In a haze, and I don't know what to do about it. Depression, school, work, &c.

February 22, 2012 11:23 AM

In a sleepy haze, and I don't know what to do about it.

My question is pretty typical in terms of questions about depression, but I still find myself not knowing where to go from here. I'm sorry for the length, but I can't really pinpoint what the problem is.

I'm in the last year of an undergraduate program, and I've completed all my coursework. I'm working on my senior project currently and plan to graduate in June. Ever since my second year of college, I've had trouble staying on the ball, but I've managed to come through with pretty good grades regardless, since I'm in a (more permissive) humanities program and feel I'm good at what I do, when I actually do it.

The problem is that now that my life is somewhat shapeless, I don't have the guilt I did before from failing my responsibilities, but I have a new listlessness that seems impossible to conquer. My main problem is that my depression takes the form of exhaustion. (I'm quite sure it's depression based on family history and clinical screenings.) I find myself unable to operate on a schedule that doesn't start at noon and end at about 5:00 AM. While I was in classes, this would result in me missing sometimes two or three days of classes at a time (missing one would send me into a spiral), and missing morning classes pretty consistently.

I work almost full-time at the university. My job is very boring, but I don't mind it because we are allowed to listen to music and surf the internet while we work. My hours are flexible. Last quarter when I was still in classes, I arranged it so my first class would be around noon, and I still managed to sleep in too much and miss class out of anxiety. Now my work hours are more around 11-ish, but I find it extremely difficult to make it on time. I've tried many things: I've set multiple alarms, all over my room, but I turn them off and go back to bed like a zombie. My boyfriend offered to give me wake-up calls, but I started to feel guilty about it and sometimes afterward I would still go back to bed. I downloaded the iPhone Sleep Alarm app, which wakes you up naturally based on REM patterns (and seems to work really well!), but if I'm tired I just go back to sleep anyway. I don't think it's health related, since I've had a variety of screenings in the last year (check-ups, surgery work-ups, &c.) that haven't turned up anything abnormal.

I've seen various mental health care professionals in the last few years on my student insurance. I'm currently starting to take Wellbutrin again, after trying two or three times but getting freaked out by the idea of being medicated. It's given me a little more energy when I'm awake but I'm waiting for it to kick in (it's only been a few days, and I've never taken it for more than a week).

I've tried therapy, but my first therapist wasn't a good match, and I don't have the extra funds to pay the co-pay if I go outside the university. Also, I have an extremely difficult time making appointments (which is the reason I make appointments in the first place). I've been blacklisted by their therapy branch because I've skipped so many times (the director has emailed me directly to give other options when I make a request for intake). My psychiatrist still sees me, which I'm glad for, because she's kind of a lifeline. I feel honestly so helpless, like I can't make it to appointments without my mom or dad driving me there-- I'm living alone in the city for school.

This is starting to boil over because I'm looking at graduation in a few months, and I'd like to stay in the city for another year or so, but the effort involved in finding a new, sufficiently-paying job seems Herculean. All I can see myself doing is going home and living with my parents until I can find a small stream of income (and someone to babysit me) so I can pay student loans and all. Trying to write a cover letter is like trying to write a poem in a foreign language. I think the real problem is that thinking about starting a new job, training, taking a bus to work, all seems like a recipe for disaster. (Though, in the past, starting a new job has given me the bump I needed to get back on a reasonable schedule.)

Last winter break I went home and it was terrible. I couldn't sleep at night and slept in until 2 or 3 in the afternoon every day. It made me feel awful, because my dad likes to spend time with me in the day and I couldn't will myself out of bed. I felt like an overgrown teenager: I was blunt and awkward with everyone, and my grandfather remarked to my mom after I visited him that I was "getting shyer and shyer." I felt anxious and withdrawn and mostly because I was exhausted. I've never felt so deep in the grip of sleep-- depression, but in the form of perpetual struggle with sleep.

Last night I was up until 5 tossing and turning, which is probably because of the Wellbutrin. Even when I get to bed earlier, it seems waking up at a normal time (8 or 9 in the morning) is literally impossible, or something that on miraculous occasions might happen but will result in me feeling groggy all day and not being able to work on my school project at night. I feel like I'm torn between being productive (which happens in the late hours when I'm energized) and leading a responsible adult life (going to work at a respectable hour, &c.)

