How to focus when severely depressed?

April 1, 2009 3:46 PM

How can I focus when severely depressed?

I'm a professional writer who suffers from severe depression. I can cope with most of it -- the medication side effects, the anhedonia, and I can manage through the worst lows without killing myself. But what I can't seem to do at all anymore is focus. I can't seem to concentrate on any one thing long enough to complete a significant task or make sense of the things I'm reading or basically anything I need to be able to do in order to do my job.

I'm looking for any and all suggestions about how to get my brain back to alert status, although without any drugs stronger than caffeine. Herbal remedies? I'll try 'em. Yoga positions? Fine. I exercise every day. I take the antidepressants. I feel like I'm doing everything I know how to do, but I just feel mentally sluggish about half the time, and in my job that's completely not okay. I can't phone in the work that I do, and so I'm getting more and more frustrated and feeling more and more helpless, which is causing a feedback loop in my brain that needs short-circuiting.

Here's what I'm not looking for. I'm not looking for amateur psychiatry -- I have a very competent doctor who's done as much as she can to fine-tune the medication that I take. I've been dealing with this crap for twenty years, and I'm pretty clear on the pharmacological side of things. I'm looking for life strategies, diet tips, behavioral changes, that sort of thing.

Thanks!

posted by anonymous to health & fitness (27 comments total)

Headphones with a constant stream of trance music. YMMV
posted by Salvor Hardin at 4:03 PM on April 1

Hmm . . . you're anonymous, so you can't answer me, but . . . there is a difference between psychiatry and psychology. My understanding is, psychiatrists deal more with the physiological part of depression and prescribe medication, whereas psychologists try to get what's actually going on in your thought patterns. I definitely believe that some patients are better candidates for one or the other. A psychologist is not an amateur psychiatrist- a good one will have gone through several years of training to get their PhD or PsyD. Maybe this could help you. I certainly believe your doctor is competent, but one person (even a very smart person) doesn't know everything. Someone else may see things differently. I am a big believer in second opinions. Two heads are better than one, especially when they belong to smart and well-trained people (with training treating the same thing from different angles.)

If you don't like that suggestion, then I'd maybe try getting out of your element for a while if you can. Take a vacation, little road trip, go camping and look at nature. Sometimes that helps me break out of a rut. I think that endless sameness makes it hard to focus- even rearranging your office furniture or something may help.
posted by lblair at 4:04 PM on April 1 [1 favorite]

When you say you can't focus, what do you mean, exactly? Does your mind wander? Do you find yourself unable to sit still long enough to do it? Do you just zone out completely? Is it the same at all times of the day?

Some general advice - start small. You had enough focus to write this post, you'll likely be able to absorb the answers you receive. Focus as long as you can, stop, re-focus.
posted by The Light Fantastic at 4:04 PM on April 1

Get yourself a timer and aim to work in bursts - if you can only focus for five minutes, then set a timer for five minutes and go. Same thing for breaks, set a timer for breaks and then alternate - work, break, work, break. Try for 6 minutes of work, then 7 and so on. I think you'll be more comfortable getting short bursts of work in rather than the daunting prospect of having to focus all day.
posted by lizbunny at 4:15 PM on April 1 [3 favorites]

Huh. This book might have been written for you. Just check out that title.
posted by Theloupgarou at 4:22 PM on April 1 [4 favorites]

I use Instant Boss when I have focus problems. The working in short sprints with the goal of just moving things forward in 10 or 15 minutes really helps me. Before I know it I've worked for a couple hours and made more progress than when I feel focused.

There seems to be something about have small boxes of time that switches me over to school exam mode and that's a mode where I have always surprised myself with what I can get done.
posted by srboisvert at 4:23 PM on April 1

Change of scenery (write out in nature, by a lake, at a favourite (quiet!) coffeeshop, bookstore, etc), short writing sessions (15min. to one hour at a time, with breaks to go outside or do a small, satisfying chore or something physical) and try to eliminate your caffeine habit if you have one (do as I say, not as I do, in this case, as I'm sucking down espresso while I type) by really ensuring that you're as physically rested and nourished as possible. These are the only things that work for me when dealing with situational depression that makes it impossible to focus. I've been a programmer for twelve years and have dealt with death and loss and grief and depression multiple times in that period, each time having to rebuild my focus in order to do the work that supports me. It was nothing short of exhausting, but I finally found some skills to cope.

