This is my depressed stance.

January 15, 2008 10:44 AM

How do people who's depressed get better? More specifically, how do they get the motivation to get better if they are depressed and, therefore, not really caring about anything? I'm not sure how to phrase this question better. If it's chatfilter, feel free to delete it.
posted by Memo to health & fitness (29 comments total)

Drugs. Prozac et al can give you enough of a lift to get yourself motivated, even if it's just enough motivation to get out of bed. Sometimes getting out of bed can be enough motivation to make an appointment with a therapist. Call your primary care doc and make an appointment to talk to him/her about meds and getting recommendations for therapists.

(IANAAnything except for a formerly depressed person)
posted by Nathanial Hörnblowér at 10:56 AM on January 15, 2008 [2 favorites has favorites]

Usually a change has to be introduced that interrupts their pattern. Sometimes this is deliberate and voluntary, like going to therapy, or changing one's diet, exercise, or sleep habits to see if that helps. Sometimes that interruption is the result of the depression itself: losing a job, ending a relationship. And sometimes the interruption happens naturally due to forces outside of one's control-- though this is less common, and shouldn't be counted on to ever happen.

The more that the interruption is based on some conscious decision on their part, the more likely they are to get better (and STAY better).
posted by hermitosis at 10:56 AM on January 15, 2008

Not eating junk food and making myself go out for a walk, even if it's just around the block. The not eating junk food is easiest to start with because it's more a non-action than an action, if that makes sense.
posted by small_ruminant at 10:57 AM on January 15, 2008

In my experience, you have short bursts of motivation to do-something-about-it, assisted by loved ones - if you act fast, those bursts can be enough to get to a doctor and get some antidepressants. Once you have that, it helps take the "edge" off the depression, so you can concentrate on what you need to do (get outside, get counselling, get a job, etc.) to feel better.

I guess if you never got that motivation, the depression would deteriorate until you were hospitalized by friends and family or by a suicide attempt, at which point you would get treatment.
posted by pocams at 10:57 AM on January 15, 2008 [1 favorite has favorites]

Well, "people" is a broad word (and, for that matter, so is "depressed"). Some people who are depressed "pull themselves out of it" (through exercise, diet, lifestyle changes, or sheer force of will). However, for truly (clinically) depressed individuals, it's unlikely that self help will lead to getting better. Therapy, drugs, or a combination thereof are usually called for. There are other treatments for particularly intractable cases, including electroshock therapy.
posted by pardonyou? at 11:03 AM on January 15, 2008

From my own long varied experiences with chronic depression, it was realizing that despite being sad and down all the time there was a core of my being that did want to stay alive. I would ponder suicide constantly, spend days in bed, and listen to the lying voice that told me I had always and would always be thus. But there was a part of me that realized that I was suffering an illness that could be treated. There were times when that core didn't make itself known until the last possible moment; but knowing that core was there was enough. From there it was a matter of making a call (in my case, to the community services board) and saying "I am unwell and I need help."

Depression lies: about what one is capable of, what ones experiences have been (and will be), and about the choices available. Seeing the lies for what they are was the key, for me.
posted by waraw at 11:04 AM on January 15, 2008 [6 favorites has favorites]

Stumbling on Happiness offers this relevant Blaise Pascal quote:

All men seek happiness. This is without exception. Whatever different means they employ, they all tend to this end. The cause of some going to war, and of others avoiding it, is the same desire in both, attended with different views. The will never takes the least step but to this object. This is the motive of every action of every man, even of those who hang themselves.

So probably all depressed people have the motivation. Maybe it's more a question of whether they can really recognize ways to get better or whether they would actually take pleasure in getting better (since feeling sorry for yourself is enjoyable in a way).
posted by hjo3 at 11:04 AM on January 15, 2008 [2 favorites has favorites]

I don't think it's accurate to say that a depressed person "doesn't care about anything." At least it wasn't in my case. It may seem that way, as a depressed person ceases to care about many things which he did before, and even those which he does still care about, he cares about less than he did before.

