Depression and Anxiety as it prevents you from doing what you want

September 20, 2015 7:39 AM

I hope some of you can speak to a specific area of depression that I see expressed in various examples but don't know exactly what to call it. I am hoping for tips on overcoming this specific aspect while I work on the larger problem.

I've known that I've suffered from depression for 30 years. Anxiety/fear is perhaps older, a part of my earliest memories. At my age, I'm rapidly losing hope that I'll ever really be free of either forever but I continue to get treatment.

I used to think that I was simply unmotivated when it came to avoiding things that I literally wanted to do. But I see a lot of examples both written and in art (1, 2, 3).

It's basically this: There are things you want to do. You know you want to do them. But you can't relax. You can't have fun. You can't do those things without a significant increase in mental pain. And so you don't do them and the pain of having not done them becomes heavier each day.

Once per day (and it's usually after that first hit of coffee), I get the feeling that I can do the things I want to do. This lasts about an hour or so, at which point I need external forces (responsibilities, job, etc.) to motivate me to do anything. Indeed, everything becomes something I don't want to do. I have projects that I've been "working on" for months that I just can't finish because it becomes excruciating to work on them.

Maybe this is just a feature of being in the "storm," but I'd like to know what you've done to help yourself do those things you honestly want to do... but just can't.

posted by tcv to Health & Fitness (10 answers total)

Best answer: So...this is maybe a long shot, but the post-coffee detail made me think. In addition to trying to treat your anxiety and depression, have you talked to your therapist about treatment and strategies for ADHD?

For me, it worked in a slightly different and convoluted direction: I was struggling with some symptoms of anxiety and ADHD. I treated the ADHD with medication (adderall) that made my anxiety way, way worse, and in combination with some life stuff that was going on, that was finally enough that I decided to start a low dose of anti-anxiety medication (Zoloft). HOLY SHIT it was a miracle. I'd say 90% of that feeling of "it's my own weight working against me" immobility vanished. I can do basic tasks like clean my house, pay bills, etc. with a fraction of the misery and effort they used to require, leaving me with a lot more energy to take on other, bigger things.

It's a complicated situation because the usual treatment for ADHD (stimulants) can make anxiety worse - I stopped the Adderall and will never go on it again - and I assume you're already on some kind of anxiety med or anti-depressant. But I wonder if a careful talk about medication (I hear good things about Wellbutrin) with your treatment provider along with all of the really useful life strategies for dealing with ADHD available on metafilter and elsewhere might end up being a life-changer for you.
posted by pretentious illiterate at 8:12 AM on September 20, 2015 [6 favorites]

You say you are seeking treatment. Does that mean you are currently in treatment? Have you raised this question with a therapist?

Here's what has helped me when I'm struggling with doing the things I want to do:

* Identify just one small step. Share it with an online support system. Then do that one thing and report back.
* Ask a friend to support me while I work on a project. I don't generally need them to actually do anything, just to be present - they can work on their own project, too.
* Some things you can take into your therapist's office - unopened mail for example.
* Break down projects into tiny steps and try to take tiny steps every day.
* Prioritize. I cannot do all the projects, especially while I am depressed. So I might pick the project I am closest to finishing and set all the others aside and just work on finishing that one project.

You say: There are things you want to do. You know you want to do them.... You can't do those things without a significant increase in mental pain.

Does the mental pain persist after the first 5 minutes of doing? I find that anxiety makes it very hard for me to approach certain projects, but once I do approach them the anxiety fades. So you might try committing to just 5 minutes on a project, after which you can quit if you want to.

Good luck!
posted by bunderful at 8:15 AM on September 20, 2015 [3 favorites]

Talk to your doctor about Wellbutrin. I have a long history of anxiety and depression, with mild ADD. I'd had mixed results with SSRIs over the years. Went off for awhile, then crashed this spring. My doctor put my on Wellbutrin (brand name) and Xanax to tide me over to get my panic attacks under control.

I found Wellbutrin very stimulating at first, and needed the Xanax to get the spiraling anxiety under control. I found I don't need it as much after 6 weeks. The benefit of Wellbutrin is that you can actually start doing the things you have to do without having that crippling circle of negative thoughts bog you down.

I'm still adjusting, but it is easier getting going in the morning. I also noticed a lot fewer self-deprecating thoughts. Bear in mind that it is a definite stimulant. I wouldn't recommend taking it in your situation without at least an initial period of anti-anxiety meds. You can work on cognitive measures to address the anxiety later.
posted by Sweet Dee Kat at 8:33 AM on September 20, 2015 [1 favorite]

SNRI antidepressants (including Effexor and Cymbalta, and there's a new one but I can't remember the name) work not only on serotonin but also norepinephrine, which is linked with motivation, focus, and energy. I found that when I switched from an SSRI (which only works on serotonin) to an SNRI, my motivation was enormously increased.

I'm no longer on any medications, and I find now that consistent aerobic exercise produces a similar effect. (Though my anxiety and depression was so bad previously that I would not have been able to maintain an exercise routine without also being on medication.)