I'm mainly looking for ways that I can get myself on a normal schedule without feeling awful. I'm hoping the Wellbutrin will work for me, and am ready to make big changes. I currently smoke once or twice a day (I was self-medicating before Wellbutrin, and it worked surprisingly well, but obviously isn't a good solution), but I think it makes me more deeply tired. I sometimes drink coffee. My eating schedule isn't the best because I'm often too exhausted to grocery shop or cook, and I try not to spend a lot of money on pre-prepared foods. I think I need some kind of compromise. I remember in the past when this problem was less pronounced that cutting out all stimulants and having a strict eating/sleeping schedule helped but that seems so distant, it would really be nice to hear some concrete suggestions, about anything really.

The weirdest thing is that I'm not really accountable to anyone. Most of my friends have graduated and moved, and my parents don't really ask me about the specifics of my life, so I mostly hang out with my boyfriend at the moment. Telling him about what I've done (or haven't done) during the day usually makes me feel vulnerable and uncomfortable, because I can't be proud of what I accomplish. In the past, peer pressure has really helped me stay on task and live a "normal" student life. I feel scared about being depressed, since in the past that's when I've treated people the worst. Nothing I do makes me very happy except working on my senior project, because I feel like it's something creative and interesting that I'm responsible for. When I get really down I can't even open a book, but I've found that the boost from smoking and now Wellbutrin has helped me get out of mental ruts and I'm much better at applying what I know about catastrophizing and positive self-talk. I'm pretty cool with my attitude and mood lately (though advice is welcome), I just want to function during the daylight hours.

This is ridiculously long! Thank you!

posted by stoneandstar to human relations (18 answers total)

I think I need some kind of compromise.

dingdingdingdingding! You're ill right now. Don't worry so much about a "normal" student life. You like working on your senior project and you'll probably manage to finish school, right? So fuck everything else and scale back what it means to "function during the daylight hours." I often suggest this approach. Lots of Mefites swear by the Feeling Good Handbook for CBT help when you can't get to therapy.

Because you work at the university, you may get more slack than a "regular" employee in a "regular" job would. Can you explain that you have a chronic illness and ask to adjust your hours a little so you can come in a bit later?

waiting for Wellbutrin to kick in

Try fish oil, enough so that you're getting 1000mg of EPA (not combined EPA and DHA, but EPA) per day. You can also add a B-complex vitamin. A multi can't hurt either if you're not eating well. Have you had your D levels tested? Low vitamin D levels can make symptoms like exhaustion much worse. You may need to supplement D, but while I can recommend the fish oil and B complex without much worry, I wouldn't supplement the D without a doctor's input because it's fat-soluble. Don't worry about coffee and nicotine right now. (Note that smoking makes Wellbutrin less effective, though quitting might also be depressing and upsetting.)

My eating schedule isn't the best because I'm often too exhausted to grocery shop or cook, and I try not to spend a lot of money on pre-prepared foods.

Okay, right now you can eat fairly healthily or fairly cheaply, but probably not both. You just don't have the energy for it. Get pre-prepared foods: takeout salads for lunch would be a good way to get some veggies, as would trays of pre-cut fruit or vegetables. Bagged spinach can be steamed in the microwave in about 2 minutes. Buy Ensure, stick it in the fridge, and slug one or two in the morning. Frozen meals for dinner are perfectly fine. Give a box of Kraft Dinner a boost by throwing some wilted spinach on top. Don't shy away from healthy fats--avocados and oils and nuts--because recent research suggests fatty foods support emotional health.

And also, don't worry about a few months from now. Most depressive episodes do lift after a few months whether there's medical intervention or not. The weather's getting better. May might feel like a completely different world. Bird by bird, dude.
posted by liketitanic at 11:50 AM on February 22, 2012 [13 favorites]

It also sounds like you could have anxiety, which might get worse with the Wellbutrin. When I had diagnosed anxiety, my behaviour was a lot like yours -exhausted, but couldn't sleep at night. I was creating my own little avoidance pattern with that. My anxiety was situational, and I did stay on Wellbutrin through it (lower dose than most people though). My doc did add Buspar to combat the anxiety, which helped immensely. I was able to drop that after the anxious making situations went away, in a few months.

I am not a doctor. I should not play one on Metafilter. Good luck!
posted by kellyblah at 11:51 AM on February 22, 2012

Was your visit home for Winter Break the only vacation you've given yourself in the past few years? That may have a lot to do with it. I'm a bit zombie-ish these days, and was myself toying with seeing a therapist, but then realized that "you know, the fact that I haven't had any time off in TEN YEARS may have more to do with it. I am probably just legitimately tired."

