3 Neglected Symptoms of Chronic Depression (and potential solutions)
If you’re reading this, you may have depression (or know someone who does). Chronic low-grade depression, also known as dysthymia or persistent depressive disorder, is an underlying contributor to so many unhappy moments, missed appointments, and relationship difficulties. It’s one of the most difficult mental illness to get a diagnosis for because many people who have it don’t reach out for help until after 2 years of feeling ill. It can develop into major depressive disorder (MDD), which has higher potential for serious health consequences such as suicide, or it may remain unacknowledged for the sufferer’s entire life. About 5% of people in the United States have dysthymia, but less than half are diagnosed. Women are three times as likely as men to have it, and the average age at diagnosis is 31. Anyone (even children and the elderly) can have this disorder, so don’t rule someone out if they don’t match this description.
Dysthymia makes people appear to be ok, just maybe a little grouchy or slow moving, which is why it’s so difficult to identify. And even if we accept a diagnosis, it’s so easy to forget that some of these annoying symptoms are the hallmark of the disease. If you suspect that you or someone you know has dysthymia and you want nutritional support, read on.
1) Low self-esteem
Anyone can have low self-esteem occasionally, which is why it’s hard to tell if it’s part of a bigger problem. With depression and anxiety, low self-esteem often stems from a cyclical negative conversation in the brain of the sufferer that reinforces the concept that they are less than they should be. Whether the topic is productivity, relationships, personal goals, body image, or eating right, these people honestly believe they are not good enough and probably never will be. And often, nothing rational that you say or do can convince them otherwise.
If someone you love approaches you with feelings of low self-esteem, the best thing you can do is offer them unconditional love and support. That doesn’t mean lying to them, or painting the situation with pastel colors and Pollyanna optimism. It means offering to be present with them while they suffer, holding space for them to work through it, and assuring them that no matter what, they have you.
2) Difficulty with productivity
Procrastination expert? That’s a huge red flag for low-grade depression. Procrastination (and subsequent fulfillment of the task in question) often means that the person can’t bring themselves to expend the energy required to do the task, but not so much that they totally miss it. People with chronic depression are experts at finding a way to live in society despite feeling crummy all the time, and this is visible in cycles of productivity followed by procrastination.
Researching a paper for weeks but not writing it until the day before it’s due
Waiting for errands to pile up so they can be done all at once
Putting off an important phone call or paperwork submission until the deadline
Talking about a plan for months (or years) before actually doing it
Meeting with a nutritionist once or twice, and then ghosting them
It’s important to note that, while procrastination is annoying to you, it’s even more annoying to the person doing it. They often can’t understand why they are acting this way, and consider it a moral failing on their part (thus prompting the negative self-esteem loop). The best way to help someone with productivity isn’t necessarily to give them structure (which could stress them out), but to search with them for the underlying cause of their apprehension surrounding the task that they are trying to accomplish.
Many times, a deep-rooted fear of failure and/or punishment is the reason that they are so hesitant to complete a task. Or, their physical energy is so low that it must be rationed to more hierarchically important tasks, like eating and going to work. Give grace in these circumstances, because making demands of people in this situation will likely aggravate the situation rather than support it. When overall health improves, productivity increases. This is why nutritional support is so important for chronic depression.
In addition to low self-esteem and productivity issues, people with chronic low-grade depression often seem to be pessimistic for no reason. Unlike those with MDD, people with persistent depressive disorder are capable of feeling pleasure, but they tend to shy away from acknowledging positive experiences. They may have trouble enjoying a pleasant dinner, concert, or conversation. Things that make other people happy (like trees, pets, and sunshine) have less of an effect on them. When talking about the future, they will likely think of the worst-case scenario or something similarly unpleasant, rather than trust that everything will work out or plan to shape the future according to their dreams.
The truth is, pessimism is a defense mechanism that prevents the pain of loss. People with low-grade depression often find the pain of loss the be so intense that they fight to avoid it. Fear of rejection in a relationship prompts them to believe that no one could ever love them, even if someone they know is showing interest. Fear of failure at work prompts them to avoid extra responsibilities or promotions, and claim that no one appreciates what they have to offer. Fear of hurting someone’s feelings prompts them to avoid direct conflict and instead be passively negative.
Ok, so this all sounds pretty sad, and it’s a beautiful day outside, so…
Actually, dissociating happiness and sadness is the opposite of helpful for people with chronic depression. It is possible to be sad inside and still have hope and joy. It is possible to feel pessimistic and allow your friend to do something nice for you. It is possible to think you are ugly and still accept a compliment from a loved one. It just takes work, and an open mind.
So how can food help? The truth is, chronic depression is a complex problem, often with multiple root causes. Sometimes it completely resolves when vitamin deficiencies are addressed. Other times, learned habits and genetic predispositions cause a lifetime of struggle that can be minimized with proper nutrition.
Vitamin D, B6, folate, and B12, calcium, iron, zinc, and magnesium all contribute to the production of serotonin, SAMe, and melatonin. These nutrients must be sufficient for your body to attend to stabilize mood on its own. Adequate protein is also required to create various neurotransmitters involved in stress response and mood regulation. And omega 3 fatty acids are especially supportive in conjunction with pharmaceutical therapy.
Not surprisingly, many people in the U.S. are nutrient insufficient. This can happen to anyone, but is most prominent in low-income populations and people of color. It is important to recognize that not everyone who needs to eat a nutrient-dense diet is capable of doing so. But (especially if you tend to get caught up in the what-ifs), don’t let that keep you from doing the best with the information that you have.
It’s also incredibly important to seek help from a qualified mental health practitioner. If you don’t know where to turn, some local therapists that I recommend are:
Finally, medication is sometimes necessary to improve symptoms long enough for lifestyle changes to take place. This doesn’t mean everyone should be taking medication, but that there is no shame in doing so. Work with your doctor and don’t be afraid to advocate for changes in medication type and dosing if needed. In many cases, a combination of medication, nutrition/lifestyle changes, and therapy works best.
In the comments, let me know what was the biggest change (nutrition or otherwise) that made a difference in your depression.
Hang in there, you’re worth it.
Burhani & Rasenick, 2017. Fish oil and depression: The skinny on fats. Journal of Integrative Neuroscience, 16 (1), S115-S124.