Academia, depression, apathy, and meaning
January 18, 2014 11:27 AM   Subscribe

I have been diagnosed with major depression for a couple years now (4-5). I am in a PhD program and about to graduate soon, couple months. I need small tangible things I can do everyday to feel like my life, my career matters, what I do everyday matters, put myself up to goals and challenges, and make an effort to achieve them. More inside.

I am on meds for the major depression (since more than a year) and the depression is not as bad as it used to be before meds. Its not super good either, but after talking with the p-doc and counselor, it seems like this is about how much recovery they would expect with meds.

My problem is, I still feel as though everything is meaningless. Its just like a gray, mindless, day-to-day existence where I don't much care about what happens to me. My counselor says I need to make efforts - her advice mostly comes down to "exercise everyday". I don't have energy issues as the reason I don't exercise, but I just feel like a lump of a body, that does not want to do anything at all.

I have to graduate soon 4-ish months, and I just feel like it doesn't matter anymore what I do. Theoretically I know it probably does, but in my mind, I just can't feel, or think that what happens to me matters - and I don't want to take any action AT ALL. That is one of the biggest reasons I'm having trouble finishing my thesis for instance. My PhD study was a horrendous experience, and I probably will go back to my clinical practice because grad school was utter misery for me - not necessarily because I lacked the brains but because of the depression, general misfortune with my adviser etc. (see earlier posts).

I've just sort of fallen out of the "circle of life", so to speak - I've stopped all contact with other people beside my family (husband, parents) because I feel utterly ashamed and guilty about all my failures (probably the depression talking, but its difficult to get out of that frame of mind). I don't care how I dress, how much I weigh anymore (200 lbs, for someone who was 150 lbs 5 years back), whether I eat or what I eat, how I live, whether I clean or not (from someone who used to clean apartment to relax before all this!), whether or not I meet my commitments. I've really just turned into someone I don't recognize.

I know I need to do something to stop this. Meds have helped in that they've stopped my crying spells (I don't, in fact, can't cry anymore for whatever reason - sometimes I'm stressed and feel like I want to cry, but I cannot), feelings of despair (despair has probably changed to "I don't care anymore"), my energy, and sleep. But living like this cannot go on - I want to be present in my life, feel my life, be able to influence it. I don't feel like I can at this point, but I want to believe I can.

Can you suggest small things I can do everyday to help? I am not sure if I articulated what I need - probably how do I internalize the belief and faith that I can change my life circumstances for the better from here?

I am not sure if books will help me at this time. I've read plenty and done nothing. I want to DO things to feel like I can change things. What do I do?
posted by greta_01 to Health & Fitness (18 answers total) 22 users marked this as a favorite
What lights your fire? Gives you passion? for me I really got into knitting- it gave me joy. And, in my darkest moments, I try and draw on something I love being around horses, and I try and feel what it is like- the feel, the smell, the sounds. Have you tried CBT?
posted by TRUELOTUS at 11:32 AM on January 18, 2014

I'm really glad you started back with the antidepressants. To me it sounds like it's time to talk to a different doctor, for a second opinion on type and dose.
posted by Houstonian at 11:36 AM on January 18, 2014 [10 favorites]

Exercise really is essential. I don't know anyone who goes on a brisk 30 minute walk everyday and is still mired in depression.

Food? I feel much better on a diet that is high in fat and protein and veggies. It's essential you find a nourishing diet that doesn't adversely effect your blood sugar.

Read for pleasure. When I was at my most depressed all I could manage were Jackie Collins novels- luckily i hadnt read any before so I spent that year reading all if them.

Put make up on, shower every day, wear decent clothes...

Wash your sheets and pillow cases once a week or every 2 weeks.

Start doing nice things for people. Recently I started using I can send cards- 2 for 5 bucks.... It's easy, makes the receivers feel good, and eases guilt about feeling isolated!

Get a nice big indoor plant from Ikea and stick your Xmas lights in it- that has really perked me up!