For me, it was seeing one of those self-quizzes printed in the campus newspaper, e.g., "If you answered YES to five or more of these questions, you may be clinically depressed." There was a lot I didn't care about, but I still cared enough to know I didn't want to go on feeling the way I had been, and that self-quiz gave me the impetus to act on that and seek treatment.
posted by DevilsAdvocate at 11:09 AM on January 15, 2008

Interesting. I was able to begin getting out of my worst depression through one such 'conscious decision,' in that I recognized I was doing very badly. I extrapolated that feeling, thinking about what the future looked like if I didn't begin to feel any better. It was very clear to me that feeling that miserable consistently throughout life until death overtook me was not acceptable or tolerable. Drastic self-destructive steps, though they crossed my mind, were also ruled out for a lot of non-negotiable personal reasons, not least impact on others, and not least that I knew I had been happy before and could probably manage to be so again.

So I was led to the rational conclusion that things needed to change, were unlikely to change on their own, and needed to change in ways that held some hope of a positive result rather than a negative result, for me and others. When that was the only answer left that made any sense, I took some steps to start getting better - calling a therapist was the first one. But it's important for me to note that I didn't really believe, necessarily, that anything - drugs, therapy, exercise, changes in routine - was actually going to be successful at making me feel better; I just knew that making some move to get better was the only acceptable alternative to continuing as I was. I was, in a sense, hemmed in by logic to the point that treatment was the only choice, whether or not I felt I had the energy or believed in it.

In the end, some of those things I didn't believe would work did work, and really well. Part of depression is faulty thinking, and once I recognized that I wasn't really thinking all that well and that so far my style of thinking hadn't really improved matters, I became able to admit that maybe people knew a few things I didn't about the impact of therapy, exercise, changes in inner conversations, and other tactics, and could stop tormenting myself by deciding they wouldn't work before giving them a try and that I had to solve it all myself.
posted by Miko at 11:10 AM on January 15, 2008 [3 favorites has favorites]

for truly (clinically) depressed individuals

I think you might mean chronically depressed individuals. Episodic depression is true depression too.
posted by Miko at 11:12 AM on January 15, 2008

As Miko points out, there are differences between "normal" (my Term) Blues, chronic and acute depression.

Admittedly I only know from personal experience what the difference is:-
But let me put it this way.
I have had situations in my life that were very, very depressing. Tragic and unexpected loss of a parent, slow, personality eating illness of the other parent, still-birth of my second child, termination of pregnancy. I was profoundly sad, and lonely and thought no-one could understand.
But I could still (just) get up in the mornings cos that what I had to do.

Now maybe I would have benefitted from some SSRIs and therapy during those times but I lived in Ireland, where everyone and his/her Auntie wants to help. There's a whole support network in community like mine that NOTICE, get involved and offer help (whether you want it or not!). So if you are low like this and you do not have a support network, please, please look for professional help.

However on the one occasion in my life where I was acutly, clinically depressed, I could not get out of bed. I could not run or eat healthily (hell EAT- what's that?). I could not care for my small children and I was seriously looking at how nice suicide sounded. It was attractive.

Then I needed professional help, SSRI and CBT, and I'm extremely grateful I got it.

As a community we offer real support to our members who get depressed but we should maybe try to see how much we are transferring our our experience of these states, low, the blue, chronic, acute,

Please?
posted by Wilder at 11:19 AM on January 15, 2008 [2 favorites has favorites]

I almost want to ask if there is something more specific we can brainstorm about, though I know the question was really general. And as Wilder points out, depressive episodes even vary in their severity person to person, so what worked last time might need to work differently next time.

