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How do I keep myself disciplined?
November 11, 2010 3:30 AM   Subscribe

How do I make myself buckle down and keep to a normal-person schedule during my current extended period of extreme sadness?

Due to circumstances completely beyond my control, I am feeling some extreme sadness and loneliness right now. I can expect these feelings to continue almost nonstop through the end of April.

But I'm a person. Sometimes I go out and spend time with friends. Sometimes I run errands and accomplish tasks. But most of the time, I'm functioning as a person undergoing a major depressive episode: extreme appetite fluctuations, erratic at best sleep schedule, sudden onset crying jags, mood swings.

I have a job that requires me to work varying shifts from week to week. I need to be able to focus on that job and do it well. I need to be able to come home at night and go to sleep. I need to be able to talk to people and to accomplish tasks and to take care of my awesome puppy.

How do I overcome or use my sadness to function as a normal person with real-world responsibilities?
posted by Night_owl to Health & Fitness (26 answers total) 22 users marked this as a favorite
 
Have you got something that brings you joy that you can take to work and spend a few minutes doing during your breaks? Maybe a favorite book, a poetry collection, an internet image gallery, a site with posts that you usually find funny, a snack that leaves you feeling better, something crafty to do, or maybe a friend (or several) who wouldn't mind being part of an organized five minute pick-me-up phone call program set for your break times. Maybe all of those things. Just small but joyous things that you can rely on and use to boost your mood a bit and carry you through the day. Something like a transportable happiness kit.
posted by Ahab at 4:18 AM on November 11, 2010


Try to get out in the fresh air and get some exercise. Take that awesome puppy out to a park someplace (if you can) and talk to the other "dog People".

Put yourself on Fish Oil, it's great for everything and certainly helps with depression.

Keep your chin up--"this too shall pass".
posted by AuntieRuth at 4:52 AM on November 11, 2010 [4 favorites]


Do you have friends you can ask for support? It's not a moral necessity to get through this completely on your own (although it may be a practical one, depending on your circumstances).

Do you know people who might be happy to take your puppy for a walk, or bring you some groceries, or just have you over for a meal or drinks or TV watching without requiring a constant supply of witty banter? You are allowed to ask those people for help. No doubt you will return the favour at a later date.

Also, during this time it is acceptable to have your house in a mess and not beat yourself up about it.
posted by emilyw at 5:03 AM on November 11, 2010


I second exercise, and a simple diet that cuts out sugars, caffeine and carbs, since all three can create mood and energy swings throughout the day. Maybe instead of telling yourself to get everything together, just try to focus on one simple thing - feeding yourself two or three nutritious meals a day, and going for a walk at a scheduled time every day. If you can control that one part of your life, you might find that you're better prepared to tackle everything else.

(I speak from experience - I cut out caffeine and reduced my sugar intake dramatically, and both have helped me better manage my life through anxiety attack periods. )
posted by ukdanae at 5:06 AM on November 11, 2010 [1 favorite]


This year has been an obnoxiously horrific year, and I too find myself sad, but not clinically depressed. I have somehow managed to work 50-60 hours a week (and only call in sick one day), as well as continue talking to friends.

What's worked for me:
-eating whatever I want, whenever I want. This has been the hardest for me, because I am not hungry; I also normally make very healthy, vegetarian meals for all of my meals. Now, I eat out a lot more, and eat Skittles and a Clif bar for more meals than I'd like to admit. For me, that's calories, and that's what I need.
-running. This is my thing that keeps me from going truly insane, I think. I don't run every day, or even most days because of the time issue, but I do it often enough. I have heard other people take up knitting.
-tv series. I'm currently watching The Wire and Grey's Anatomy whenever - if I can't sleep, if I need a distraction, if I don't want to be alone.
-crying when I need to. This has made for an odd assortment of places where I have cried. (Ann Taylor Loft, the bus, during a concert, etc.)
-Crying kind of ties in to recognizing the sadness. I can't just power through everything acting like things aren't sad. I can't just act like everything's okay. What enables me, though, to feel a little bit brighter, and a little bit more like everything's okay, is going with the sadness. A few days ago, I stared to pick a fight with my roommate about some dumb thing. I don't care about Dumb Thing; what I do care about is that I just found a picture of my father, and I miss him. We stopped mid-fight when I apologized (mumbling, but whatever I had). Then I went and cried (I cry all the time! It's the worst! Oh well!) and laid around and then rejoined society when I felt able to do so.

