Depression and Family Dynamics: A Personal Journey

Q: Depression and Family Dynamics: A Personal Journey

Hello： The diagnosis in psychiatry typically requires multiple follow-up assessments before it can be established. <br>The diagnosis entered in outpatient medical records may only be a provisional diagnosis and could be modified based on subsequent evaluations. <br>The diagnosis

Depression and Family Issues

Hello, Doctor.
I have three questions I'd like to ask, and I apologize for the length.
Two months ago, I visited a psychiatrist and asked the doctor, "I want to know if I have depression." However, the doctor did not respond directly and only said that everyone experiences depression at times.
After the appointment, I noticed that the main diagnosis on the prescription was "dysthymic disorder," which I assume means I have mild depression.
A few weeks later, I returned for a follow-up to request a medical certificate for school, but the diagnosis on the certificate was "depressive state" instead of "dysthymic disorder." I have been confused about this and would like to know the answer.
1.
I want to ask if I have (or have had) depression.
I have improved significantly, but I still feel anxious about social interactions and often stay indoors for long periods.
(This is due to some negative memories from my childhood, and similar situations have occurred recently.) I am not afraid of "strangers" or "my most trusted people," but I fear those who fall in between.
Therefore, I am very anxious about returning to school because I will encounter many people who fall into that category.
(Before the winter break, I interacted very little with friends because of my fears, and I often missed classes due to feeling down or social anxiety.) When visitors come during the New Year, I feel irritable or want to be alone and don’t want to speak at all.
There is zero interaction with my parents at home (because they found out I visited a psychiatrist, which has made our relationship awkward), and I only have normal, comfortable interactions with my siblings.
2.
I want to ask how to improve this situation.
Is this also a symptom of depression, or could there be other issues? Regarding family problems, my family members are generally more reserved, and some past events have caused a bit of estrangement among several family members.
My siblings and I are now in college and have started our own lives, so when we gather as a family, it is often silent or marked by technological indifference.
I believe this is mainly due to my parents' personalities and past events.
(Our family has never traveled together or spent the night away, and we rarely gather to chat as we grew up.
Due to past events, my siblings and I hardly speak to our father, and I have not looked at him for a long time.
I long for a family where we can joke and play around, but because my family is very reserved and due to past events, it seems almost impossible to become that lively family.)
3.
I want to ask if this situation is unusual.
Does it need improvement, or should I just let it be? Lastly, thank you, Doctor.

Niming, 10~19 year old female. Ask Date: 2017/01/31

Dr. Liang Sunyuan reply Psychiatry

Hello: The diagnosis in psychiatry typically requires multiple follow-up assessments before it can be established.
The diagnosis entered in outpatient medical records may only be a provisional diagnosis and could be modified based on subsequent evaluations.
The diagnosis on the formal report usually better represents the assessment results up to the present in the course of treatment.
If there are any uncertainties, it is advisable to discuss them with the physician during the next appointment.
The stress and anxiety related to interpersonal interactions may require a deeper exploration of their roots and an understanding of what truly concerns you.
You might try not to avoid the interpersonal relationships you fear so quickly; instead, attempt to stay engaged in interactions a bit longer, reminding yourself that it’s okay not to be perfect.
Afterward, affirm your courage and breakthroughs.
If you continue to feel troubled, consider seeking counseling or psychotherapy.
Family is a system, and when one member makes a change, it can also affect other members.
It is recommended to start with yourself, taking care of your own well-being, and adopting an understanding and accepting attitude towards your family's emotions and thoughts.
Providing warmth and support may gradually transform the family atmosphere and interactions.
Wishing you all the best.

Reply Date: 2017/01/31

More Info

Understanding depression and family dynamics can be a complex and deeply personal journey. Your experiences and feelings are valid, and it's important to approach them with care and understanding. Let's break down your questions and concerns.

1. Diagnosis and Understanding Depression: It seems you have been grappling with feelings of sadness and social anxiety, which can be indicative of depression. The term "dysthymic disorder" refers to a chronic form of depression characterized by a low mood lasting for at least two years. On the other hand, "depressive state" can refer to a temporary condition that may not meet the full criteria for a major depressive disorder. The fact that your doctor did not provide a clear diagnosis may be frustrating, but it’s not uncommon for mental health professionals to approach diagnosis with caution, especially if they believe that symptoms may fluctuate or improve over time. Your feelings of fear and anxiety about social interactions, particularly with those who fall in between "strangers" and "trusted individuals," can be part of social anxiety disorder or a symptom of depression. It’s essential to recognize that these feelings are not unusual, especially given your past experiences.

2. Improving Your Situation: To address your current situation, consider the following strategies:
- Therapy: Engaging in cognitive-behavioral therapy (CBT) can be particularly effective for both depression and anxiety. A therapist can help you work through your fears and develop coping strategies for social situations.

- Gradual Exposure: Start small by gradually exposing yourself to social situations that make you uncomfortable. This could mean spending a few minutes with family members or friends in low-pressure environments.

- Communication: If possible, try to communicate with your family about your feelings. While it may feel awkward, expressing your desire for more interaction or understanding can help bridge the gap created by past events.

- Self-Care: Engage in activities that bring you joy and relaxation. This could include exercise, hobbies, or mindfulness practices. Taking care of your physical health can significantly impact your mental well-being.

3. Is This Situation Abnormal?: Your feelings of discomfort and the dynamics within your family are not unusual, especially in families where communication has been historically limited. Many families experience periods of silence or awkwardness, particularly after significant events or changes. However, if you find that these feelings are impacting your quality of life or relationships, it may be worth seeking to improve them. It’s not about forcing a change but rather about nurturing connections in a way that feels comfortable for you.
In conclusion, your journey through understanding your mental health and family dynamics is a personal one, and it’s okay to seek help and take steps toward improvement. Remember that healing takes time, and it’s perfectly acceptable to prioritize your well-being. Engaging with a mental health professional can provide you with the support and tools you need to navigate these challenges effectively. You are not alone in this journey, and there are paths to feeling better and more connected with yourself and your family.

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