Is there such a thing as rehab for depression?

April 21, 2008 11:54 AM

Is there such a thing as rehab for depression?

Details:
Just finished my Ph.D. Struggled a lot through the last few years of grad school, including serious bouts of depression, hence was just trying to pull through finishing my degree, and didn’t line up a postdoc or other job immediately following. Currently “employed” by thesis advisor in same laboratory, but feel like I have royally screwed this up by falling insanely behind on a major project (and covering as if I wasn’t, hoping I would get it together in the past few days. I haven’t.) I’ve also been intermittently sick over the past few months, and missing more work due to that. I’ve been told that I am probably burnt out. Really thought things would get better, but I’m feeling back at square one (except that I have my degree. Square two, then.) Tempted to quit current semi-job, since this is going so poorly, and I feel like I have overstayed my welcome since I’m burning out/getting depressed on my advisor’s dime. Admittedly, its all made worse by the fact that I feel immense pressure every time friends, family, and colleagues ask me "What are you doing now/next?"

Then what? Throughout the entire course of school, I’ve seen doctors for both med management and therapy. I’ll have catastrophic coverage until September, but the mental health services/prescription coverage runs out shortly.
I’m almost afraid to start a job in this state, especially using my connections/network, because I fear falling into this state (missing work, etc) in another job, again.
Unfortunately, I have no savings, and not-working can only last so long. I feel flippant going on vacation in the middle of not having my life together at all.

I have often thought that I wish there was some sort of rehab for depression which would be a few weeks of hardcore motivation/revitalization, and then I’d be “better.” Is there such a thing? Would it be worth going into debt for? I know this is black/white, catastrophic thinking, but I feel like if had HAD a chemical addiction, at least I’d know what to do with myself right now. (I’ve been close in the past, but have so far successfully veered away. Except for my not-working/surfing-the-web addiction, I’m doing decently, addictionwise)

Sorry this is so long. I feel like I’m out of ideas here, and feeling very stuck, as I dread working/talking to my advisor tomorrow/contemplating leaving my current "job". Thanks in advance for any advice. throwaway email at: FeelingStuck at gmail.com

posted by anonymous to health & fitness (17 comments total)

I'm not exactly sure if there's an actual place you can go, but there is a twelve-step program known as Emotions Anonymous.. I think they probably have meetings also..

Hope you feel better soon! (And that you are checking this thread because I'm not emailing it to you)
posted by majikstreet at 12:06 PM on April 21, 2008

I don't know of any "boot-camps" for mental health, but perhaps you could check around your area for weekend "intensives" - which are usually group therapy, and thus a bit cheaper than one on one.

I would urge you to NOT quit your job yet. When you are depressed is the worst time to make big decisions about your life. I would urge you to talk to your advisor about the state of your project, the anxiety of covering up how behind you are can't be helping your mental state.
posted by The Light Fantastic at 12:08 PM on April 21, 2008

There is definitely inpatient treatment for depression. Whether or not it's helpful will depend on the facility and your expectations. I wouldn't expect to be magically cured. I would expect a safe environment where you can express yourself completely freely. I would expect that they would give you tools to manage your life that you can take back out into the real world. In some ways, it's an escape from the daily pressures that can make you strong enough to face them again.

Caveat: I was an inpatient when I was a teenager, not as an adult, so the treatment probably varies somewhat.

Best wishes, and kudos to you for seeking help - I know how difficult this can be.
posted by desjardins at 12:08 PM on April 21, 2008

I would definitely be aware that the depression is going to make you catastrophize your current situation. It may be that it's not such a big deal to your advisor that you're behind on the project; it could be that he thinks you're valuable regardless of the outcome of the project, that maybe the project had problems anyway, maybe it doesn't matter so much if it's finished a little later, etc.

I'd make sure any judgment about problems with your work is coming from your advisor, and that you're not just preemptively guessing about it and shooting yourself in the foot.
posted by dixie flatline at 12:42 PM on April 21, 2008 [1 favorite]

Both therapists and meds vary a great deal in efficacy. I'd approximate that my current therapist is 20 times more helpful than my last one, for example. For another example, a friend of mine (really) had no luck on any of the meds, and then on any combination of the meds, until finally they lucked onto a combination that actually helps. My advice? As long as you have insurance, keep getting treatment. Find THE BEST therapist you can find. Search the web, ask doctors for references, etc.