I kind of minimize my interactions with other people when I am feeling incredibly aggressive, which I am wont to feel some times, these days. (Go get lunch, a coffee, to my room, leave the party...)

Also, listen to The Mountain Goats - This Year: I am going to make it through this year if it kills me.
posted by quadrilaterals at 5:10 AM on November 11, 2010 [14 favorites]


I am in the middle of a major depressive episode myself right now, and as far as i'm concerned, for the next few months, I win for just showing up.

Also, favourite This Year times a million.
posted by PinkMoose at 5:19 AM on November 11, 2010 [1 favorite]


There is a book on the topic: Get It Done When You're Depressed. I own it but I haven't actually read it. I'm not sure what that says about me. (Maybe that my antidepressant is working....)

When I've been majorly, hugely depressed I've typed up a checklist of the most basic things I need to take care of every day. I kept the list pretty basic so I wouldn't feel too overwhelmed to even try to get through it, just the minimum things I had to do to take care of myself and keep my life from crashing down: shower, take meds & vitamins, brush teeth, open mail, eat some vegetables, take out the trash.

I've also had some limited success with making myself follow a few simple routines: 1) come home from work, get mail, put bags & coat away, open & sort mail, feed animals. 2) get up in the morning, start coffee, do 15 minutes of straightening the up apartment while waiting for coffee.

Having rules, checklists and routines helps with the feeling of being constantly overwhelmed with all the little decisions of an average day. When you are stressed or depressed or in crisis of some sort, it is mentally exhausting to have to continually try to figure out which of the million things on your plate you should be doing at the moment and which you can let slide. If you set up a few rules and routines once and write them down, you don't have to think about it again for awhile.
posted by Serene Empress Dork at 5:31 AM on November 11, 2010 [1 favorite]


Side note: I will try not to butt into the thread more often than necessary.

Any tips on setting routines when working shifts vary (what days of the week, what times of day, etc.)? Sometimes I will work an early morning to midafternoon shift, sometimes an evening to late night, sometimes a midday to early evening. Days of the week also change.
posted by Night_owl at 5:38 AM on November 11, 2010


Check your MeMail.
posted by MonkeyToes at 5:54 AM on November 11, 2010 [2 favorites]


In that case I would tie routines to the predictable events of each day: have a "getting up" routine that you do at whatever time you get up; a "coming home" routine; a "before sleep" routine; a "day off" routine.

A few things like meds or pet feeding should probably be more closely tied to a specific time of day, as much as you can manage.

You might also want to set up an even more abbreviated routine with just the bare-bones basics for days you are especially busy or low on energy.
posted by Serene Empress Dork at 5:59 AM on November 11, 2010


Green space. Ideally, actual outdoor living trees or grass green space. But failing that, green sheets on your bed, or a green blanket.

If there aren't people you can see in real life on a regular basis, try to schedule a weekly phone call with someone who 'gets' you.

Food. Eat enough. Water. Drink more than you think you need.

Take the puppy for long walks, and be diligent about training. Proper training now will save you lots of angst in the future, and it gives a structure to your time. Teach the puppy to lie quietly while you cook, without getting up until you tell her (him) to.

Writing saved my life in some of my darkest days - three longhand pages of 'morning notes' (Thank, Julia Cameron) really helps me to see what I'm worries/sad/angry about, and helps me make a plan to change what I can and tolerate what can't be changed.
posted by bilabial at 6:21 AM on November 11, 2010


Something that has worked for me (though I've never struggled with depression, just extreme lack of motivation) has been an "if X then Y" decision tree.

For example: A) "If I work a shift before 9am then I will get up at 7. I will let the puppy outside and then I will drink my coffee. I will play with the puppy for fifteen minutes and then I will get in the shower and get dressed for work." B) "If I work a shift after 12pm then puppy gets an hour long walk after I drink my coffee."

I know it sounds sort of ridiculous but the very basic logical language makes tasks appear more logical in sort of a "Deep breath, you know what to do next" sort of way.

