Seven Challenges of Late-Stage Depression

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Fatigue, feeling hopeless, lack of motivation, and changes in sleep and diet – these are some of the problems that can be observed from the earliest days of many depressive episodes.

However, after a person suffers from depression long enough, they’re likely to see the flavor of their struggles changing. Sure, unreasonably persistent bouts of hopelessness, sadness, and other symptomatic feelings and behaviors may always affect a person as long as they’re actively depressed, but after years of riding a wave of psychiatric illness, new challenges begin to arise as well. These challenges are often unique to people who have fought their melancholia for many years, and have begun to adapt to its many demands. People in this situation start to face secondary challenges.

These are not problems that you’ll find in psychology textbooks, nor is an inexperienced talk therapist likely to know how to treat them. They are subtle and mature issues that have solidified in the lives of their victims over the course of many years. Many of them are not caused by depression itself, but rather, by the person’s response to their experience of depression. I’ve described seven of these secondary problems below based on how they’ve affected me in the ten years that I’ve suffered from depression.

1. Over-analyzing everything.

Over time, people with depression tend to learn to look for signs of its symptoms. When done in moderation, staying vigilant about spotting warning signals can be very helpful: catching a depressive episode early creates an opportunity to head it off before it escalates. However, being hyper-conscious about finding symptoms everywhere can be unhealthy. Interpreting every last unpleasant experience as part of a psychiatric illness can be inaccurate and anxiety-inducing. Sometimes a bad mood is just a bad mood. However, after many years of depression, it can be difficult not to label every tired, angry, or sad experience as diseased.

2. Writing off pain as “the usual” because it’s been around for so long.

If discomfort sticks around long enough, people have a knack for adjusting to it, sometimes to the extent that pain becomes the body’s new “normal”. When this happens, a person’s beliefs about what life is supposed to feel like may change to adapt to the constant pain. For example, realizing “I’m in a bad mood” may stop garnering the response, “That’s unusual and I should do something to fix it,” and may start garnering the response, “That’s typical for me and I’m just going to let myself continue to feel pain.” A very unhealthy complacency may develop this way. Expecting to feel unwell can destroy a person’s motivation to do anything about it.

3. Distinguishing involuntary symptoms from voluntary choices.

After being depressed for an extended period of time, it becomes really hard to know the difference between what you can’t do because of your disease versus what you can do but choose not to. I’ve been in this conundrum many times. I find myself lying in bed, wondering if my lack of motivation to get up and perform my daily responsibilities is due to uncontrollable medical reasons, or if it’s because I just don’t feel like getting up. This distinction is important: When depression is stopping you from doing any sort of work, whether it’s grocery shopping or household chores or a paid job, it’s okay to give yourself a temporary break from getting things done. But if you’re making a voluntary decision not to handle your responsibilities, taking an extended break from getting things done isn’t as warranted. Discerning true depression from a normal lack of willingness to work can become infuriatingly tricky after a long time spent oscillating among varying degrees of melancholia.

4. Therapy exhaustion.

The goal of talk therapy, very simply put, is to teach clients how to modify their thoughts and behaviors in order to improve their quality of life. However, trying too hard to feel better can be exhausting, especially if you’re trying all the time. In the end, that may actually make you feel worse. That’s why it’s incredibly important to learn to recognize when it’s more draining than helpful to drive to your therapist’s office, try to remember the advice they give you, and make changes to your lifestyle. Doing all of those things is critically important when you’re depressed, but doing them too vigorously and for too long can cause more stress than improvement – especially when your depression is fed by a biological illness that talk therapy can’t totally fix without the aid of medicine.

5. Being depressed about being depressed.

Depression doesn’t afflict anyone with the same intensity all the time. Even a severely melancholic person will likely have occasional moments of relief. However, those cheerful (or at least, less depressed) moments may be tainted by the knowledge that they’re probably not permanent. When you expect that crushing sadness to return, you may usher it in faster, because you’re depressing yourself just thinking about being depressed. This pattern, like all the other patterns described in this essay, tends to get worse when you’ve been depressed for years. A person with brand-new symptoms has known psychiatric stability their whole lives, so that’s what they continue to expect. However, those of us who can measure our despondency in “years” or even “decades” are more likely to bring ourselves down unnecessarily because melancholia has been our resting state for so long that it’s what we expect to feel.

6. Anticipating seasonal depression.

Maybe it’s the first rainy day of spring that triggers your depression, or it might be the first snowfall of late autumn. After you spend enough time getting tossed back and forth between emotional stability when the sun is shining and irrational melancholia when clouds appear, you’re likely to notice that your moods are tied up in the weather. That’s when you may begin to dread the seasons that you know bring out your psychiatric symptoms. That dread in and of itself can start to bring you down, even in the heart of summer when previously you would have been okay. Suddenly you’re dealing with a layer of weather-related anxiety on top of your medical mood problems.

7. Harboring depression-tinged beliefs even after recovering.

Your daily patterns, automatic thoughts, and even spiritual beliefs change to accommodate the pessimism and existential discomfort that come along with being clinically depressed for an extended period. It isn’t easy to shake off the habits that develop in response to being mentally ill for a long time, no matter how well you recover from that illness. If depression teaches you that you’re worthless (even though you’re not!), it’s hard to learn to love yourself again, even if your depressive symptoms recede. Your brain told you for years that your life doesn’t mean anything, then bombarded you with a biological sadness just to drive that point home. Though your mood may clear with the aid of therapy, medicine, and time, your inaccurate belief about the pointlessness of existence may still figuratively cling to your brain cells.

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My goal in describing these problems isn’t to explain how to fix them; if I knew their solutions, I promise I would tell you. The point of this article is to bring your awareness to issues that aren’t often talked about in the hopes that recognizing them will help you discover their solutions. We need to discuss these subtle, late-stage problems with our doctors and therapists so that they may learn how to treat them, as well as with our families and friends so that they may learn how to walk us through them. Until then, our best course of action is to talk to medical professionals, take the pills they prescribe us, and try to send our symptoms back to hell without going with them.

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**Photo credit to Tori Amos