Also, read the book Feeling Good. It's crucial to realize that when you are depressed, you will have thoughts that are overly pessimistic and NOT NECESSARILY TRUE. Thoughts like "my advisor's going to be disappointed," "I'm a failure," "I won't be able to succeed if I get a job," etc. The book helps you recognize and overcome such irrational thoughts.
posted by callmejay at 1:00 PM on April 21, 2008 [1 favorite]

Have you talked with the advisor about the depression?

In any case, do not make any decisions about quitting etc. before you've talked with your advisor about the state of your project. Many of us grad students (or former grad students) are familiar with the feeling of being "in the hole", further behind than we'd like, sure the advisor will be pissed if we tell them, thus avoiding talking to the advisor, etc. The problem grows in our mind because of the fear. It almost always feels better when we actually do talk with our advisors.

In your case, you have nothing to lose. The absolute worst case is that your advisor agrees that you should leave the lab; that would suck but at least you'd know and it's no worse than quitting of your own accord. Much more likely is that your advisor will be supportive. Hell, I've been told that 25% of the professors in my former department were having problems with depression. Your advisor will be familiar with it, both in the case of students and (quite likely) in their own life.

It may be that a break or vacation is warranted. Good advisors know the value of time off and the need to recuperate. Talk with yours about this.

And: best of luck. This is a tough time, but you can pull through this. mefimail me if you'd like; I've just been through a similar transition.
posted by wyzewoman at 1:39 PM on April 21, 2008 [1 favorite]

Unfortunately, what you've described isn't really akin to drug rehab, though drug rehab is akin to an inpatient stay in a mental health facility. Neither drug rehab nor an inpatient stay in a mental health facility is going to be based on a motivational regimen and both barely provide the time or environment needed for revitalization, unless you're going private pay to some celebuhab type joint. Drug rehab (been there, went covered only by welfare, it was not glamorous) is really more a place for convalescence rather than rejuvenation. The first four days of detox are physically grueling as you're coming off whatever chemicals brought you there. But this is only the acute phase of detox, and the rest of your 28 days will likely be spent going long stretches without sleep, experiencing a laundry list of physical and emotional discomforts, etc. You'll be surrounded by hardcore addicts, many of whom are coming out of abandoned houses, shooting galleries, brothels, who are streetwalkers, career criminals, etc. It's not really what you see on Intervention, it's a little closer to a prison stay, where you have to sleep with one eye open, stash your valuables, get into confrontations with other patients over things like individual cereal boxes or bars of soap.

Inpatient stays in mental health facilities (seen all of them in Philly while working in mental health) aren't very different from this. You've got to realize that while you're struggling with depression, other people around you in a mental health facility are going to be dealing with chronic paranoid schizophrenia, behavioral and personality disorders, etc. Some of them will have histories of assaultive behavior and some of them will be sexually inappropriate and/or aggressive. If you're feeling like suicide might be an imminent danger, then an inpatient mental health stay is where you go to be protected from yourself, locked down for 72 hours, stabilized on medication. That's kind of what inpatient mental health stays are about. Like rehab, it's almost purely convalescent and not based on a regimen of motivational activities.

There's a wide range of variation between different facilities in different regions that you may or may not have access to depending on the insurance you have. However, inpatient drug rehab and mental health stays aren't generally relaxing, they aren't fun, and probably won't give you the boost you're looking for. Maybe consider a retreat of some kind? There's a broad array of different motivational/spiritual seminars/retreats available out there that might provide you with a more peaceful and rejuvenating setting.
posted by The Straightener at 1:45 PM on April 21, 2008

Everyone deserves a break, whether they have a diagnosed illness or not. If you've just slogged your way through to a doctorate, I'd say you would be entitled. Only you know what's required to start and maintain a career in your field, but I think it's very common for graduates to reward themselves with a break.

My recommendation is to plan a decent break - a couple or 3 months- start to tell people about it, try to complete outstanding obligations, like this overdue project... and then take the break. Disconnect from as much as you want to (including parents and siblings), go somewhere that makes you happy, and allow yourself to do whatever you want. Do the fun stuff you keep putting off because you were busy.

