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my depression's back. now what?
February 25, 2014 9:29 AM   Subscribe

My depression has slowly, subtly trickled back into my life and now it is here full-throttle. I don't know what I'm supposed to do or what I need to feel better.

I was doing so well and was completely happy and anxiety-free for several months when I started Prozac last summer. Now I'm finding it almost impossible to get out of bed in the morning. I'm always lethargic. I cry sometimes. I feel hopeless and lonely and worthless. The simplest tasks feel like overwhelming chores.

I sought therapy when I felt the symptoms were coming back, but many of the CBT-oriented therapists in my area are not accepting new clients. I settled on a psychoanalytical guy, but I really don't know if it's helped at all. He likes for me to talk about my past and my dreams and my repressed anger, etc. I think I may need more concrete tools, but he said I have too much "depth" for CBT.

I've also found that being around my parents makes it worse. I went home this weekend to recharge and study and eat home-cooked meals, and when I came back to my apartment on Sunday I felt awful. I'm close to my mom and we speak every day, but I can't stand my dad (he is an alcoholic, and a very negative, critical person). When I was doing well mentally, I felt like I could be around them without getting wrapped up in the dysfunctionality of it all. Lately I feel like it just takes over and makes me feel worthless and bitter all over again.

Anyway, I guess I need a few hacks or pick-me-ups just to get me up from this low point. How can I force myself to get out of bed in the morning? Today, I planned to go to a 7AM workout, and school after at 930. I slept through both, snoozing my alarm for 3+ hours.

I tried filling my planner up for the week with daily Things To Do, i.e., scheduled work-out classes, put in my class times, work hours, and put in a few hours of studying every day. I thought being in a busy routine would help, but I can't get myself to even get through one day of it. UGH.

Please help.
posted by DayTripper to Human Relations (16 answers total) 7 users marked this as a favorite
 
I sought therapy when I felt the symptoms were coming back, but many of the CBT-oriented therapists in my area are not accepting new clients.

Seems like you need to travel outside of your area, or take on the CBT-oriented therapists that aren't part of the "many" who aren't accepting new clients. You don't need ALL of them to say "come be my client", just one.
posted by hal_c_on at 9:32 AM on February 25


Are you still on the Prozac? If so, it sounds like it has pooped out on you. I'm intimately familiar with that and the only thing that helps is dosage adjustment or changing meds altogether. Looking at your posting history, it seems like you have a lot of stress in your life right now. I'll agree with hal_c_on that you need to find a therapist that can give you some concrete skills. You might want to try DBT as an alternative to CBT, though they are related. Memail if you want to talk. I grew up with an alcoholic mother so I know how the disease can impact you.
posted by kathrynm at 9:41 AM on February 25 [1 favorite]


I tried filling my planner up for the week with daily Things To Do, i.e., scheduled work-out classes, put in my class times, work hours, and put in a few hours of studying every day. I thought being in a busy routine would help, but I can't get myself to even get through one day of it. UGH.

Start small.

Greet every day with two goals: Get through the day (doing what's required of you - your school work, etc), and do one thing, just one thing every day, that makes your life better in some concrete way.

It doesn't matter what it is. Doesn't matter how big or how small the act is. Just do something that you will designate as What I Did Today to Make My Life Better. At least one. Every single day. Keep a log of them if you want to.

Again, they can be small. Do the dishes so your kitchen smells nice. Clean the toilet. Get a haircut in a style you know works. Learn to moonwalk. Go thrifting and maybe pick up some clothes that look good on you. Go for a long enough walk that it counts as exercise to you. Cook a meal with leftovers you can pack for dinner for a couple nights. Pick up your apartment. Do one thing, every day.

Once you've done that one thing, the rest of the day is yours. Do whatever you want with it. Watch Netflix. Whatever. It's yours.

Pick up some melatonin and try going to bed earlier. Getting out of bed is a massive feat when depressed - do what you can to ease the difficulty as much as possible.

It won't fix everything but it will help.
posted by FAMOUS MONSTER at 9:43 AM on February 25 [18 favorites]


I think I may need more concrete tools, but he said I have too much "depth" for CBT.

