I have depression, and I may never get better. That might sound defeatist, but it’s actually the most freeing thought I’ve ever had. My life got better on the day I accepted my depression wouldn’t. “I may never get better” is basically my mantra. That’s because the moment I stopped working tirelessly to cure my depression was the moment I stopped feeling like an abject failure. I didn’t — and don’t — need to solve this illness to live a decent life. Instead, it’s my job to live with it.
I have persistent depressive disorder, also known as dysthymia or chronic depression. According to The Mayo Clinic, PDD is a “continuous, long-term (chronic) form of depression” and those affected by it “may be described as having a gloomy personality, constantly complaining or incapable of having fun.” (I’ve been called an IRL Daria.)
Unlike episodes of major depressive disorder, which are horrible but typically go away with time and treatment, PDD has more staying power. By definition, it’s an extended form of depression that lasts for at least two years, and sometimes it lasts forever. For people living with PDD, recovery is our own personal Neverending Story, minus the flying dog.
So what causes persistent depressive disorder? Your guess is as good as mine. You could be at greater risk if you have a family history of depression or you’ve experienced significant trauma, but the medical community can’t pinpoint a single cause. It’s ineffable, like the question of whether God exists or why I still love watching The Bachelor.
I wasn’t officially diagnosed as depressed until after almost drowning in my bathtub at the age of 30. My near-death experience wasn’t a bona fide suicide attempt — I was just so exhausted I was literally struggling to keep my head above water. I was the human embodiment of an overused cliché. One of the dangers of PDD is because my baseline mood was a feeling of anguish and misery, I had no idea anything was wrong. I assumed self-loathing and malaise were just a part of the human condition. For three whole decades, I was convinced happy people were liars.
My doctor believed I was experiencing major depressive disorder, and we were optimistic I would get better with the right treatment plan. I approached recovery the way I did my master’s degree: with an iron will and an even stronger work ethic. If I tried hard enough, I was convinced I could fix myself. I would become a bright and shiny, non-depressed Sarah — a person who never cried on the subway, had the energy to do yoga, and who didn’t hate herself.
In my fantasies, my illness followed the same trajectory as Meredith Grey. In the early seasons of Grey’s Anatomy, Meredith is often referred to as “dark and twisty.” In one memorable episode, she accidentally falls into the ocean and decides not to swim to safety, and yet her illness is ultimately overcome with a few weeks of therapy, just in time for her to end up with McDreamy by the season four finale.
Unfortunately, my depression didn’t get resolved before May sweeps. Anti-depressants didn’t ease all my symptoms, even when my doctor doubled — and later tripled — my dose. Weekly therapy sessions helped me cope, but there were days when I felt hopeless and alone. I liquidated my frequent flyer miles and went on vacation, but travel wasn’t my miracle cure, either.
Throughout this battle, a voice in my head kept insisting, “Work harder, Sarah! Just find the right solution! Be the Serena Williams of your own depression, and bloody well beat it!” Eventually, my doctor realised she was out of her depth and referred me to a psychiatrist named Anna.
Anna looked really healthy, like the kind of person who bicycled and ate very well. It was Anna who finally diagnosed me with chronic depression, breaking the news to me gently, likely worried it would upset me. The thing is, it didn’t.
The relief I felt at my new diagnosis was like taking off your Spanx after a wedding with an open bar and midnight buffet. Suddenly, I could breathe. The realisation I couldn’t solve depression like it was a math problem freed me from the belief it was my job to do so. There was no formula of therapy + antidepressants + the right exercise regimen that would fix me. I could relax. The only thing left to do was to manage my illness the best I could.
A year after my diagnosis with PDD, I accept “bad depression days” are part of my life, the same way I watch The Bachelor on Monday nights or take the subway to work. Thanks to medication and therapy, my once severe depression symptoms are now moderate. But there are times when I feel despondent. I cry in public, a lot, and frequently for no real reason. The last time I did so, I was on vacation in California with my fiancé. As we walked through the lobby of our hotel, I abruptly burst into sobs. Before my PDD diagnosis, this sort of breakdown would have humiliated me. But I’ve resolved not to add my own insults to injury anymore. That day, I made no attempt to hide my tears. I cried with my head held high.
Please don’t misunderstand me. I don’t want to glamorise depression. It’s a disease that affects my quality of life, and, according to some studies, may even reduce my overall life expectancy. If anyone invents a miracle cure, please let me know. I’ll definitely take it. At the same time, it’s fine if my sickness never gets fixed. I’m okay with not being okay.
If you are struggling with mental health issues, please get help. Call Mind on 0300 123 3393 or text 86463.