If you're currently in therapy, ask your therapist about this idea. You might even want to stay in therapy for some of the break, but not all of it... you deserve a break from that too.
posted by Artful Codger at 1:48 PM on April 21, 2008 [1 favorite]

Have you looked into cognitive behavioral therapy (CBT)? I say this as someone who has been recommended it multiple times but not really gotten into it in depth. It might be a group therapy kind of thing; it might be one-on-one sessions; it might be some combination of the two, with or without medication. I'm told that the book Feeling Good, recommended above, goes along with this regimen.

As someone who has been in a similar situation, and continues to be to some degree, I know how hard it is to try to find some way to get out of your head for a while. How about working on therapy and trying to be mindful of whether it is or isn't helping in the ways you need it to, while simultaneously working on checking off some of your to-do list for life? Make one, if you haven't already. Go crazy. (No pun intended... ouch...) Put some off-the-wall and expensive stuff in there as well as little things or things that would take a while. Mine includes everything from "get a passport" to "touch a snake" to "finish knitting a sweater" to "run a marathon" to "go to Japan" -- the thing is, you'll find that some opportunities pop up when you least expect them, or that you'll need to just DO SOMETHING, and then you can say, "Hey! I can pick something on this list!" You can look forward to something, and when you've done it you can also feel a little bit of accomplishment, which always makes me feel better about my place on the planet.
posted by Madamina at 2:02 PM on April 21, 2008

First of all, if you've just finished your Ph.D you deserve a break! Remember that you are in the rarefied air of academia, where pushing yourself to the nth degree all the time is the unhealthy norm. That norm is catching up with you, and you need to give yourself some life space, a safe harbor in which the ship of your soul can right itself and prepare for the next voyage. (Just because you don't see others around you doing this doesn't mean that it is wrong or unhealthy). This doesn't necessarily mean a vacation (although it could). I find that when I've been depressed, unstructured vacation time just leaves more time and space for unhealthy negative thoughts to take hold. A more sustainable solution might be to look for a short-term, low pressure job that will leave you plenty of time to exercise, pursue non-academic interests, and nurture the parts of you that have necessarily been neglected during your recently completed graduate work. A friend of mine found this kind of situation as a traveling teacher in a mobile science lab that brought cool experiential learning to schools across his city.

Hope that helps. Take care of yourself, keep up with the therapy if possible, and trust that the healthy, rested, and nurtured version of yourself will handle the big picture questions.
posted by man on the run at 2:03 PM on April 21, 2008 [1 favorite]

you know, you might find that something like outward bound might be useful. it's not specifically geared toward mental health, but i imagine it would be incredibly affirming and empowering. plus it would be a nice vacation, and you'll probably get in shape.
posted by thinkingwoman at 2:07 PM on April 21, 2008

Seconding the "Feeling Good" book
posted by mrbill at 2:49 PM on April 21, 2008

I find that when I've been depressed, unstructured vacation time just leaves more time and space for unhealthy negative thoughts to take hold.

YES, YES, YES. Not only that, but it reduces your social contact, which drives you further from reality and makes you feel all alone.
posted by sondrialiac at 4:01 PM on April 21, 2008

Take a vacation, you need it! and don't feel guilty about it. take like a month off and go somewhere warm and sunny. give yourself enough time to get your head out of grad world, and maybe with some perspective you'll be reenergized and able to go back and forge a path.. or you'll be ready to go elsewhere. it's so easy to get stuck in academe esp if one tends toward depression. happens to a lot of people. And it's very hard to force yourself or guilt yourself, while already depressed and stuck, to find a way out of it without just plain taking a break. Look on it as the most efficient way to move forward, if that helps.
posted by citron at 4:10 PM on April 21, 2008

well, sondrialiac has a point. Maybe a "vacation" somewhere with friends or family which has at least structured vacation activities, eg, get up, make food, go for a long walk, etc. Just so you get out of the house and get fresh air and sunshine every day.
posted by citron at 4:12 PM on April 21, 2008

Wow...I can so relate to your desire for "depression rehab." There have been times when I was so deep into it and flipping out about the world rushing by that I longed for a pause button so I could take time to do nothing (or be depressed), followed by catching up but taking as much time as I'd need.