Maybe YOU are also just tired. This isn't the most convenient time, I realize -- since you still have a project to work on -- but try giving yourself SOME kind of break; at the very least, just ONE DAY one weekend when you don't talk to anyone, don't do any work, and decide "I am going to do whatever I want and FUCK ANYONE WHO THINKS I SHOULDN'T," and see if that helps a tiny bit. We NEED down time, and it sounds like you haven't been giving yourself much. (Yeah, I know, you went to visit your family, but it sounds like your father nagging you to do stuff with them all the time didn't make things very restful for you; maybe next time you see them, have a heart-to-heart with your dad about you needing just a couple days to decompress first BEFORE he hits you with the "hey, kids, let's all go BOWLING!" stuff or whatever.)
posted by EmpressCallipygos at 11:53 AM on February 22, 2012 [1 favorite]

1. Lots of other people have been in the same boat. You're not alone.

2. There are professionals who can help you. Good ones understand that difficulty showing up is part of the problem and don't hold that against you. Keep looking for someone who is convenient for you to see and you can afford. Its worth it to work on these issues now. It you don't they just come back worse and worse and it gets harder as you get older.

3. No shame in meds. Its a chemical fix to the chemical component to the problem. Talk to your doctor about taking something like Ritalin or Adderall in the morning to get you moving. Don't take Wellbutrin in the afternoon.

4. Exercise. Preferably outdoors. Maybe where there are other people around. Even if its just walking. Sounds like there may be seasonal element to this so light may help.

5. You'll get lots of advice here and elsewhere. Most of it will sound stupid or obvious. Or you'll say to yourself that if you could do what people are suggesting than you wouldn't feel this way in the first place and need to ask for their advice. For a long time nothing that you try will work. Until suddenly it does. And then you'll give the same advice to others, even though you know how hard it is to actually follow and that it may not work for a long time.
posted by RandlePatrickMcMurphy at 12:01 PM on February 22, 2012 [1 favorite]

Before I say too much, I just wanted to say that you have seriously accomplished a lot for yourself despite what's going on. I think you need to give yourself some credit for that.

I know that will probably sound unbelievable to you right now, especially since a lot of people in our age range seem to be doing a lot more exciting things. But, you are not in a good place right now (to put it lightly) and I know this isn't what you want to hear, but you need help. So, don't compare yourself to other people when you are dealing with your own stuff right now. You will do more things when you are ready to do so.

This is going to involve a process of getting better. But, I think more than anything you need to give yourself a break.

Get out of the house at least once a day whether that's doing something like getting a coffee, going to the bookstore or record store, going to the gym or whatever. Just get out of the house once a day. Otherwise, the anxiety tends to build up and you won't feel that great staying inside of the house even if it's comfortable for you.

Don't create an hourly or timely kind of schedule for yourself. Create a daily to do list with small tasks on it instead. I find it difficult to wake up early because I am so exhausted, but I find that it helps if I create a to do list for certain things. Also, talk to you employer and figure out if you can change your availability, then do so.

I prefer taking my meds late at night so that way I can just sleep it off. I don't know what would work better for you, but maybe you should take the meds at a different time like night time so that way they are on your night table as a reminder. That way, you can be more consistent with your meds and take them for longer than a week since it takes a while for the meds to kick in.

Keep looking for a therapist. There are a lot of great therapists out there. I know this because I have worked with quite a few professionals through the university. Getting to places is very difficult for me because of my anxiety. I used to use cab rides as a cop out, but at the end of the day I still got to where I needed to go. However, I feel much better walking to the bus stop and taking the bus because it proves that I have overcome that obstacle.

Talk to your psychiatrist. Get referrals from your psychiatrist and see how she can help you. She should know of quite a few therapists that can help you out.

Please feel free to memail me. I really hope that things improve for you. Know that you are not alone even when it feels like you are completely on your own.
posted by livinglearning at 12:14 PM on February 22, 2012 [1 favorite]

The weirdest thing is that I'm not really accountable to anyone. Most of my friends have graduated and moved, and my parents don't really ask me about the specifics of my life, so I mostly hang out with my boyfriend at the moment. Telling him about what I've done (or haven't done) during the day usually makes me feel vulnerable and uncomfortable, because I can't be proud of what I accomplish. In the past, peer pressure has really helped me stay on task and live a "normal" student life.