So you may want to talk to your doctor about a medication switch (or about starting medication) or about whether adding more exercise is appropriate.
posted by jaguar at 9:00 AM on September 20, 2015 [2 favorites]

Anti-depressants do help. But it also sounds like a history of disordered thinking - It will go wrong, I'll screw it up, It will be criticized, What's the point. I have tried CPT with limited success, and will keep trying. try to locate your successes, large or small, and amplify them. Keep a list of things that went right.
posted by theora55 at 9:20 AM on September 20, 2015 [2 favorites]

CBT, of course.
posted by theora55 at 9:40 AM on September 20, 2015

Pretentious Illiterate makes a good suggestion. You should talk to your doctor about the possibility that ADHD meds, or an antidepressant that increases attentiveness, are a missing piece of your treatment. I originally began taking ritalin (and now Vyvanse) for "Resistant Depression," but that has morphed into an ADHD diagnosis. A doctor who really listened to me noticed that no matter how well I felt, I always fretted about work and distractibility. It's now clear to me that years of coping with attention and motivation problems using unhealthy coping strategies (enormous amounts of caffeine, long periods of cigarettes and no sleep when the chips were down) exacerbated chronic dysthymia into major depression.

I hope your doctor will have a meaningful discussion of this possibility with you. Of course I don't believe in doctor shopping, but it is important that you work with someone who will treat all of your symptoms rather than just those that dominate when your depression is at its worse. I did have a psychiatrist for a few years who insisted that I was too high achieving to fit the ADHD profile. Because I liked and trusted him, in addition to feeling guilty for needing so much "help," I went along with his decision to discontinue the Ritalin. He retired suddenly and my new physician suggested, after just a few months of treating me, that I resume taking a stimulant. It has made all the difference. Without the anti-depressants, I would sleep and cry my life away. Without the ADHD medicine, it takes extraordinary effort for me to get motivated, organized and out of the house.
posted by GeorgieYeats at 9:49 AM on September 20, 2015 [2 favorites]

Response by poster: @pretentious illiterate: No, I haven't talked about ADHD treatments. I've been in treatment since I was 15 years old and that has never come up. (It's not a continuous treatment, but it's nearly so.) It's not to say it _shouldn't_ be considered... only that it's not come up. Zoloft is the medication I am currently transitioning off of in order to go to Cymbalta.

@bunderful: Those are wonderful tips and I really appreciate them. I had never considered bringing the item into the therapist's office. That would be interesting. Hmmmm... I do have a friend who supports me in this particular project I'm working on right now and, yes, it does indeed help for him to be there. I think that he feels like he really doesn't give me all that much technical support. (The project is light programming.) However, his clarifying the goals helps when it becomes hard to think through all the internal chaos. Regarding your question about the pain persisting: The pain never really ceases. It ramps up before and in the beginning and it eases off but it never goes away. I am always afraid. I sincerely mean always. Yes, I am in treatment. I see a psychotherapist 1 to 2 days a week and work with a psychiatrist and a nutritionist (due to a NOS eating disorder).

@Sweet Dee Kat: I've been on a Tricyclic once before but mostly SSRIs (Prozac, Paxil, Zoloft). I have just started both transitioning off 250mg Zoloft and taking 30mg Cymbalta (SNRI). I tried Wellbutrin when was I in my 20s for a very short period during which I experienced nausea that increased in duration daily. I'm not above trying it again, but that was my experience at the time.

@jaguar: Yes, I am moving to an SNRI now. As for exercise, I get about... 20 minutes every other day. It's not a lot, but it's fairly strenuous... a cross-fit type of exercise.

@theora55: I won't say that disordered thinking isn't a feature. Sure it is. I have found CBT over the years to be only somewhat effective and, at time, requiring a lot of energy to very minimal effect. I know it works very well for many people, but I've only found it marginal. I think that CBT feels more effective when my medical house is in better order, though. ;-)

@GeorgieYeats: I will ask my psychiatrist when I see her for a med check-in in about a week. I don't know that I really feel _distracted_ so much as afraid, however. Nevertheless, it's worth the conversation. Thank you.
posted by tcv at 10:14 AM on September 20, 2015 [1 favorite]

This sounds like executive dysfunction to me. You know you need to do it, that the consequences of not doing it are probably huge, but you just... can't put the pieces together enough to do it. Sometimes meds like Wellbutrin help, other times it's more a question of chopping the work down into small enough chunks, and other times it's like this giant boulder of inertia that you just need to figure out how to get rolling because once you get started it's fine.

I cope by anxiously making to-do lists that get more and more detailed over time until I have concrete steps I can tackle and then I wait for a high spoon day to push through some steps. Forgiving myself for days that I don't get anything tangible done also helps a lot because then I spend less time in anxious shame spirals and more time in anxious figure-this-out mode. (I am autistic and have PTSD so I'm more on the overwhelmed/anxious/terrified side than the inattentive side.)
posted by buteo at 3:26 PM on September 20, 2015 [2 favorites]

Response by poster: @buteo: Sometimes lists help. Sometimes... I will pick that up again. Thank you.
posted by tcv at 5:39 PM on September 20, 2015