Also, I have taken great joy in training dogs over the years. Doing something basic can take a lot of repeated effort, like teaching commands for "heel" and "come". If you've mastered those then maybe pick a trick like, "shake hands" and decide you're going to spend a certain amount of time each day teaching Pup-Pup to master that trick. It's fun and something you can do for a short amount of time (like ten minutes) every day.
posted by blue_bicycle at 6:42 AM on November 11, 2010 [3 favorites]


Take a training class with your puppy. Obedience, agility, clicker tricks, doesn't matter (as long as it's positive). This gives you a set time each week to think about something other than yourself, and having the homework gives you goals to work towards on a short-term and regular basis. Plus it will make your puppy happy AND let you meet new people.
posted by biscotti at 6:50 AM on November 11, 2010


I agree with the bare-bones routine suggestions.

In my case, I find that some (but not too many) real-world responsibilities (but not "pressure") actually help, because they let me maintain some sort of basic routine. The other stuff just kind of fall in place or are ignored, I figure if they are important enough, my subconscious will somehow make me do them anyway. The fact that you are aware that you need to take care of your (awesome) puppy is a good sign! But I would disagree with this statement: "I need to be able to focus on that job and do it well". In my opinion, you should give yourself a break -- just be aware of the bare minimum you need to do. For instance, show up for work on time, take care of puppy, etc. Please don't put additional pressure on yourself and try to "keep yourself disciplined". And cliched but true -- this too shall pass. Do you have someone to talk to about this?


(FWIW, during the last year, my dad was diagnosed with cancer, I finished my PhD program, was interviewing for jobs, but ended up with a less-than-perfect one, separated from my husband, dad passed away, moved to a new city/new job where I don't know anybody and am quite alone... etc. What keeps me going is that I have 155 students who expect me to be there on time for various classes during the week).
posted by prenominal at 6:53 AM on November 11, 2010 [2 favorites]


But I would disagree with this statement: "I need to be able to focus on that job and do it well". In my opinion, you should give yourself a break -- just be aware of the bare minimum you need to do.

I agree. Use the brief moments of peace and clarity to make a checklist of what you will do that day (the bare minimum ideally). Be realistic in your expectations of yourself.
posted by salvia at 7:27 AM on November 11, 2010


It helps me to prepare for the next morning before I go to bed at night. Set out clothes. Set out a box of cereal. Load the ipod with walking-to-campus music. If I've got a big can't-forget Thing To Do first thing in the morning, I tape a note to the bathroom mirror. The goal is to be able to make it out of bed and out the door without making any decisions. Everything's set up and decided ahead of time and I can just go.

This is mainly a depression-fighting trick for me right now. It's been a long time since I did shift work. But I wish I'd used this trick back when I was on different shifts all the damn time. Whether you're depressed or just on a chaotic schedule, there's still that moment when the alarm goes off and you don't know what the fuck is going on. (Where am I? What day is it? What do I do next? And depression makes it way to easy to answer all those questions with "I don't know and I don't care.")
posted by nebulawindphone at 7:32 AM on November 11, 2010 [1 favorite]


It helps me to prepare for the next morning before I go to bed at night. Set out clothes. Set out a box of cereal. Load the ipod with walking-to-campus music. If I've got a big can't-forget Thing To Do first thing in the morning, I tape a note to the bathroom mirror. The goal is to be able to make it out of bed and out the door without making any decisions. Everything's set up and decided ahead of time and I can just go.

This is excellent advice. My experience with depression and depression-like moods is that oftentimes we can make decisions just fine, and we can handle pressure just fine, but the combination of the two makes us shut right down. Maybe that's the definition of stress?

So yes, make decisions ahead of time as much as you can, have some rules or a decision tree in place for making decisions under pressure, and also decline pressured decisions when you can. "You know, I will have to check my schedule, let me get back to you. When do you need to know my answer?" Then, and this is important, write it down and don't forget to think about it later when you aren't feeling pressure.

Plus, it is way easier to sleep when you have your ducks in a row for the next morning.

Don't rely too heavily on the "until April" thing. For two reasons: things could change and whatever it is might not happen in April, and that disappointment will be even less fun if you have basically white-knuckled it until then. And the thought process of "it won't be better in April" sort of programs you to not allow yourself to feel better until then.

