Once more into the abyss...

September 5, 2011 6:13 PM

When you've pulled yourself back from an emotional meltdown, how do you stop from falling back in repeatedly while you're trying to feel better?

So, before we start this, I'll say that I'm on Wellbutrin, Buspar, and Ritalin LA for depression, anxiety, and ADHD. I've also done therapy this past summer, but I only get so many sessions per year through my grad program.

On Friday, I had an emotional meltdown where I basically came to the conclusion that I could do nothing of worth, and that I did not deserve to be happy. My wife tried her best to pull my head out of my ass, but it was a pretty brutal evening for both of us. I kept pointing out little things that seemed to sum (in my head) to one epic life of being a fucking failure.

In the light of day, I know this isn't true - or, at least, I should know it isn't true. We went to a wedding this weekend, and I was feeling emotionally better, if not just slightly nauseous from travel/dehydration/alcohol on our way back today.

Now, this evening, I realized that I had forgotten to do something for a class I'm teaching tomorrow, and even though I'd had a good weekend, all of those feelings from Friday came rushing back. It seemed like because I was already on the edge from the last trip into the abyss, it was easier to fall back in this time. Forgetting this one little thing wouldn't normally have set me off, but in the context of my meltdown on Friday, it did.

We resolved it after a little work, but as soon as it started going downhill, instead of being able to stop it like I might have in other times, it careened out of control.

How do you stop this? When you're healing and still raw, how do you drop yourself from repeatedly tripping into the depressing abyss of self-loathing and hatred?

posted by SNWidget to Human Relations (24 answers total)

Best answer: You should look into mindfulness approaches. Avoiding falling into the abyss is a learnable skill.
posted by yarly at 6:27 PM on September 5, 2011 [7 favorites]

I think you need to figure out how you can go back to therapy. Otherwise you are inadventently putting your wife into that role and I doubt that's the best thing to do in the long run.
posted by bquarters at 6:35 PM on September 5, 2011 [4 favorites]

Best answer: It sounds like you're under psychiatric care. Or at least I hope since you're taking too many meds for a PCP to manage well. Call your psychiatrist and explain that you've hit a wall. He or she might be able to see you and adjust your cocktail to get you past this.

A dose of reality for you: You are not a failure. Just from your post I know that you have (a.) a wife you loves and supports you, (b.) friends and a social life, and (c.) a good job and responsibilities. Failures do not have these things.

One thing I do to help me get over the wall is make a list of things that I'm grateful for.

Good luck.
posted by dchrssyr at 6:39 PM on September 5, 2011

Response by poster: bquarters: I'm trying, trust me.

My wife and I have had long conversations about our roles, and what she is and isn't willing to do for me. She's not my therapist, and I'm not treating her as such. Friday was one of those nights where I just couldn't say anything positive about myself, and I definitely slid into something similar this evening.
posted by SNWidget at 6:40 PM on September 5, 2011

Response by poster: dchrssyr:

The biggest problem right now is that because school's started up, I suddenly have no time go see a doctor again. I basically got everything all adjusted this summer, and it was working very, very well. I'm more apt to believe that this was just a one time lapse where everything sort of crashed down.

Done threadsitting, I promise.
posted by SNWidget at 6:41 PM on September 5, 2011

Sigh. If you're making excuses then you're not taking your mental health seriously. It's your responsibility, not your wife's. I feel for you, SNWidget.
posted by dchrssyr at 6:49 PM on September 5, 2011 [2 favorites]

If you're having a hard time getting to a therapist, you might try one (or more) of Albert Ellis' self-help books. I benefited quite a bit from his anger and anxiety books. This one might be useful for you (and there are plenty of others. They only require a few bucks (and a pretty reasonable time commitment). It might be worth a try.
posted by noahpoah at 6:50 PM on September 5, 2011

Best answer: You mentioned drinking at the wedding. Do try to avoid alcohol as it can aggravate depression. On preview, I see rope-rider is saying the same. Trust us, we've been there.
posted by mareli at 6:51 PM on September 5, 2011