Salvor Hardin hit on a great technique that I also find very helpful - I use sbagen binaural beats behind low music in my headphones, and it really helps me focus for those short periods of time. Even if I get in the "flow" and feel I can code for fifteen hours straight, I've learned that I pay a huge price for it in the end, so I try really really hard to stick with short, repeatable coding sessions with breaks in between.

Lastly, someone suggested in a writer's forum I frequent to leave off daily writing sessions mid-sentence. I thought this was crazy, but I realized that I sometimes do this when I code - I leave off purposely in the middle of a function or with a bug that has an immediate known cause, because it gives me a hook to pick up the next day which immediately throws me into the "flow" and eliminates those frustrating hours of staring at a blank white screen.

Depression shows physically in the brain. I've dealt with a few traumatic situations that lead immediately to depression and it really did feel as if I had to heal my brain in order to get my focus under some semblance of control. That meant that I saw gradual progress over long periods of time, instead of making great jumps or flipping a switch and finding the magic solution to getting my focus back. After my mother died, for the first time since I was a toddler I couldn't read a page of writing and know what I'd just read - I could only hold a sentence or so at a time in my head. I dealt with a sort of pseudo-amnesia and short term memory loss that scared the heck out of me, made my job damned near impossible and sent me straight into therapy - where I was told that it was totally normal given the situation, but wasn't given any techniques to cope with it. So I spent awhile log-rolling, basically - a bunch of trial and error while my brain healed and my heart healed and my focus returned. The techniques above are what I found worked the best and kept me moving forward even when I felt lost and overwhelmed.
posted by annathea at 4:30 PM on April 1 [2 favorites]

I'm not looking for amateur psychiatry

Discuss it with a professional.

What part of, "I have a very competent doctor who's done as much as she can to fine-tune the medication that I take," did you not understand, f&w?

I also have a very competent therapist, who has done an excellent job with my medication for my depression. However, I didn't know until the last couple years that metabolic issues (in my case, thyroid problems) were also ramping up the depression and circumventing the meds to some extent, so you might want to consider physical factors that could be affecting your mental acuity. For instance, I don't know if you are male or female, but estrogen deficiencies have been linked to language problems ("verbal memory"), too.

I've also found that exercise helps, just like you mentioned--but for me it definitely works best at specific times of the day (in the evening or mid-morning rather than when I first get up), so you could try varying your exercise routine to see if that helps you focus. I know I personally write better immediately after I exercise (endorphin rush, maybe?), rather than, for example, right now, hours later. I'm tired, and feeling really sluggish, which is really frustrating and affecting how I word this answer.
posted by misha at 4:31 PM on April 1

Here's a suggestion from my own depression battles: Sometimes I can piggyback focus off of a book, magazine article, TV show - anything at all that I can pay attention to for more than a few seconds. What I mean is, if I can find something to halfway interest me enough to concentrate on, I can hold onto that mind set and immediately shift into doing some work. The hard part can be finding anything to interest me when I'm in a bad funk.
posted by lazydog at 4:33 PM on April 1

Turn off your computer, TV, etc...

Great advice from Cory Doctorow:
Writing in the Age of Distraction
posted by glider at 4:43 PM on April 1

Meditation.
posted by Ironmouth at 4:47 PM on April 1 [2 favorites]

Structure a schedule. I absolutely loathe these, but they are effective at getting things done. You do X task from this time to this time. Regardless of whether you get as much done as you want, you spend all of that time on the task, and nothing else. No shuffling around priorities to evade something either, just do what you have written down.

As for diet, get an appointment with a nutritionist. Some things are pretty common sense. Less takeout, more cooking, less meats and grains, more vegetables. Avoid salt, drink more water. That caffeine? Cut it out in entirety if you can help it. Seriously, many people do not realize how utterly addicted they are to caffeine, and how much it hurts their focus and sleep. Make sure you do get enough sleep, and not too much. 7-8 hours a day is good. 10 or more is very bad. Don't beat yourself up for not meeting a goal. That's counter-productive, just continue working towards the goals ahead of you.