Also, make sure to eat plenty of foods that contain tryptophan. I recently made this connection for myself, and I'll bet it works for others as well. Tryptophan is an essential amino acid that is the precursor to serotonin (comfort/ease/happy) and melatonin (sleep). If you don't have enough, all sorts of stuff goes out of whack. I've been experimenting, and when I'm feeling down, nothing makes me feel better than a meal of chicken, or fish or eggs or sunflower seeds. Any food whose protein to carbohydrate ratio is high, so the negative effects of carbo-loading don't bring me down. Worth a shot. I find that life is a lot easier to cope with if I've had eggs for breakfast...
posted by gjc at 8:09 AM on November 11, 2010 [1 favorite]


Not sure if you already do but see if you can put your bills on autopayment. At least that's one less thing you have to worry about. Write down the due dates and basic amount on a piece of paper and put it where you always see it (fridge?) for easy tracking.

Sometime when getting up and "living" is enough of a struggle, the last thing you need is to pay bills however, if you miss paying them, then that's another depressive influence on top of the one you have.

I'm sorry your'e going through it. Many of us know how it is. I went on meds but it's not for everyone.
posted by stormpooper at 8:49 AM on November 11, 2010


I'm very sorry that you're having to go through something that makes you sad for so long.

There are several things within your control that you can do to help.

1) Most important is regular exercise. No single behavior has more positive impact on mood.

2) Buy supplements that have been clinically tested with depression.
Rhodiola Rosea is an amazing natural extract that has been shown to reduce depression significantly in clinical studies. Much better than taking psychotropic meds with all their side effects.

3) Fish oil has also been shown effective with depression-- i believe you need to take 3 or 4 grams for it to have the impact you need.

4) If you're too low to get out of the house to buy these products, go to iHerb.com. Read all the reviews-- and make a quick no hassle purchase without leaving your house.

5) You should get into some kind of therapy with someone who gets whatever is going on for you. Just making a human connection and having someone who appreciates your loss or whatever circumstances are prompting your sadness through April will make a difference.

If you can't afford a seasoned licensed clinician, call your local psychoanalytic institute (google for your city); most institutes have licensed (and often very skilled) clinicians who are willing to treat clients for a lower fee.
posted by drjmac at 9:35 AM on November 11, 2010


It almost sounds like you're talking about a sort of seasonal-cycling thing. Plus the whole variable-workshift thing makes me cringe: Mood problems get worse when sleep hygiene isn't (or can't be) maintained.

There are some good suggestions, but here are a few extra from my point of view:

Consider getting a full-spectrum light. Make sure this light hits your eye directly as soon as possible after you get up for at least 20 minutes or so (e.g., as you go through your morning routine). Try to keep your sleep phase as regular as possible (given your tough work schedule).

Pace drjmac, I would recommend a CBT therapist rather than a psychoanalytic therapist. I'm not aware of any research that suggests psychoanalytic techniques really help mood disorders, but I am aware of good solid research on CBT with mood problems. If you have a university that trains doctoral- or master's-level clinicians in your area, they may run a training clinic that will be affordable. Another option is to try using a decent manual like The Feeling Good Handbook.

Best of luck and strength. Sounds like a really tough situation.
posted by PsychoTherapist at 12:22 PM on November 11, 2010


Was recommended this in the past, just now starting to work through it...
posted by littleredwagon at 12:34 PM on November 11, 2010


I very much agree with what others said about finding a therapist, especially one who does CBT.

I find the worst thing for me is to just sit around and mope. If you think you can make yourself go regularly, sign up for some kind of class or lessons, because it will give you something to do outside the house on a regular basis.
posted by shponglespore at 3:17 PM on November 11, 2010


Hey. I just came out of a bad long depressive episode, and I'm sorry to hear you're going through this. There are lots of great suggestions already, and generally, I second all of them.

I'm agoraphobic, so I have a hard time getting out of the house even in the best of circumstances. What really helped for me was doing a lot of nice stuff - for me. For about a month and a half, I had a daily acupuncture appointment (at a community acupuncture clinic) in the morning - that made sure I got out of the house, and made sure I talked to some one I was acquainted with. When I had time, after the acupuncture appt, I'd stop at a coffee shop and read the paper - so much so that I became a regular, and they were very happy to see me, which is so very nice when you're not so happy to be yourself. I got massages whenever I could, I went to the community hot tub, and I even made it to the nearest Korean women's spa to get a scrub and moisture.

