I actually knew I was depressed. It isn’t a surprise or anything. However I have been looking through my files for ‘evidence’ to give my insurance company for my migraines and came across my psychologists letters to my doctor.
Initially when she diagnosed me she diagnosed me with mood disorder associated with a medical condition; as in depression associated with my chronic pain. And primary insomnia. I remember this because, yeah, it made sense to me. In pain, also depressed. However, she got to know me and changed that to Major Depressive Disorder. I don’t remember that, but, that being said I was depressed at the time and my memory of such things is hazy at best. I had been returning to work after my first suicide attempt and was seeing her because I was worried work would pretty much cause a second attempt. And I was right, but it would take some time.
Different people are affected in different ways by major depression. Some people have trouble sleeping, they lose weight, and they generally feel agitated and irritable. Others may sleep and eat too much and continuously feel worthless and guilty. Still others can function reasonably well at work and put on a “happy face” in front of others, while deep down they feel quite depressed and disinterested in life. There is no one way that people look and behave when they have major depression. However, most people will either have depressed mood or a general loss of interest in activities they once enjoyed, or a combination of both. In addition they will have other physical and mental symptoms that may include fatigue, difficulty with concentration and memory, feelings of hopelessness and helplessness, headaches, body aches, and thoughts of suicide.All about depression.com
I guess I can see why she changed it. My depression did become its own beast. Initially years ago I do believe it became a problem simply because of the pain. The pain was getting the best of me and I was pushing through the pain to work… and it was really becoming a massive problem so I was depressed about it. But tack on a few years of That and it ingrains itself pretty good. Get some strong habitual depressive thoughts. Some steady suicidal ideation and a couple of attempts in there. A lot of self-worth issues and guilt. But I masked my depression very well, up to the suicide attempt obviously and other than no succeeding I regret that I can no longer mask it. I prefer to pretend it is all well and just deal with it myself. But clearly that is risky when you are suicidal.
After the second attempt my current psychologist sent me to a psychiatrist for medication. Clearly he agreed it is Major Depressive Disorder and at the time needed to be medicated as well. And it really, really did. I would get in a lot of pain and all I would think about is wanting to die. How much better off everyone would be. How much better off I would be not suffering. How I wouldn’t be a burden anymore. And I was useless anyway, no one would miss that. Take me away and there is no one thinking she was necessary for this or that. I was fundamentally useless with pain. Those thoughts and more on repeat. The med, Abilify, stops that. I do get suicidal, from pain alone. But I do not get the plummeting mood that drives me to want to die, just die that very moment. It evens it out. So I am depressed but it is milder and easier to tolerate. The pain isn’t so I still get the issues with that.
Here is the criteria I found on All about depression.com
Diagnosis of Major Depressive Disorder, Single Episode
From Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition
A. The person experiences a single major depressive episode:
- For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.
- Depressed mood. For children and adolescents, this may be irritable mood.
- A significantly reduced level of interest or pleasure in most or all activities.
- A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.
- Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).
- Behavior that is agitated or slowed down. Others should be able to observe this.
- Feeling fatigued, or diminished energy.
- Thoughts of worthlessness or extreme guilt (not about being ill).
- Ability to think, concentrate, or make decisions is reduced.
- Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.
- The persons’ symptoms do not indicate a mixed episode.
- The person’s symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.
- The person’s symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.
- The person’s symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).
B. Another disorder does not better explain the major depressive episode.
C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).
It is a pretty serious co-morbid for migraines and chronic pain. We have to have it treated well and see a psychologist to manage it.