I wanted to ask this question, but I need to first let everyone know I am not asking it in the way most people do. I am not trying to compare depression to being sad, or blue, or going through a rough period. The exact opposite actually. I am asking if there is a difference between the real illnesses on the depression spectrum and someone who has just always been unhappy and hated their life? 

I am 52 year old man who has been depressed almost 40 years. It might have started out as a clinical depression, but things kind of fell apart when I was a teenager and I was never quite able to put them back together. Medications and therapy always had limited effect. I am currently doing TMS and about half way through I kind of feel worse. I have always had a passive suicidal ideation, but have had to accept that is not on the table because I can't to do that to my wife. So I am in the position where I will probably die relatively soon anyway, and my last thoughts will be that it all just wasn't worth it. Within a decade no one will remember me, and there will be no marker or accomplishment  to carry on that I existed.

The limited success of treatment has got me wondering something though. What if I am trying to "treat" a problem that doesn't exist? What if there was never anything underlying it all to treat in the first place. What if my brain works fine, but I am just a loser in the genetic lottery and I never had a chance to begin with. What if there is no "imbalance" to correct, the only thing that ever needed correcting was me and now it is too late?

Do you think there is a difference between someone with a real treatable mental illness and someone just trapped in a life they don't want to live who isn't strong enough to escape it? Is there a point in always holding out hope or is there a time to finally face the only reality you can?