It is a lot to ask to ask a seriously depressed person to "feel motivated" about anything. But motivation in this case might not need to mean activity, excitement, or get-up-and-go, but just simple willingness. Wanting to be able to avoid more emotional pain is motivation, too. So if it's a question of looking up a phone number, making an appointment, driving to an appointment, or some other concrete action, sometimes a friend or loved one can help the depressed person out by doing some of those actions - especially if they know that kind of help would be welcome.
posted by Miko at 11:34 AM on January 15, 2008

This thread offers some really, really good advice.

http://ask.metafilter.com/71817/What-can-I-do-to-help-slay-the-sadness-demon.
posted by notjustfoxybrown at 11:50 AM on January 15, 2008

pocam FTW, at least in my experience. At first, I would recognize the problem but not be motivated to take the steps to do anything about it. Guidance from loved ones who know you well and can see you are showing some symptoms is very helpful during that time.

Eventually, you recognize the symptoms for yourself and know what to do. You figure out what works and throw out the rest. For people like me, with both a genetic background and a chemical imbalance, that usually means taking anti-depressants.
posted by misha at 11:54 AM on January 15, 2008

Usually the right drug will alter some brain chemicals that can help lift the cloud of despair.
Then, you may be able to think clearer and sort out what is bothering you and how it's taking a toll on your life and determine what you need to do about it.
The wrong drug can make you feel even worse. Drug therapy is usually by trial and error.
Talk therapy helps some people and there are studies that say that talk therapy doesnt help at all.
posted by sandra194 at 12:23 PM on January 15, 2008

notjustfoxybrown: I knew I had seen something like that before. Thanks.

Miko: Being specific, I was asking for myself. I see my life and I want to change it but I can't muster the necessary effort to do it because it feels useless. I didn't want to go in that direction with that post to avoid having to post as anonymous, and generic answers were bound to be interesting too.


Thanks everyone for your answers. This is a very subjective subject so I won't mark any answer as best or I would have to mark them all.
posted by Memo at 1:05 PM on January 15, 2008

Memo: Good luck to you. I wanted to post in this thread because I know what you mean - part of overcoming my depression was just plain suspending my disbelief that it was useless. A lot, lot, lot of people have felt exactly that way and managed to get through it. I think taking a small first step would be really helpful. Throw yourself a little lifeline into the future. Call a helpline or make an appointment to talk to someone; if they think you might want to look into drugs, hear them out. Do pay some special note to what waraw said: "Depression lies." The voice telling you it's useless, don't bother, it's too much effort and you won't succeed anyway is part of the depression, not part of you. If you can listen to and amplify any of the other, more hopeful voices that might also be found in your head, you begin to get a wedge under the thing and start doing small things with the idea that who knows, they might make you feel better.
posted by Miko at 1:16 PM on January 15, 2008

I just got better. Eventually I learned how to change my mental patterns, so the anxiety that caused my depression relaxed. Part of it was stumbling on things that make me happy. My mother has an allergy to the colour yellow, and light, so I live in a light proofed, foggy environment, and as I meandered about the house in a depressed funk, I discovered that sticking my head under the blackout curtains briefly lifted the fog that seemed to permeate my brain.

The not eating, and not getting out of bed thing both seemed to correct themselves, though not over night. As I mentioned anxiety was at the root of my depression, and it wasn’t just that my body shut down and didn’t want to act, it’s that I somehow developed agoraphobia. I had no friends, and was confined to the house looking after my home schooled brother and sister.

I think what snapped is that I started contemplating suicide and realized I was in too deep. I started using online joke websites to make me laugh, which helped. After that I made my mother help me get a therapist, and while the man was as useless as a third nipple (he assumed I was on pot), the appointments got me out of the house and eventually convinced my mother to fire me.

After that I was free to go back to school, get a job and get on with my life. These days I keep the depression stamped down by always trying to force myself to go a bit beyond my comfort levels (mostly via travel) and keep busy enough that I don’t have time to be sad. A blistering pace with a full course load, a boyfriend, extra curricular and a job are very stressful, but they beat the pants off lying in bed, unshowered and unfed, thinking that tomorrow will be as terrible as today.
posted by Phalene at 1:40 PM on January 15, 2008

I wouldn't call myself healthy exactly, because I still find it easy to slip back into depression, but I'm definitely better.