Also, remember to take some time for yourself. I would suggest finding a place with scenery you enjoy, and just taking a walk for a while. If you start to think about other things, just tell yourself to stop it, and just think about something you see or hear around you in the moment. I also have found that turning my speakers to moderately low volume and flipping on a few of these helps me relax a bit when things feel too intense.

One more suggestion, I have found that I work best when I am in a public place, semi-familiar, and around other people. Libraries work very well for this purpose, especially near reference sections. University libraries are particularly good for a work environment, although you likely won't have internet access unless you're enrolled or in an alumni association.

Finally, I second the opinion of checking around for a psychologist. They are far better trained to help you with behavior issues. Combined with a nutritionist, that will give you plenty of professional advice to complement your psych's work.
posted by Saydur at 4:52 PM on April 1 [1 favorite]

This is more writing than psychiatric advice, but I am in somewhat of the same boat and this is what I do:

I set a timer for 10 minutes. 10 minutes to write, 10 minutes to relax, listen to music, whatever. Repeat. I never have to focus for more than 10 minutes at once.
posted by drjimmy11 at 4:55 PM on April 1

As a wanna-be writer (cant claim to be pro just yet) who suffers from anxiety and depression, I know exactly what you are talking about. Here are some of my coping strategies:

1) Daily exercise (which you seem to have covered)
2) Clean diet rich in Omega-3
3) Proper sleep
4) Change of scenery when I feel I am slipping or lacking focus. Sometimes a small walk can do wonders.
5) Write it out. Use your skills as a writer to keep a journal of your thoughts.
6) Meditation. There are many eastern approaches being implemented in the west as treatment for depression. Buddhist philosophy and meditation practice has helped me alot.
7) Personal motivation. Sometimes, the only way you can get out of a funk is by pure will power. Doesn't always work, but change can only happen if the individual is willing.

Hope this helps!
posted by scarello at 4:57 PM on April 1 [2 favorites]

I know you say without drugs, but some doctors have been prescribing Modafinil -- "Provigil" to improve depression wakefulness and alertness. It doesn't give you any of the sensations you get with typical stimulants like caffeine or amphetamines. Just more wakeful.

Take it with a grain of salt.
posted by floam at 5:01 PM on April 1

Seconding Get It Done When You're Depressed, in Theloupgarou's link. It is exactly what you need. It's not about getting rid of depression, it's about being productive while depressed.
posted by game warden to the events rhino at 5:22 PM on April 1

I would recommend this book as well. The author has a fairly simple centering exercise that he recommends, based on his understanding of neuropsychology.

Here's the quick version of a centering exercise he recommends. It seems too easy, but I've found that it works remarkably well. Give it a shot -- it's painless and you have nothing to lose but about 10 minutes of your time.
posted by UrineSoakedRube at 6:01 PM on April 1 [1 favorite]

So, I am going to borrow two of the above suggestions, since they have worked for me in the past:
Scarello's the Omega-3 suggestion: I started taking fish oil tablets and have seen an improvement in my depression. My doctor told me that flax-seed would help too.
Also drjimmy11's suggestion: I have to work in 15 minute spurts, then take a 15 minute break. I also make sure that what I do in the 15 minute break, I can stop after the 15 minutes (I don't watch a tv show or movie that I can't pause and come back to).

I know that you already have a trusted, well liked doctor. But, do you have "therapy" sessions or just "med reviews"? If you only have a 15 minute "med review" (which is what I have with my doctor), have you considered going to see someone for talk therapy? I also see a "therapist" in addition to my doctor. These sessions are more helpful for me to find what my triggers are (I'm bi-polar) and how to overcome any issues that arise.
posted by kochanie at 6:04 PM on April 1

Getting better sleep, taking a B multi-vitamin, and omega-3 fish capsules does wonders.
posted by damn dirty ape at 7:03 PM on April 1 [1 favorite]