For me, it really helped to find small projects and finish them, and to get some exercise whenever I could. But those daily acupuncture appointments really made a huge difference for me. If acupuncture isn't your thing, do something else that makes you feel like you're taking care of yourself.

And if I can be of any help, memail me.
posted by vjpdx at 9:13 PM on November 11, 2010


Based on my own experience, one thing it's all too easy to let slide is consistent, reasonably-healthy meals. If you're working varying shifts it may be harder to schedule these, but I found it so easy to just be like "Oh, I'm kind of hungry but eating takes work and I'll still be hungry later, so I'll wait and eat then," and then "then" gets later and later. Doing this just fed* the cycle — my schedule was all screwed up AND I felt even more like crap because I wasn't eating well.

Healthy meals are mostly better than junk, and definitely go ahead and snack if you get hungry, but I think just obligating yourself to eat 3 meals a day, at whatever mealtimes fit around your shifts, might help a lot with maintaining a routine and making sure you have the energy to keep going.

*argh, no pun intended
posted by josyphine at 4:10 AM on November 12, 2010


Dear PsychoTherapist— you raise a very interesting point. Appreciate your respectful challenge. Contrary to popular belief among CBT proponents, there is ample research demonstrating the effectiveness of psychoanalytic/psychodynamic psychotherapies with mood disorders. In fact, recurrent studies (5 independent meta-analyses) show that psychodynamic therapy has a bigger and more lasting effect on depression and other common disorders (generalized anxiety, etc.), even when the treatment ends, and that other non-psychodynamic (such as CBT) tend to decay over time for the most common disorders. (Abbass et al., 2006; Anderson & Lambert, 1995; de Maat et al., 2009; Leichsenring & Rabung, 2008; Leichsenring et al., 2004). de Maat, Dekker, Schoevers, & de Jonghe, 2006; Gloaguen, Cottraux, Cucharet, & Blackburn, 1998; Hollon et al., 2005; Westen, Novotny, & Thompson- Brenner, 2004).

Even more interesting, a team of independent investigators found that psychodynamic methods predicted successful outcome in cognitive therapy (Castonguay,Goldfried, Wiser, Raue, & Hayes, 1996). In other words, CBT clinicians who practiced (unknowingly?) psychodynamic methods (relationship-oriented, experiencing vs thought-oriented) were most successful in their CBT work and clinicians who most rigidly adhered to the cognitive treatment model (per Beck focusing on distorted cognitions) predicted poorer outcomes.

It’s not just psychoanalytic/psychodynamic techniques that are supported in the literature. Psychoanalytic concepts are also increasingly more evident in the neuroscience literature. http://www.scientificamerican.com/article.cfm?id=neuroscience-meets-psychoanalysis

Here’s a wonderful article summarizing all the research that is out there, demonstrating the effectiveness of psychoanalytic/dynamic therapies. http://www.apa.org/pubs/journals/releases/amp-65-2-shedler.pdf

As a clinical psychologist in practice for over 25 years, I’ve really grown to appreciate a variety of methods and techniques—while the contemporary “psychoanalytic” approach is always central for me, I also use CBT techniques at times. I also use experiential /existential methods to make contact with my patients. When I was first in practice, I was more dogmatic—over the years, I’ve grown to really appreciate the eclectic model.

In response to your suggestion that Night Owl would be better off seeking treatment at a university's "training clinic"—having been a pre-doctoral intern at a major university’s student counseling center, I can tell you with first-hand knowledge that there’s a big difference between clinicians in training (whether at the MA or Ph.D. level) at a university clinic and a licensed clinician working on a secondary doctorate at a psychoanalytic institute. You have a much better chance of getting a seasoned (licensed often for 10+ years) clinician at a psychoanalytic institute. At a university counseling center, the focus is on brief treatment. Night Owl is expecting to be challenged for more than 5 months—my suggestion was based upon the belief that it would be nice if Night Owl could have the option of support beyond the typical 12 sessions that will be granted at a University clinic. If you read the studies closely, you will find that a psychodynamic therapy will address underlying issues and have more of a lasting impact on Night Owl's depression than a straight CBT treatment.
posted by drjmac at 2:32 PM on November 14, 2010


Thanks, you guys. I'm still struggling. Even worse right now, actually, but rereading this thread reminds me that I have a support system. So thanks.
posted by Night_owl at 10:23 AM on January 23, 2011


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