I credit: a good therapist, the right medication, and constant vigilance.

It's hard for me to remember how it was that I got around to seeking help, because of the nature of the beast, I suppose.

I wish I could remember what got me to my doctor in the spring of 2005, because that's the experience that's probably most relevant. I had been in and out of therapy a number of times since I was a child, but never really felt better. The winter of 2004/05 was really hard: SO in school, grandmother died, knee injury, a LOT of work stress. What I remember now is being consistently, constantly unhappy and unable to do anything.

It may have been something as inane as a regular checkup with a new doctor -- who I discovered that I really liked and really trusted. She talked me through some options, helped me set up an appointment with a new therapist, and helped me figure out that I wanted to try medication. (Later, she helped me figure out that I needed to change medications.)

The new therapist was of the cognitive-behavioral therapy variety, which I highly recommend. I did a little over a year of therapy with her, and that got me to a place where I could recognize my warning signs better and do some work to talk better to myself.

Both she & my doctor left my managed care plan, which was pretty rough, and I think that's part of why I let my mental health slide over the winter of 2006/07: over the course of the winter I dealt with a lot of stresses and eventually crashed out.

Part of what helped then was identifying my danger signs, and knowing that I didn't want it to get any worse. Part of it was the insistence of my significant other, who has suffered with me, and who finally said, "whatever you're doing isn't working. you need to do something different."

It's REALLY hard to do, but when you get to therapy, you need to figure out if you work with this person. If not, it's hard to make progress. I probably set myself back several years back in 1999 or so, when I went to a therapist and felt really uncomfortable, so I quit without trying again with somebody else.

My current therapist is very practical, works well with my psychiatrist, and I trust her a lot. I'm seeing her in a maintenance mode right now, knowing that winter can be rough -- mostly lack of exercise, I think. It's easy for me to slide.

I think I've recommended this in several mental health threads, but I can't recommend it often enough or strongly enough: Feeling Good is excellent for handling depression. In particular, you may find some of the techniques useful in getting you to a point where you can seek help.
posted by epersonae at 1:53 PM on January 15, 2008

My wife is clinically depressed. Last week she brought home a new kitten. Events like this swing her back up.

When she feels that she may soon slip into a level of depression where she may become a harm to herself or others, she will generally get back on her med schedule, which are designed to level her mood swings and curb anxiety.
posted by Brocktoon at 2:19 PM on January 15, 2008

I have been clincally depressed, to the point of a basically nonfunctional immune system. This depression lasted about 13 years from start to finish, although I relapse at times (a half-a-lifetime habit is hard to break).

Getting over the depression involved a lot of self-examination, and a lot of talking about it to the boy who was first a friend, then a boyfriend, then my husband. It was an incremental process of examining what was triggering me, and removing those things from my life. I did it largely via stubbornness. At the end of it, when I'd managed to achieve emotional stability, I went on drugs to reset my brain chemicals somewhat; since I'd been severely depressed since childhood, I'd essentially lost the ability to feel happy at all, and the drugs nudged my brain back into (relatively) normal patterns. I needed a lot of emotional support and encouragement, though. And I'm extremely stubborn.

Incidentally, exercise and diet didn't help; I eat very healthily, and always have - and exercise was kind of impossible for most of it due to pain and injury. Even now, I've got to be very careful with exercise, because too much triggers a depressive episode - and if I'm at all unstable, 'too much' is something like a brisk half-hour walk. Annoying, but that's the way it is for me.

I didn't really 'seek help', so to speak; I decided I was unhappy with the status quo and changed it through force of will. YMMV.

... That said, I'm going to undergo counselling soon for issues that didn't come up during that time; they've only surfaced recently (in the last year or so) as concerns, and I'm not making any progress by myself on them, so I'm seeking outside help. This is largely because these are trauma things that I don't have the tools to handle; the earlier depression was more about family/life issues/changes.
posted by ysabet at 2:46 PM on January 15, 2008

Miko: Thanks, I really appreciate it.
posted by Memo at 3:22 PM on January 15, 2008

You can get help while acknowledging that it might, or heck, probably will be useless.

