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Alicia_MSW, Psychotherapist
Category: Mental Health
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Experience:  Specializing in mental health counseling
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Do I have mild or moderate depression? 3 months ago me and

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Do I have mild or moderate depression? 3 months ago me and my boyfriend broke up, and I took it hard, I started suffering with my depression and anxiety again and doctor decided to take me off citalopram as it wasn't helping, and to be honest i'd really rather not put chemicals in my body anymore. I've been over 2 weeks free of citalopram now, after being on it for about 1.5 years.
He said if i'm still struggling I should take st john's wort, which I am. I walk everyday, eat well, see friends when I feel able, and try and do odd jobs around the house to keep busy. (I had to give up my job 2 months ago I was so bad). I have made alot of improvement since it started 3 months ago but, I have days where I feel more able to do things then others.
Like today I feel particularly depressed for no reason, so I wouldn't wan't to socialise, I would just stay around the house (though I have been for a walk).
I feel like i'm doing everything I can to help myself, but is this just a process, just keep doing what I'm doing and it will get better? It's so hard to see if I will be happy again and be able to work and be at peace with myself.
Hi there,

I can understand your concern about being off of anti-depressants, and I can appreciate your desire to avoid medication. Some studies have shown that St. John's wort can have a beneficial impact on mild forms of depression (you might want to refer to this fact sheet for more information, if you're interested:

Based on what you're saying, and this is only for informational purposes since we cannot provide a diagnosis on this website, it sounds like you might be suffering from mild depression, also known as dysthymic disorder. This information may help to clarify the difference:
According to the DSM-IV, mild-to-moderate depression—termed dysthymic disorder—is marked by milder symptoms than major depression, but the symptoms are prolonged and protracted.

Dysthymia is characterized by depressed mood for most of the day, on more days than not, for at least two years. Additionally, a diagnosis of dysthymia requires the presence of at least two of these symptoms while depressed:

poor appetite or overeating
trouble sleeping or sleeping too much
fatigue, loss of energy, or tired all the time
low self-esteem
impaired concentration and difficulty making decisions
feelings of hopelessness and helplessness
To be considered as indicative of dysthymia, the first two years of depressed mood cannot include any episodes of major depression. Furthermore, diagnosis of dysthymia precludes a history of manic episodes and requires that depressed mood occur not during the course of some other psychiatric disorder such as schizophrenia. In addition, no underlying cause of depressed mood, such as a general (i.e., other than psychiatric) medical condition or substance abuse, must be present.

The symptoms of dysthymia cause significant distress or impairment in social, occupational, and other important areas of functioning.

I say that it sounds like mild depression because you are able to function in your regular life (even if it's a struggle at times), you're socializing, eating right, keeping busy and staying active. If you had severe depression, you wouldn't be able to engage in these activities. There's nothing wrong with feeling like you want time alone - you don't have to force yourself to be social if you don't feel like it.
You are doing a good job, from what I can see. It is a process and it's a matter of taking it day by day. One step at a time. You will be happy again and over time, you will feel better - you just have to keep putting one foot in front of the other.
Good luck!
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Customer: replied 4 years ago.
Thank you for your thorough response. It's true that I am functioning, but i'm not living. I have had to give up a life that I was happy with 3 months ago - I was living. This has only come back with it's brutal force since me and my partner broke up.

I now cannot work, I don't enjoy doing things like I used to, and if I do go out and socialise it is mostly forced so that I can overcome the depression.
The dysthymic disorder, is this something I am prone to when something bad happens in my life? I can't live with this for 2 years? I just wouldn't cope.

Do you think that I might need to go back on medication? I would rather not go back on meds but if it can help me recover, i'm happy to do so.

I will read through the link you sent me about st johns wort, thank you.
Customer: replied 4 years ago.
Sorry I meant to reply, not accept.

Any further info would help, thank you.
Not a problem. I do hear what you are saying, in terms of feeling like you're functioning but not living. And that's no way to live. However, it's not so unusual to experience a relapse in depressive symptoms due to stressful circumstances or losses (such as you've experienced with your break-up.) It's very hard for anyone to deal with circumstances like this, let alone if you have a predisposition to depression, so I give you a lot of credit for trying to be strong and deal with it on your own - by trying to push through it, so to speak. Now, I can't say for sure that it's dysthymic disorder, of course, because we can't provide a diagnosis on this website. However, dysthymia is generally believed to be a chronic condition, meaning that even if some of your symptoms occasionally seem to "disappear", you may have to deal with the condition on an ongoing basis, particularly when certain life factors trigger these symptoms.
Since I can't say for sure if it is dysthymia, I can't say whether you should go back on the medication with certainty. However, it's usually best treated with medication (see this information from the Mayo Clinic: Also see the side links for more info.
I would suggest that you first think about seeing a psychotherapist to discuss your symptoms, especially since it was the break up that triggered these feelings. Perhaps short-term therapy can help - and if you see an improvement after a few weeks, then maybe medication won't be necessary. But if you continue to feel this way and St. John's wort isn't having any effect, then you might want to consider going back on medication (and remember, it doesn't have to be forever.) Please let me know if you have any additional questions.
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Customer: replied 4 years ago.
Thanks doc. I think some days I just feel stronger then others, which allows me to push myself and go out and socialise etc. I am prone to depression in stressful circumstances, especially with heartbreak... so I guess it is just a waiting game, I just wish I knew how long for. I feel like 3 months has been an absolute age.

I have been having cbt for around 6 weeks now, and soon councilling to deal with my breakup issues. But I would like to see a psychotherapist.

Perhaps all I can do is just keep at it, taking the st johns wort and see how I get on. If im still the same in a few weeks perhaps I will need to go back on medication for a bit, as the withdrawl of citalopram would have worn off mostly by then.

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