Best answer: I set up routines for myself. So "I need to be a work, then see my friends on Saturday. I might be a mess, but I'll be fine if I can make it to my next appointment." etc
posted by Lovecraft In Brooklyn at 6:55 PM on September 5, 2011 [2 favorites]

Best answer: "In the light of day..." "Now, this evening..." Something I've noticed about myself, and also noticed about my ex who was severely clinically depressed, is basically that we had "sundowning" issues. The term is usually used to refer to elderly patients whose dementia becomes a lot worse at night. Thinking back on emotional meltdowns I've had, and that I witnessed in him, they almost always occurred at night, near (or more likely after) bedtime.

This isn't the most scientific analysis ever, but I've been able to nip the majority of these meltdowns in the bud just by going to sleep earlier. If I'm not up late, I can't be up late freaking out. Something to think about.
posted by telegraph at 7:00 PM on September 5, 2011 [6 favorites]

if you're depressed and on multiple medications, you can't drink, period. also, you've got time to go see the doctor.
posted by facetious at 7:06 PM on September 5, 2011 [1 favorite]

It's not a one time lapse, based on your post, it's a two time lapse. Make time to see your doctor. Lots of things you can try that can help you long term, but based on what you've said, you need to focus on the short term right now.
posted by finding.perdita at 7:09 PM on September 5, 2011

A little something that I like to remind myself when I think I have no time for X, where X is something very important but not massively time consuming (like, say, seeing a doctor):

If I have time for MetaFilter, I have time for X.
posted by ootandaboot at 7:39 PM on September 5, 2011 [3 favorites]

Best answer: I kept pointing out little things that seemed to sum (in my head) to one epic life of being a fucking failure.

I do this too.

Stop feeding it. Recognise that it feels good to indulge in this rumination and mounting anxiety, as masochistic as that is, and that you need to resist that urge.

The following things have helped me pull out of that tailspin:

• Having a time limit. I can talk about the OMG BAD thing, but only for 15 minutes. After that, I have already talked about it and it is time to move on to something else. Have your wife time you and direct you away from the topic if (when) you drift back to it.
• Pursue an all-consuming hobby. You have to interrupt that cycle. Give yourself a difficult task that requires all of your brain. For me, sewing, cooking, and embroidery all scratch this itch. They require me to focus, which means I can't ruminate.
• Mindfulness. Pull your attention off of your racing mind and into your body. Are your shoulders tense? How's your breathing? Tight stomach? Butterflies in there? Furrowed brow? Sit with that. Does it intensify, or lessen? Does it come in waves? Choose to open your posture, breath slower and more deeply. Attend to your mind's frantic worry in the background, like a scared child. Sit with it, soothe it. Don't force it to stop.

Treat your mind the way you would treat an injured animal, or your wife if she were crying — you would approach slowly and gently, you would hold her hand in the dark and draw her close. When an infant is tired and screaming from over-stimulation, we do not turn up the music and shine flashing lights in its eyes. We bring it into a darker, quieter room and rock it gently.

Insisting on the evidence of your epic failures is equivalent to bringing that tired child to a punk concert, to yelling at your wife for crying, to introducing an injured cat to a snarling Rottweiler. Ramp it down, not up.

Bring the same gentleness to this scared person: yourself. You don't need to fix this anxiety. It is possible to provide a safe, soothing space for it.

Books to read:

Things Might Go Horribly, Terribly Wrong
The Zen Path Through Depression
The Mindfulness and Acceptance Workbook for Anxiety
posted by heatherann at 7:52 PM on September 5, 2011 [22 favorites]

Best answer: One more thing. Forgive yourself for the lapse(s). They happen, and they don't mean you're back where you started. You're making a difficult change. We all fall many times before (and after) we learn to run. What's important is that you are here, asking this question, and taking another stab at it.
posted by heatherann at 7:56 PM on September 5, 2011 [4 favorites]

Best answer: Heatherann suggests a few Acceptance and Commitment Therapy books, let me suggest two others. The Happiness Trap, by Harris and Get Out of Your Mind and Into Your Life, by Hayes.