Your shrink is a snob. Nobody has too much depth for CBT. Aparet from anything else, you need a new therapist. What is available immediately through your school's mental health services?
posted by DarlingBri at 9:43 AM on February 25 [9 favorites]


You may need to tinker with your drugs. Go to whomever prescribed the Prozac and see if you need to try something else.
posted by Ruthless Bunny at 9:58 AM on February 25 [2 favorites]


I sought therapy when I felt the symptoms were coming back, but many of the CBT-oriented therapists in my area are not accepting new clients. I settled on a psychoanalytical guy, but I really don't know if it's helped at all. He likes for me to talk about my past and my dreams and my repressed anger, etc. I think I may need more concrete tools, but he said I have too much "depth" for CBT.

DTMFA.
posted by kagredon at 9:59 AM on February 25 [9 favorites]


Sometimes getting out of bed is just plain hard until you do something to provide a little boost. Can you find a way to keep a glass of orange juice on your nightstand, maybe with ice packs in a mini cooler, and drink it when your alarm first goes off?
The spike in blood sugar might be just enough to keep you from falling back to sleep and provide the tiny boost needed to at least stand up.

Once you're standing of course, it's just one step at a time. Congratulate yourself on just physically getting out of bed. Then decide what to do next. I agree with FAMOUS MONSTER that you should start small.

And of course, also, see your Dr. to adjust your dosage or drugs, and find a therapist who won't dismiss you!
posted by trivia genius at 10:15 AM on February 25 [1 favorite]


This winter has been hard for me too. FAMOUS MONSTER is absolutely right. Start small. For me, it was getting my butt to a cardio class once a week. Then it was twice. Then three times. Before I knew it, I was back into my regular routine. Getting out of bed is easy now. A couple of months ago it would have taken nothing short of fire to get me up on time.

Sometimes I get very ambitious ("This week I will give up cigarettes, eat clean, and work out for at least six hours!") and I end up disappointed. By slowly adding new changes week after week, I'm hitting my goals.

Get your butt to the doctor and get those meds looked at. Perhaps the Prozac isn't working for you, but only a doctor can say for certain. And keep looking for a therapist with a CBT approach. Sounds like the one you're going to isn't working out for you.
posted by futureisunwritten at 10:18 AM on February 25


I think I may need more concrete tools, but he said I have too much "depth" for CBT.

Whoever said that is a quack, at best. Amazingly irresponsible.

Find a CBT practitioner, see if it helps. From a therapy point of view it is absolutely one of your best shots.
posted by jcworth at 10:21 AM on February 25


When I am in that place, I can't take joy in anything, but there are a couple things I do still take some pleasure in. Does it still feel good to eat chocolate? Get a massage? Take a bath? Stretch? If so, consciously make whatever you can put on that list the highlights of your day. Remind yourself, when you're feeling dark, that at least there is this one good thing in your life. Tiny step but it can lead to better.

Longer term, I found the book "Undoing Depression" by Richard O'Connor to be very useful in preventing the backslides like you're experiencing. It's hard to implement its ideas when you're in the midst of a deep depression (though order it from the library and see if you have it in you!) but it is great when things start to get a little better.
posted by metasarah at 10:34 AM on February 25 [1 favorite]


Hi! I'm so sorry you're going through this. Here are some thoughts:

First, know that though this is something that you can influence, what you're experiencing is real, and that sucks, but it also means there are ways to engage with it to make it better. It sounds like you already know that, but my experience of anxiety/depression is that it always helps to hear that.

Second, I don't love your therapist discouraging you from engaging with concrete and research-supported tools (CBT) to improve your internal state, and I really encourage you to try to find someone else. We all have depth, and it's disappointing that a therapist would use this as a reason not to engage with ourselves in productive ways. If you have someone who can help you shop around, this is a reasonable thing to outsource to a friend or other support person, because it can feel so daunting to engage with.

Third, have you tried mindfulness meditation? It can make a huge difference in a relatively short period of time (and even more over a long time). I find that when I'm in a twist, I can't meditate on my own, but guided meditations are great. I've been using headspace to great effect. The app is free, and there are some free meditations that you can try out, and then you can sign up for a paid subscription if it's working well.