Social pressure helps--make an appointment, or find a support group, and ask a friend to go to lunch with you beforehand and then give you a ride/walk you to your shrink appointment.

Make it easy for yourself to get help--write down phone numbers, addresses, etc. even if you don't call or go immediately.

For me the best motivation was my complete inability to enjoy myself no matter what I was doing. Going to a shrink, going for a walk, talking to a friend, they were just more things that wouldn't really please me, so why not? I kinda had to trick myself into it that way.

Good luck.
posted by sondrialiac at 4:19 PM on January 15, 2008

Sometimes it takes a friend who makes a psychiatric appointment for you and makes sure that you keep it. (I didn't have the initiative to get out of bed most days.)
posted by phliar at 4:26 PM on January 15, 2008

I woke up and decided that I simply couldn't live like that anymore. The weight of depression is too immense to describe if you've never truly experienced it. I decided that I was sick of bearing it, sick of feeling sorry for myself, sick of feeling like I was alone every second of every day, and I decided to change myself. No drugs, no therapy, just a conscious understanding that I need to get better and I'm the only person I've ever been able to rely on.

Music was the first step. The rest fell into place. It took a lot of hard work and it still haunts me sometimes, but every time I feel myself slipping I think about all the wonderful things in my life and I know they're worth hanging onto...if I let myself fall into that mindset again I'd lose everything, and I'm not willing to do that.
posted by baphomet at 4:44 PM on January 15, 2008

Thanks for posting this Memo, and thanks to everyone for their comments. This information is likely helpful to many more people than those who may speak up. Miko, once again, cheers.
posted by Richat at 5:59 PM on January 15, 2008

Wow, all this way and no Feeling Good recommendation? Seriously, if you can muster up the motivation to read a book with a silly title, it will help to open doors to 'hey this isnt so hard maybe ill try it'.

To answer your original questoin, for me whenever i'm depressed either i have to weigh the risk-vs-reward ratio of staying how I am, or suddenly an opening to break the circular pattern appears and I try to be self-aware enough to break it.

Feel free to MeFi mail for more details if you'd like.
posted by softlord at 6:24 AM on January 16, 2008

I see my life and I want to change it but I can't muster the necessary effort to do it because it feels useless.

One of the things that hit home for me in Feeling Good is that you have to test that feeling. Yes, it feels useless, but is it? Try predicting how satisfying something will be, and then come back later and rate how satisfying it actually was. What you will generally find is that you are expecting things to suck a lot more than they actually do. Do this consistently and you will realise that your brain is making terrible predictions and you should stop believing those depressed thoughts. (This is something that anti-depressants can help with.)

It also helps me to have someone else relying on me a bit. For example, I tend to stop eating when I get depressed. Now that I live with (and cook for) my partner, there's more pressure on me to cook good meals even when I'm depressed. I don't particularly feel like doing it for myself, but I don't want to let him down, so I cook and I eat and I feel better. Another example is that we have a standing dinner date every week with friends. I may not feel like leaving the house, but I don't want to let them down by cancelling, so I go to dinner and I socialize and it prevents me from laying in bed dwelling on dark thoughts.

You're a guy, but if you weren't I would also suggest considering a different type of birth control. It's definitely been a factor for me. Some types destroy my motivation, and others lift that cloud.
posted by heatherann at 8:20 AM on January 16, 2008

Memo:

Take small steps. It is a long process, and trying to do too much may trigger whatever in your mind is preventing you from taking the necessary steps to get better. First steps aren't always going to therapy or beginning an exercise program. It can be as small as finding order in your life by cleaning your bedroom or making a schedule or a list for yourself.

Also, find support for yourself. A friend with whom you can speak frankly about mental health issues is a very important support structure. Someone who knows you well enough to render an honest opinion and who can provide feedback to you is invaluable.

Best of luck.
posted by greekphilosophy at 1:46 PM on January 16, 2008