A good ACT approach is to realize that all those harsh criticisms of yourself are ultimately just thoughts, made out of words. The mind will go on and on as it will, but the problem is we "fuse" to those thoughts as if they were real. We forget that the words "you're a failure" are just words.

In ACT's version of mindfulness, we work on defusion, not getting stuck in your thoughts. You can play on this by saying to yourself, "Oh, I'm having that thought that I'm a failure again! Hello, thought, I see you over there." Or even one step more to say "Oh, I notice I'm having that thought that I'm a failure again, wow, there it is again!"

You make no effort to suppress the thought (probably wouldn't work anyway), to fight the thought, or even to evaluate the truth or falseness of the thought. It's just a thought, and your job is just to notice. And breathe. And to move on with your life.

This approach may or may not work for you. By all means discuss it with your therapist. It's just an approach that I'm finding pretty beneficial these days.
posted by jasper411 at 8:17 PM on September 5, 2011 [2 favorites]

By emotional meltdown, do you mean raging or excess emoting? If so, your meds may need adjusting. Wellbutrin has stimulant effects, as does Ritalin, of course, and the combo may be pushing you over the edge. IANAD.
posted by Wordwoman at 9:28 PM on September 5, 2011

You might start the mindfulness stuff with these videos of Thich Nhat Hahn. and this one on anger and suffering.

He has a series of very practical walking meditations (breathing in, take a step; breathing out, take a step), in which you walk and say: breathing in I embrace my anxiety, breathing out I hold my anxiety very tenderly (then cycle through which ever emotion arises - angry, fear, despair, etc., doing the same excercise). This tends to cause the negative feelings to gently go away rather than fighting them. A dear friend who was prone to anxiety attacks was able to get rid of them.
posted by zia at 10:03 PM on September 5, 2011 [2 favorites]

Always make time for your own health and wellbeing if it has the capacity to destroy your life and other people's.

Look into mindfulness, go to a therapist, stop drinking, and get your meds evaluated. Put yourself and your wife first.
posted by mleigh at 10:12 PM on September 5, 2011 [1 favorite]

Best answer: Eat.
My first, First Aid for emotional meltdown, is to eat something with protein in it.
Having a hot drink to hold is soothing and calming.

Other people have used the concept of H.A.L.T. (Hungry, Angry, Lonely, Tired), it's googleable.

I figured this out myself.

I've found that meltdowns usually don't happen because of any talky-reason, real meltdowns don't happen unless someone is hungry, and/or tired, sick/pained, cold (and even being dirty doesn't help).
When dealing with myself, OR others - triage.

'Tired' is usually a major factor, but not immediately dealable, so go in the following order.

First establish whether any high protein food has been eaten in the last couple of hours. Obtain, and consume. (I usually carry around nut-bar snacks - with depression, you have to support the body, for the body to be able to support the mind). Hot drink, as mentioned (also helps to immediately raise blood glucose levels, but you need protein to not drop again shortly).

Make sure you are warm. Cold => tense => anxious.

Ask yourself, is there any source of physical pain? Eg headache? Minimise physical pain, say take an ibuprofen for headache.

Go to the bathroom (literally if you need to - the more distressed someone is, the more likely they're unable to distinguish bodily needs from the emotional discomfort, see pain above), and splash your face with warm water and dry. Even brush your hair or tie it back if it's available. We're mammals, and that little bit of grooming really helps the psychological state.
A hot shower is also very helpful, especially if someone is cold.

There is of course sleep - if you can sleep, please do, but otherwise:

Once someone has had all these bodily needs met, *then* you can talk about the problem with someone caring. Not meeting the physical needs first, and I, you, and they, are more likely to get more distressed.

Find or talk to someone caring. Possibly not even about the issue, but just so you get a sense of human companionship.
If you don't have a person to talk to, ring a helpline.
If you don't have a helpline, write it down.

