today, though the DSM doesn’t distinguish it beyond my normal 300.4. All I can describe from experience is what I call shadows in the dark, a paralyzing inability to direct my attention anywhere but inward, downward; a dread of isolation and yet a simultaneous desire to be away from public contact for fear of a) rejection and b) contagion. So if I avoid you, please take no offense: at the moment I cannot see the end of this, yet I also understand that it will eventually pass — until (I sometimes wonder) the day that it doesn’t.

As a postscript, let me add that posting blog entries about the Akron-Auditorium Plan or the Agincourt Project seems to accompany these dysthymic incidents, which may be my own peculiar way of coping. Thanks for your patience.

[#811]


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