Clinical, major, atypical, unipolar, bipolar, dysthymia, seasonal affective disorder (SAD), postpartum, premenstrual dysphoric disorder(PMDD), General Anxiety Disorder (GAD), cyclothymia, rapid-cycling, ultradian cycling...

For anyone who has researched depression, this partial list of terms is a grim reminder of the mounting complexities of one simple word. Since I was first diagnosed with depression, the list of types, terms, and cousin mental illness' has exploded. I may feel old at times but I am not. This fast growing list of terms, definitions, and symptoms is proof that this area of health is far from being fully understood. Most of us hunting for answers find ourselves more depressed than we began and frustrated if not angry with our medical providers.

I wrote a hub (The Upside Of Being Down: Creativity of Depression) and was fixing a sister article for posting when I realized that maybe I should clear a few things up first. Mainly, what my knowledge of depression is and where it comes from.

I am not a medical expert. I am, though, a survival expert. I have faced years in the trenches and plan to survive many more. I have worked my way through the labyrinth of terms. I have read and researched. I have medicated and been counseled. I have managed diet, exercise, and sunlight. I write from experience. I would never come up with the terms cyclothymia, Premenstrual Dysphoric Disorder, or Borderline Personality Disorder. (Although, Bipolar Not Otherwise Specified [NOS] is conceivably something I could pull from the depths of my imagination.) And while my experiences are unique to me, there are a few personal realizations that are not so unique.

First off- Never self diagnose someone. Not someone you have known all your life and definately not someone you have only known for a short time. Go one step further. Do not automatically assume you are suffering from an illness compared to facing a very real aspect of life. Which brings us to point number two.

Second- At some point in life, we all suffer from depression. The term and basic emotion began as feeling sad, melancholy, down in the dumps, unhappy, and miserable. Depression is a natural response to stress, disappointment, and loss. Unfortunately, as people, we try to put emotion into neat little predictable boxes. Emotions are messy. They need to be worked through. Even if it is determined that you are suffering from more than basic life, you still have to face emotion. Simply because you are diagnosed with Bipolar depression, does not mean you do not mourn if someone close to you dies. You will still face anger if you are fired for no real reason. Emotion happens.

Third- Depression can be taught. Doom and gloom attitudes can be woven into a child's belief system. If someone is raised in an environment that has no positives, it carries consequences. This is why you need to communicate with a counselor. Do not be eager to take medications. Take a look at your internal views of the world and your personal thought process. It is very possible that you may need a little boost at first but a new out look on life can cure many an emotional problem. Depression has increased dramatically over the years and research has shown that it is not all illness. The atmosphere many are raised in is a root cause.

Fourth- Be patient with your health care providers. The term Bipolar NOS (Not Otherwise Specified) is not one I made up. It speaks volumes about how difficult it can be to diagnose. Grey areas abound and even the experts do not agree on what determines what. Do you know the difference between major depression and manic depression? It is the manic episodes. Periods of depression followed by periods of mania- restlessness, hyperactivity, racing thoughts. Manic episodes are generally shorter and many people do not even realize they are having one. It can actually be refreshing after a long bout of depression. So we fail to tell about these episodes. This results in being treated for only depression. Anti-depressants have been known to aggravate and intensify manic episodes. Here comes number five.

Fifth- Communicate. Communicate. Communicate. Keep a journal of mood and physical changes (weight, appitite, energy levels, sleep patterns, uncontrollable crying). Never automatically assume the first diagnosis is correct or wrong. Also do not assume your doctor is an idiot. Remember point four. Keep in mind the fact that 'time changes all things'. Symptoms and subtypes of depression are known to change, and evolve. Sometimes for the better and sometimes just to make sure you have not forgotten them. Keep communicating so that you can adapt with your body.

Sixth- Do not expect an easy cure. Copying with depression is a construction problem. To build a bridge from not healthy to healthy requires a number of support beams: diet, sunlight, exercise, social interaction... There are many aspects to consider. Even after it is built, yearly maintenance is required and you need to drive on it occassionally to ensure it is still strong.

Seventh- Are all these different terms, descriptions, and break downs of clinical depression truly necessary? Yes and no.

The medical profession needs them. Doctors, psychologists, and counselors are faced with a very difficult job of diagnosing. As I said earlier, there are many factors to consider. The difference between major depression and manic depression is simple but it can become catastrophic if mistreated and unobserved. Using high doses of medication for cyclothymia (often argued to be more of a temperament or personality trait rather than depression) would be reckless. Medical providers need paths to follow to ensure safety.