I think you should enlist a mutual aid society in the form of another student who wants either a workout partner or to improve their conversational English. Your half of the bargain is to keep them company or teach them slang while you go for a walk for an hour each morning. Their half of the bargain is to bang on the door of your apartment each morning until you get up and stumble outside in sweatpants and a pair of sneakers. Post a notice in the ESL lab, or similar. OR you should advertise yourself on Craigslist or to your coworkers as a dog walker. Research shows that people are more likely to show up for a friendly animal than for another person!

I spent a lot of my life trying to make myself better at administrative crap like you're describing. Finally, I just outsourced it or automated it. Made my life a lot better.
posted by Snarl Furillo at 12:17 PM on February 22, 2012

I'm mainly looking for ways that I can get myself on a normal schedule without feeling awful.

small changes. In a similar period, I made one new rule for myself. I denied myself use of the snooze bar. I could advance the alarm, I could set it later, I could do anything, but once the alarm went off, I was not allowed to hit snooze or change the time for later.

Small focus is a lot easier to pull of and a lot less of your personal baggage gets involved.
posted by Ironmouth at 12:34 PM on February 22, 2012 [1 favorite]

I'm currently starting to take Wellbutrin again, after trying two or three times but getting freaked out by the idea of being medicated. It's given me a little more energy when I'm awake but I'm waiting for it to kick in (it's only been a few days, and I've never taken it for more than a week).

Are you more or less freaked out then you are by the idea of being depressed to the point of non-functioning for the rest of your life?

If you've never taken Wellbutrin for more than a week, than you've never really been on it. I would encourage you to commit to staying on this drug for a minimum of two months. You have no idea what the choice is between you medicated and you unmedicated if you do not give it time to work. That is 4 - 6 weeks.

This is the ideal time to get on this drug, as you have few commitments and free and ample mental healthcare at your disposal, possibly for the last time in the foreseeable future. This is a golden opportunity; don't waste it.
posted by DarlingBri at 12:55 PM on February 22, 2012

Internet diagnosis disclaimer attached, but this sounds like delayed phase sleep disorder. Maybe consult a sleep specialist?
posted by Wordwoman at 1:31 PM on February 22, 2012

Write some scripts. Lots of people, and not just the clinically depressed, find that difficult projects become easier if broken down into a number of discrete steps, such that you can, at any time, tell exactly what step you're at, and what comes next. The requirements for good scripts go beyond those for good plans. You need something that you, personally, can comprehend when you're lacking the energy to really think about what you're doing.

I find that it works best if, apart from describing the tasks, I list out all the physical objects involved. Then I refer to the list when writing the description, so I can tell just what I'm writing about--not trivial when I'm depressed. Your mileage may vary.
posted by LogicalDash at 1:35 PM on February 22, 2012 [1 favorite]

Give the Wellbutrin time to work. It should pep you up some. And I mean really give it time. Two months, minimum. It made it hard for me to sleep at first, too, but eventually that evened out. I can't have any caffeine any more, though; the two together is a recipe for disaster.

Vitamin D supplements can help. They have delicious gummy vitamins now, and I find taking a handful of candy instead of with breakfast every day has helped. Lara bars are a good, no work meal replacement. They're just nuts and fruit, are very filling and won't make you crash the way something like a cereal bar or muffin would.

Is there any particular reason a noon to 5 am schedule is a bad idea for the immediate future, other than the fact that people think everyone should go to bed at 11 and wake up at 7? If you can get your work schedule to work with it, why not just ride this out for as long as it works? I'm biased on this, because I get all my creative energy between 10 pm and 2 am, and everyone is always expecting me to go to sleep instead of get shit done. You might have an easier time writing cover letters in the middle of the night, too, and if you email them when you get up the next day, no one is going to be the wiser.

However, if you want to get back on schedule, I have found the only thing that works for me is to--counter-intuitively--stay up later and later over successive nights, until I get to the point where I don't go to bed at all one night, then I usually manage to crash around midnight the next. There are some tips here that might help with that. Melatonin also works for me when I absolutely need to sleep like the rest of the world to be functional early the next day.

One more thing: could this be anxiety rather than depression? I sleep when I'm depressed, but I also sleep when I'm freaking out about stuff and just can't deal. When I'm really anxious, I don't feel anxious at all, just drowsy. My last year of university freaked me out and I slept all the time.
posted by looli at 2:00 PM on February 22, 2012

I have similar issues with the depression and sleepiness. I have been on several mood drugs in the past for depression and anxiety and none of them have really worked for me. I have tried antidepressants but they did more harm than good for me, and have tried fish oil but that didn't really do anything at all for me.

