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Sometimes I Get So Low, Down Looks Up To Me.

A bad hair day?

For one who has conquered the mind, the mind is the best of friends. But for one who has failed to do so, his very mind will be his greatest enemy. Bhagavad - Gita We have all felt sad at one time or another, but that is not depression. Sometimes we feel tired from working hard, but that is not depression. We may feel discouraged when faced with serious problems, but that is not depression.

Dysthymic Disorder (Psychology Information Online)
Dysthymic Disorder is characterized by chronic depression, but with less severity than a major depression. The essential symptom for dysthymic disorder is an almost daily depressed mood for at least two years, but without the necessary criteria for a major depression. Low energy, sleep or appetite disturbances and low self-esteem are usually part of the clinical picture as well. 
People who have dysthymic disorder will often report that they don't recall ever not feeling depressed, but they may be relatively functional in managing their life, although the symptoms are severe enough to cause distress and interference with important life role responsibilities. It is important to have a complete physical to rule out any physical illnesses that might be causing the depression. Also, if the person has a chronic medical condition that appears to be the cause for the depression (such as any chronic debilitating condition), then the correct diagnosis might be a Mood Disorder due to a general Medical Condition, even if all the criteria for dysthymic disorder are met. The question is whether the medical condition is physically causing the depression, rather than creating chronic psychological distress that is causing the depression. 
Despite the long term nature of this type of depression, psychotherapy is effective in reducing the symptoms of depression, and assisting the person in managing his/her life better. Some individuals with dysthymic disorder respond well to anti-depressant medication, in addition to psychotherapy, so an evaluation for medication may be appropriate. You should consult your psychologist if you have questions about treatment. 

Identifying Dysthymic Disorder
Depression causes changes in thinking, feeling, behavior, and physical well-being.
Changes in Thinking - Many people experience difficulty with concentration and decision making. Some people report problems with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism, poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during more serious depression.
Changes in Feelings - Many people report feeling sad for no reason. Others report that they no longer enjoy activities that they once found pleasureable. You might lack motivation, becoming more apathetic. You might feel "slowed down" and tired all the time. Sometimes irritability is a problem, and more difficulty controlling your temper. Often, dysthymic disorder leads to feelings of helplessness and hopelessness.
Changes in Behavior - You might act more apathetic, because that's how you feel. Some people do not feel comfortable with other people, so social withdrawal is common. Some people experience a change in appetitie, either eating more or less. Because of the chronic sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity and household responsibilities suffer. Some people have trouble getting out of bed.
Changes in Physical Well-Being - We already talked about the negative emotional feelings experienced during depression, but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping is common. Some people can't sleep, or don't sleep soundly. These individuals lay awake for hours, or awaken many times during the night, and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose their appetite, feel slowed down by depression, and complain of many aches and pains. 
Now imagine these symptoms lasting for months. Imagine feeling this way almost all of the time. This  may be dysthymic disorder, if several of these symptoms are present most of the time, for the past two years. Remember, all of the symptoms do not need to be present!  Of course, it's not a good idea to diagnose yourself. If you think you might be depressed, talk to a psychologist for a consultation. A licensed psychologist can assess whether you are depressed, and can determine the proper treatment for your depression. Remember, depression is treatable.   

Treatment for Dysthymic Disorder
Psychotherapy is the treatment of choice for this psychological problem. Often, antidepressant medication is also recommended because of the chronic nature of the depression in dysthymia. Psychotherapy is used to treat this depression in several ways. First, supportive counseling can help to ease the pain, and can address the feelings of hopelessness.  Second, cognitive therapy is used to change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create the depression and sustain it. Cognitive therapy can help the depressed person recognize which life problems are critical, and which are minor. It also helps them to learn how to accept the life problems that cannot be changed. Third, problem solving therapy is usually needed to change the areas of the person's life that are creating significant stress, and contributing to the depression. Behavioral therapy can help you to develop better coping skills, and interpersonal therapy can assist in resolving relationship conflicts. 

Because of the side effects and for more complex reasons I don't fully understand, I find myself unwilling to take medication to combat my life long inherent low mood. Despite the obvious flaws in the argument I suspect that I regard such medication as avoidance of 'reality' in the same way that one would regard the use of recreational drugs such as alcohol and cannabis. Nevertheless in the past I have been prescribed and taken courses of Amitriptyline, Lofepramine and Prozac. All were eventually very effective in, for the duration of the course, making the world a very much more acceptable place to be despite the side effects.

Prozac - is a proprietary form of the antidepressant drug fluoxetine hydrochloride, which has less sedative effects than some drugs of this type. Available only on prescription it is available as tablets.

Fluoxetine hydrochloride is an antidepressant drug used to treat depressive illness. It has the advantage over some other anti depressant drugs that it works by inhibiting uptake of serotonin, and so has relatively less sedative and anticholinergic side effects. It is used as tablets.

Side effects: it may impair performance of skilled tasks such as driving; may cause a rash (if so discontinue treatment), convulsions, fever, headache, tremor, nausea, vomiting, diarrhoea (which may be severe), anorexia with weight loss, slowing of the heart, hypothermia, sexual dysfunction, and occasionally blood disorders, vaginal bleeding on withdrawl, and confusion.
Warning: it should be given with caution to patients with liver or kidney damage, and those who have epilepsy, diabetes, or who are pregnant. It should be avoided in lactating women. MAO inhibitors should not be used until at least five weeks after discontinuing fluoxetine hydrochloride.

Lofepramine - is an antidepressant drug of a type that has fewer sedative properties than many others. Used to treat depressive illness, it is thus suited more to the treatment of withdrawn and apathetic patients than to those who are agitated and restless. Administration is oral in the form of tablets.

Side effects: dry mouth, drowsiness, blurred vision, constipation and urinary retention are all fairly common; there may also be heartbeat irregularities accompanying low blood pressure (hypotension). Concentration and speed of reaction are affected. Elderly patients may enter a state of confusion; younger patients may experience behavioral disturbances. There may be alteration in blood sugar levels, and weight gain.
Warning:lofepramine should not be administered to patients with heart disease or liver failure; it should be administered with extreme caution to those with epilepsy, psychoses or glaucoma, or who are pregnant. Treatment may take up to four weeks to achieve full effect; premature withdrawl of treatment thereafter may cause the return of symptoms.

Amitriptyline - is an antidepressant drug that also has sedative properties. The sedation may be a benefit to agitated or violent patients, or to those who care for them. In contrast to the treatment of depressive illness the drug may be used to prevent bed-wetting at night in youngsters. Administration is oral in the form of tablets, capsules or a dilute mixture. It is not recommended for young children.

Side effects: common effects include loss of intricacy in movement or thought, dry mouth and blurred vision; there may also be difficulty in urinating, sweating and irregular heartbeat, behavioural disturbances, a rash, a state of confusion, and/or loss of libido. Rarely there are also blood deficiencies.
Warning:amitriptyline should not be administered to patients who suffer from heart disease or psychosis; it should be administered with caution to patients who suffer from diabetes, epilepsy, liver or thyroid disease, glaucoma or urinary retention; or who are pregnant or lactating. Withdrawal of treatment must be gradual.

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