I'm getting mixed messages and not enough information from your post. Any kids? What kind of writer? Would have helped a lot - for instance, some kinds of writer would benefit from unplugging the ethernet and working throught the withdrawal anxiety; another kind of writer, that's not appropriate. As for the mixed messages, you say you lack concentration, yet also say you want more alertness. Well, normally, a lack of concentration is the same as excessive alertness - a lack of concentration is normally when unimportant issues appear important, thus the important issue is lost. I think you won't experience resolution until you resolve this confusion somewhat more. You might need less alertness, not more. Of course I would never say your medication could be making you excessively alert already, since your psychiatrist has already adjusted it perfectly, but there might not be a solution is also possible. Good luck in any case.
posted by peter_meta_kbd at 7:24 PM on April 1 [1 favorite]

Meditation is a great way to help focus your mind and alleviate depression. Mindfulness meditation in particular helps to get your focus away from your mind and on something else. By focusing your attention on your breathing or a sensation in your body or a sound, you get out of the negative feedback loop that's making you unhappy.

There are tons of books on how to do it. I like The Complete Idiot's Guide to Mindfulness Meditation because it's brief, to the point, and filled with lots of try-it-yourself exercises.
posted by oozy rat in a sanitary zoo at 7:27 PM on April 1 [1 favorite]

It's a bit counter-intuitive but like Salvor I've found headphones to an invaluable tool for preventing distraction. Besides the drowning out of environment noise, it also drowns out random thoughts. When my mind decides to take a break from the task at hand it winds up on the audio track instead of free-associating to some genuinely compelling topic.

For me the key is to choose media according to the type of work I'm doing. If reading or writing then I want something purely instrumental without storytelling (e.g. Explosions in the Sky). If I'm doing something monotonous then I'll put on NPR. Everything in between is on a spectrum with the amount of language and complexity in the work inversely related to the amount of language in the audio. For deep coding I'm very partial to soundtracks and operas (in a language I'm not fluent in) as following the story in the back of my mind serves as the buffer against distracting thoughts.
posted by Manjusri at 9:50 PM on April 1 [1 favorite]

I've been in exactly your situation, and one thing that works for me is to leave my desk every hour and do five minutes of very strenuous exercise. At work, I run up the stairwell until my heart is racing. It home, I lift dumbbells and do situps till I sweat.

These short bursts aren't a replacement for your regular exercise, but they are a good way to drip-feed your brain with endorphins throughout your work day. They also give you a few meditative moments to reflect on your work and plan the next hour. I can't count the number of times a nightmare sentence or major structural problem has spontaneously sorted itself out once my heart rate got above 100.
posted by [ixia] at 1:18 AM on April 2

Also, remember that writing when you're depressed is hard - much, much harder than, say, lifting boxes when depressed. (I should know, I've done both). Professional writing uses every faculty that depression tends to cloud - focus, fluency, inspiration, gut instinct, confidence. Your work might benefit overall if you accept that on your worst days, your mental state is incompatible with being able to do your job.

I know that when you're in the middle of it, taking a break seems like 'giving up'. But you're not giving up - you're making a professional decision that it's both painful and pointless to ask your brain to run marathons when it's genuinely, though temporarily, broken. When you know a day is going to be really bad, the best thing you can do for your writing may very well be not writing. Things may be better tomorrow.
posted by [ixia] at 3:27 AM on April 2 [1 favorite]

Sounds like you're still depressed. I spent years changing meds until I found a mix that made me feel better emotionally and didn't fog me up. I know it's a pain, but you could ask you doctor for new meds.
posted by RussHy at 6:10 AM on April 2

You might consider light therapy with sunlight or a lightbox.
posted by tybeet at 6:38 AM on April 2

Piggybacking on what [ixia] said... I have found that I needed a two-sided philosophy for this. On the one hand, I needed to accept that yes, the moods are real, sometimes they do make me unable to do my work, and there is no good in beating myself up about that. On the other hand, I needed to realize that mood is not destiny. I may be down at a given moment, I may be tempted to say "OK, today is shot, I won't be able to do anything". But every so often I do the experiment -- I just try. And I'm always surprised to see how little correlation there is between how well I think I'll be able to work, and how well I am able to work. Sometimes, just getting started is enough. (Sometimes it's not.) Sometimes, I may be horribly down in the morning and think I won't be able to do anything all day, but a few hours later I feel better and am able to get stuff done.

In short: recognize both the power and limitations of mood.
posted by wyzewoman at 7:42 AM on April 2