A little over a month ago I started eating a can of sardines every single day for lunch. (if you're a sardine noob, try the skinless/boneless ones) Sardines have the omega 3s, the vitamin D, and vitamin B12, and calcium if you eat the ones with bones. I have noticed an improvement, but I have significant stress/anxiety in my life right now so things are a bit fuzzy, however when I have felt like this in the past I have been pretty much nonfunctional and right now I'm doing okay. I've also overhauled my diet over the past few years which has helped a lot, and I try to get regular exercise.

A lot of my recent depression came from being bored with graduate school and having a boring university job. I'm not sure what to do about that in your case, but in mine I am trying to change my circumstances as well - which is the reason for my current anxiety levels,.

Anyway, my point is that eating the sardines has noticeably helped me. I also take a B complex vitamin, and I think I had a few deficiencies that I am slowly making up for. I do not currently take any medications.
posted by fromageball at 2:25 PM on February 22, 2012 [1 favorite]

Have you discussed this with your doctor? I know you say above you've had several tests, but it's not clear whether your doc was actively trying to solve this or if the tests were to address other medical concerns.

I recently wasted a LOT of time and money assuming that my anxiety was just, you know, anxiety, requiring Zoloft and lots of expensive psychiatrist appointments, only to eventually find out that a simple blood test and medication shift immediately fixed everything. Doh.

If you've already addressed this with your doc then ignore this comment :)
posted by bunderful at 3:27 PM on February 22, 2012

My eating schedule isn't the best because I'm often too exhausted to grocery shop or cook, and I try not to spend a lot of money on pre-prepared foods.

IANAD/IANYD - If you haven't already, get your doctor to check your iron levels - iron deficiency will make you feel lethargic and exacerbate a lot of the things you are feeling.
posted by mleigh at 4:54 PM on February 22, 2012

Exercise has worked wonders for me. I no longer feel tired during the day, even if I didn't get enough sleep the night before (lack of sleep still does affect me negatively in other ways though.) However I no longer have that sleepy, sluggish feeling I used to have. I most do high-intensity aerobics and yoga. It also does wonders for my mood, and stress relief.
posted by bearette at 7:02 PM on February 22, 2012

Take a look at delayed sleep phase disorder and see if that rings any bells.

There are night jobs out there, and some of them even pay a little bit more than the day shift. A friend of mine was quite happy working nights as a hotel desk clerk, and had about 4 hours of free time each night at work to study or do crafts.
posted by yohko at 2:22 PM on February 24, 2012 [1 favorite]

I started taking Wellbutrin a little over a year ago, and I will join in the chorus of folks urging you to give it more time to take effect. It has changed my life so much for the better. I'm not going to pretend I don't still have bad days, or even the occasional bad week. But I no longer have bad months.

I used to have stretches where I felt really great about life and the future etc., and then something would trip me up and I'd start slowly going down, down, down, to the point where you are now, it sounds like. Couldnt get up on time, showering felt like a herculean effort, every tiny problem caused a major anxiety attack... sound familiar? Then somehow after a couple months of that I would somehow pull myself out of it and create some new life plan that was going to make everything better (but was totally unrealistic, of course) and then I'd get back to being really happy and excited... until I would get tripped up again a month or so later and it started all over again.

Wellbutrin has enabled me to a) not be so easily knocked off balance, b) catch myself sooner when I do get off-balance, which keeps me from falling into the pit of despair, c) set more realistic and attainable goals which I then usually can meet and feel good when I do, which reinforces the sunny outlook, and d) be more forgiving of myself when it doesn't turn out as well as I'd hoped.

I hope you are able to find a way to help yourself feel better soon. Be as kind to yourself as you possibly can -- you are being very strong and brave by taking the initiative to take back control of your life. Also, there is nothing wrong with taking medication to help you get there. All that matters is that it works!! Clearly I'm biased, but you'll find that most people on this forum will tell you the same thing. Think of it this way: if your vision was failing, you could either keep squinting and insisting that if you try hard enough you'd be able to see just fine -- or you could go get yourself a pair of glasses and move on with your life!
posted by roscopcoletrane at 8:39 PM on February 26, 2012 [1 favorite]

A month later, thanks everyone! I'm back on Wellbutrin (for a month) and it turns out I was having a problem switching between different generics. On the one that works for me, and it's working great. The advice to focus on baseline needs was really helpful too.
posted by stoneandstar at 3:47 PM on March 22, 2012 [2 favorites]