Writing down thoughts is better than churning them around in your head.
It slows you down, makes it easier to see the logical fallacies or exaggerations in those thoughts, and see where you are only presenting one side of an issue, and makes it easier to pull back from the brink.


Another thing to write down, is your own summary of anything I have written above, or what other commenters have posted. Because you need to decide ahead of time what to do when you are falling down, and you need to remember it, and not have to make decisions about it all, when you're in a distressed state.

So yeah, Elysum's Mental First Aid.


And the great thing is, while you've noticed that you're more likely to be close to the edge after being distressed like this, the good news is the better you deal with them, and longer you go between them, the easier it gets, and the further from the emotional pits you get.

Also, it helps to realise that it's not really the abyss - yeah, it's an emotional pit, but cycles lead you out of them as well as into them - it just might take a little longer, but it'll be ok.
posted by Elysum at 12:55 AM on September 6, 2011 [26 favorites]

Best answer: There's a mantra I use when this hits me. I understand and accept that I have depression, that this is a part of me. But it's not all of me.

I am not my depression. My depression is not me.

Deep breath. Repeat.

I am not my depression. My depression is not me.

Another deep breath.

I am not my depression. My depression is not me.

Over and over. Reminding myself that this is a disease. Sometimes I get angry at it for pulling me down. Sometimes it seems so silly to me that it can do that. But I still have to remind myself:

I am not my depression. My depression is not me.

It is part of me, but not all of me. I try hard to remind myself of it, and this mantra drives it home.

It may not work for you - it doesn't work 100% for me - but still, I hope it does help you a little along the way.
posted by mephron at 1:57 AM on September 6, 2011

Best answer: I was going to chime in with something similar to what Elysum said. I call it Back To Basics.

When I melt down I try to 1) drink more water, 2) eat healthy food and 3) take a walk/get some exercise.

If nothing else, it buys me some time to feel differently.
posted by vitabellosi at 3:37 AM on September 6, 2011

"When you're healing and still raw, how do you drop yourself from repeatedly tripping into the depressing abyss of self-loathing and hatred?"

I make seemingly unrelated changes in my life. I rearrange the furniture in my home so that things will look different. The fact that things look different helps to reinforce the fact that I FEEL different. And I may buy some new clothes. Again, the goal isn't to make myself feel different. A new look doesn't solve problems. But, if you've already solved the problem, a new look can help to reinforce the idea of A New You. I once moved into a new apartment when a long term relationship ended. It really helped.

I believe in reinforcing positive changes with other positive changes, even if they're not related.
posted by 2oh1 at 12:33 PM on September 6, 2011

Best answer: Oh yeah - to follow on from 2oh1's point,
once Mental First Aid has been completed:

Go tidy your sock drawer.

I know this sounds ridiculous. But it really helps. And it doesn't have to be the sock drawer, but something just that easy - junk drawer is too hard! And not anything you've been 'putting off'.
Just, match & fold your socks, and put them in the drawer neatly.

I think this works, because you are establishing a feeling of control, of agency, over one tiny part of your life. And it's a distractor, something calming until your brain stops freaking out.
But yeah, when everything feels out of control, tidying socks is one small step for man, that things are controllable.


I also sometimes listen to EFT Talk Radio Thingy - http://www.taptalkradio.com/23-releasing-sabotage/
Disclaimer: If you listen to it, you'll notice it functions as nice, healthy, CBT-style turning thoughts around to a more positive self-dialogue. But I have been unable to find anything similar from a CBT framework.
The founder has a strong vein of 'woo', and believes it works by tapping specific acupuncture meridians. It doesn't, a study showed tapping randomly, or on a doll, works just as well. What it is basically, is healthy self-talk, combined with an emotionally calming distractor.
It's one of those things where, if the proponents weren't pushing obviously wrong-headed notions of how it works, and miracle cures, more people would have noticed that it *does* actually work (in a helpful, but non-miracle kinda way), rather than distancing themselves.
posted by Elysum at 6:50 PM on September 10, 2011 [1 favorite]