So, why no? For us non-medically educated sufferers, this detailed knowledge is not needed. If you are concerned that your depression may be more then a normal reaction to life, DO NOT research until your brain is bursting. All this information, at first, can take a depressive episode to a new low of helplessness. It is overwhelming. It does leave one wondering how anyone can possibly find the truth. Begin working with your medical provider and find a base of sanity in all the emotion before satisfying your need to research in depth.

The second danger takes me back to my first point. Self-diagnosing. Once we determine something to be true, we have a tendency to try and make our world fit that truth. We leave out vital information when talking to the doctor because it does not fit our image of the illness. We create memories without even realizing it and in the matter of mental illness, the disease will willing help you believe the lies. If you are seeking help, you are most likely on an emotional roller coaster of sorts. You may well be desperate for answers- right or wrong. So you research and determine you are suffering from Bipolar II- a form of manic depression where the manic episodes are rather weak and difficult to notice. You go to the doctor and present him with everything you can to prove this diagnosis. You are determined to have him believe you. You need him to. You need to be 'curred'. You go so far as to remember having severe lows in the middle of the summer. Its always been that way- regardless of the season. In truth it is the middle of a really dark and dreary winter. You are suffering from Seasonal Affective Disorder (SAD)- the winter blues. There is a difference in treatment. One requires medication and life altering decisions, while the other may be solved with a sun lamp and some small life changes. Yes, SAD can develop into a sever concern and require more action but the miracle of 15 minutes in front of a sun lamp is amazing. Better than any medication out there. Anyway the point is: Do Not Poison Your Mind with pre-made assumptions.

Keep your mind open. You do not want to hide truths from the person helping you. Especially in the begining. Take knowledge one step at a time.

Eight- Okay, so don't read reams of scientific information on the subject when in search of relief. But there are some overviews of subjects that it will not hurt to know and be prepared to talk about.

      A) Type of Emotion that is overwhelmingly present:
           Anxiety is different from sadness.
           High strung emotions are different from blunted ones.
           Is anger the ruling emotion or is worthlessness?
    

      B)Physical Disruptions:
           How you are sleeping and appetite are commonly discussed signs.
           What about chronic headaches, tense muscles, fatigue, restlessness, concentration, being easily startled...
    

     C) Psychosis:
           The big concerns are hallucinations, delusions, paranoia, and excessive repeated thoughts and actions.
           But there is also impulsivness, distorted self image, inappropriate guilt, and indifference to being or desire to hurt oneself.
   

     D)Social Aspects and Environmental Issues:
          Have you withdrawn from social activity, bounce from one unstable relationship to another, are unable to hold a job?
         Has there been a death of someone close to you?
         Any diseases, or significant life changes like moving, promotion, or divorce?
        What kind of stress do you deal with at work and at home?
         Do you drink?
   

      E) Frequency and length of the matters discussed in A thru C as they relate to D. That's a mouthful but very important. Just because you bounce from one job to the next, or are having problems sleeping, or have cried a lot recently does not mean you are suffering from Clinical Depression. It is a combination of symptoms. Last I read, they look for five or more symptoms that last more than two weeks.

     F)Last is a matter of degrees: Too much, too little, or appropriate
            Do you become aggravated when your kid spills the milk and doesn't clean it up or do you become violently angry?
            Do you cry a tear or two unexpectedly or find yourself sobbing uncontrollably for no reason?
           Do you often feel like you are in the way or feel you are completely worthless?
           Are you often tired or exhausted? (For me , it can feel like someone is draining the blood from my body.)

When I began writing about depression, I intended to show why it is so difficult to face depression on a personal level. I wanted to share the quirks of the illness and how it feeds itself and keeps a person ensnared. My first hub was The Upside Of Being Down: Creativity Of Depression. It describes how depression has affected my dreams and the vivid stories or images it has given me. Those were the kind of articles I intended to write. As I said at the beginning of this article, though, I felt I should clarify where I stand in terms of depression. When reading anything I write remember these things: I am not a medical professional, I am writing as someone who has faced melancholy for at least 20 years. My experience started young, was not a normal reaction to life, has been fed by what life has thrown at me and has led me down many different paths. I have been as far into this pit as one can go without actually dieing and have found solid ground with which to live on. I do not believe in easy answers, do not mind the challenge, and never stop looking at how depression has shaped my past and continues to shape my future.
Now that I have written far more than I intended to, I say farewell.