Finally, do you have people who can be your cheerleaders? These are people who can provide some external encouragement and structure. I find I'm better at following through when I've told someone what I plan to do (and FOR ME, it's best if that person will be enthusiastic when I succeed and loving, forgiving, and encouraging when I don't manage to come through.) If you don't have someone like that and a stranger might help, memail me.

Hang in there!
posted by spindrifter at 10:35 AM on February 25


Depression sucks. I have been there too.

One thing that has been so important for me in the past to beat it, personally, has been diet and exercise. At first, I was able to do the diet and exercise almost as a punishment on myself - like feeding the depression. But slowly, it has seemed to cause a whole change of gears in my head.

Also, nth above - get a new therapist
posted by Flood at 10:39 AM on February 25


I find getting up in the mornings incredibly hard, and have found a Lumie lamp (that turns on gradually over 30 minutes with natural daylight) incredibly helpful. I know it's probably the last thing you want to do, but I find (when I can force myself to do it) that getting outside for some fresh air and exercise really helps when I can feel myself getting down.

I'd also recommend Cognitive Analytic Therapy, which goes a bit deeper than CBT but also provides concrete tools for recovery.

Good luck!
posted by Dorothea_in_Rome at 11:15 AM on February 25


My sleep schedule and my mental health are inextricably linked. If one is stable, the other is stable. If one gets screwed up, the other gets screwed up.

I turn on a bedside sunlamp similar to this at the same time every morning. It helps tremendously to prevent that downward slide into sleeping later and later in the mornings and staying awake later at night when my anxiety is worse, and anytime I actually get up on time in the morning I feel terrible because I'm not well-rested... Even if all I do is wake up and stare at the lamp, it keeps things from getting worse.

Going outside is even better, but going outside would require getting out of bed.
posted by Bentobox Humperdinck at 12:12 PM on February 25 [2 favorites]


I'm piling on with all the people who said to go get your medication checked out, because something's up if your Prozac just pooped out on you. Maybe you need a different dose or to try a slightly different drug or something, but that sounds like a medical issue.

On the other hand, some of this might just be that you're feeling tired and bummed out. For example, I don't think it's necessarily a medical issue that you're hitting the snooze when, as soon as you get up, you're supposed to go on a hearty run and then sit in class for hours. Dude, of course you'd rather sleep. Try planning to do something so enjoyable it's worth getting up for, first thing. That way you'll be more tempted to get up.

For me, that's lazing around and having a couple cups of coffee. Maybe breakfast, if I didn't eat too late the night before. Oh, that's another trick -- don't eat after dinner, so in the morning you're starving and have to get up.

Also, try to get on a good sleep schedule (whatever that means for you personally) -- it's a ticket to feeling crappy if your sleep schedule is off, because you're always tired yet never asleep, which means you will almost definitely be grumpy and unproductive.

I also don't think it's necessarily a medical issue that you're feeling bummed after spending days with your parents. Suddenly having to play the part of "powerless little kid," especially when your parents happen to be PITAs for whatever reason (like your dad being a negative alcoholic), is not exactly going to make you feel buoyant. There might be other stuff going on, but honestly, I would expect you to come back after a visit to your parents feeling kind of exhausted and mope-y, that's pretty par for the course for adults, I think.

So yeah, I guess on top of getting a checkup by another mental health professional (your current "no CBT for you" guy does sound pretty odd. "You're deep" is a bizarre thing for a professional to tell a patient altogether, in my opinion) -- I think you should just let yourself be not-that-enthusiastic about stuff that kind of sucks, like jogging and hanging out with your parents and waking up early for class, and try to build things that are actually purely pleasurable into your life. And try to get on a normal sleeping/eating schedule, because not being on one is a guarantee that you'll feel out of sorts, even if everything else is fine.
posted by rue72 at 12:20 PM on February 25


Another person echoing the advice to get your meds checked with the prescriber. I've been on effexor for a couple of years and this year I worked out with my doctors help that it seems that during the winter months I need a little bit more. This is likely due to the decrease in light and weather keeping me inside more and not as active. On his advice as something to try I also changed what time of day I take it which made a difference.

It sucks but these sorts of meds can be fiddly and as some also suggested they just stop working for no apparent reason. This happened to a friend of mine and once they were changed altogether she was fine again.
posted by Jalliah at 6:48 PM on February 25


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