Other people have said some of this already, but here's what I'd do (ideally) in your position (not so different from mine, except that I'm still in those final, struggling years of a PhD):

Create a plan.
Create structure.
Create accountability.

First off, I also think that if you can take a short (like a week?) vacation, that would be good. I would try to go somewhere else if possible - even a few days in a hotel someplace different might bring a nice change of pace (and a psychological separation from everything that's currently weighing you down). Spend time outside, not cooped up the whole day. Read graphic novels or compelling fiction for long stretches, take naps, listen to music, and eat tasty food. Maybe spend some time writing in a journal if you think it would be helpful.

Okay, vacation over. Once you get back to real life (it can't be avoided permanently), you should create a plan, and that plan should incorporate structure and accountability in ways that will help you move forward with your life.

You'll want to set goals (not too many) for your career. You'll need to figure out the steps (little, tiny steps) you'll need to take to reach your goals (sound familiar?). You'll need to create structures (in your daily schedule, in your progress toward goals, etc) that will support you making these steps toward said goals. And, having done a PhD, I'm sure you know that building in accountability not only to yourself but also to others will vastly increase not only the chances that you'll achieve your goals, but the speed with which you do so.

I feel what you're saying about how the future looks so bleak. Recognize that a large part of why it looks that was is because you're depressed, and depressed people have a way of seeing things in insidiously distorted ways.

Be as up front with your advisor as you can, or are comfortable being. Would s/he be amenable to letting you take a short break, then coming back once you've regrouped? Is there someone else's project you could work on?

Check with universities in your area to see if they have a low-cost psychological clinic. These are on-campus clinics where grad students learn how to do therapy and you reap the benefits of their inexperience and enthusiasm by paying a much lower fee than you normally would.

I STRONGLY URGE you to find someplace like that and do some CBT. I have been doing that recently and it is perfect for the kind of situation you're describing, where your thoughts are affecting your behaviors and emotions in negative ways. You'll be required to do exercises that might seem simplistic but are actually a great way to help yourself structure your life, make better decisions day-to-day, etc. Plus, if you're in therapy for a while, you'll be accountable to the therapist as far as doing the CBT exercises, and as infantilizing as some of this can feel it can help you turn your life around in ways that help you feel more powerful and in control about things.

CBT is big on goal-setting, so you could use the time to set goals for your career, and then have the built-in structure of therapy to help you make progress toward something. Even the hour of therapy each week provides some structure (you have to stay on top of the exercises which aren't time-consuming, but do require you to pay attention to your thoughts, how you spend your time during the week, and so forth).

As for medication, people at a university clinic should be able to help with where you can go for that, and you might check into getting help from the pharmaceutical company itself (they do have programs for this). Sometimes doctors may have free samples they can give you, though that's unlikely to be a long-term option.

Also, if you haven't tried it, what about GTD or something else like it? I use elements of it on and off (but more on), and it also helps a lot. When I feel overwhelmed, sometimes just picking up my apartment and then updating my GTD stuff (project lists, calendar, etc) helps a lot.

It definitely sounds like you're burnt out, and that's a hard state to move past. Personally, I think that for depression and burn-out both the key is not to "relax," but rather to...move. Both literally and figuratively. There's a quote from a Bollywood film, Jaan-E-Mann, that says "Move a little, the world will move too..." I really like that - I've found that once I take action, no matter how small, things start to change for the better elsewhere. Personally I would be wary right now of doing less, you know? Don't bury yourself with activity (it sounds like that's not even a possibility right now, anyhow); just take some small actions to get things moving and start turning yourself around.

Take care of yourself, treat yourself well, and do things that are in your best interest in the long run.

(Oh, and when people keep asking you "what's next?" maybe you can tell them you don't want to talk about it right now? Frame it as a "basking in the triumph of having finished my PhD" or whatever works to change the subject.)
posted by splendid animal at 6:12 PM on April 21, 2008 [1 favorite]

Take a vacation from academia. Do some outdoor work, if you can get it. Farm or laboring would be ideal, especially if you're male and large (makes it easier to get and to do). Six months to a year later, come back fitter and healthier and much more keen to put into practice all the ideas you've been thinking about as you stack bricks or pull weeds.
posted by aeschenkarnos at 9:44 PM on April 21, 2008