I'm sure ill think of others, but these have really helped me!
posted by misspony at 11:42 AM on January 18, 2014 [6 favorites]

I find that taking care of my space and getting it straight and nice helps my mood. It's also some mild exertion that helps me off the couch and out of brooding mode, which is, for me, essential: get moving.

Congratulations on the upcoming completion of your program. Accomplishing this while fighting depression is very impressive, and you should feel good about that.
posted by thelonius at 11:59 AM on January 18, 2014 [1 favorite]

The recommendation of exercise for the management symptoms of depression sounds trite and may feel invalidating, but what studies have shown it can do is moderate mood and help regulate the physiological effects of stress (via activity on the HPA axis - catecholamines, cortisol, etc). I'm short on time today, can't find a particular study I'm thinking of; this one's about teens but gives an idea about this. Exercise doesn't help with the problem of meaning, but better situates you to approach it, by helping to address mood.

Admittedly the first month is difficult (new habit; maybe DOMs if you try something other than walking). It may take social support to get through that month, so ask for help that way.

One motivational effect of regular activity is seeing measurable/objective improvements in performance (e.g. time walked), if you track your progress (recommended).

Anecdotally, I found it helped ground me in my body -- subjectively speaking, that felt important (and amazing. After the first month).
posted by cotton dress sock at 12:09 PM on January 18, 2014 [1 favorite]

Action precedes motivation.
posted by aniola at 12:10 PM on January 18, 2014 [8 favorites]

Something really small that has helped me is to lay out your clothes for the next day and putting a little handwritten note on top of them - a quote, or just "have a nice day" or "hi!" It sounds a bit twee or silly but it's about practicing intention - and having good intentions for the day as early as the night before.
posted by sweetkid at 12:34 PM on January 18, 2014 [3 favorites]

It may be hard but I would try and get in touch with old friends and making some new ones. It has helped me to realize I'm not the only with problems, angst, frustrations, complications, and short comings. That really our pain and flaws don't isolate us but actually form this strange bond between you and most of your fellow human beings (don't know if you are religious at all, but getting involved in religious organizations can help, volunteer for a non-profit -- maybe something involving children or young adults, look into groups, join a casual/recreation sports league/team, join a book club). Read some James Baldwin.

Sometimes when something depresses me or stresses me out, I try to remember something that depressed or stressed me out five years ago. And usually I find myself remarking at how unnecessary that had been. And out of the self examination, I have told myself couple of things that helped beat back the tide of depression pretty decisively:

(1) as with most things our body does, a feeling/state of mind is a reaction to something (if it's hot, move your hand); so with depression, your body may be over reacting, but it is reacting to something -- PhD program was bad, about to start a job search and that sounds unpleasant, not sure if you like your degree anymore; it's just like your hand feeling hot/burned. Do not interpret this signal from your body as you are worthless or life is meaningless. It is just a reminder from your body, perhaps annoyingly constant (like your feet constantly hurting even though you've known your shoes hurt since you put them on), that you need to change things or things are changing and you need to react/act/plan/etc. You are probably a pretty analytical person. You like to examine and find the good and bad in things -- perhaps to a merciless/rigorous degree. Putting that sort of attention on yourself can be brutal. But the upside is that you will make smart decisions. You will find what isn't working and change it. React to this pain and use it to motivate you to achieve new and great things.

(2) I told myself -- wrote it out actually as just one sentence on stark white paper-- I will not waste anymore of my life being unhappy (it's just super inefficient and there is no upside to it). Whatever situation, I will embrace it and go forward -- even small moments matter, such as "they invited to this movie but it's not very good" (I go anyway and try to find the good stuff in it and maybe it just gets me outside or I get to see some cool previews or eat some super buttery popcorn and drink a coke). Not everything will be fun, I still mutter curses under my breath and make sarcastic jokes, but at the core I try to remain pleasant and realistic. Every day you are depressed is a waste. It helps nothing (it's only use is as a stimulus to get something changed so the feeling will go away -- see item (1)). Be a force for positivity/good. The world rebounds to you what you put out there.

I have not cracked the code on existence, but I do know this: be it God, just plain causation, or something else, you are here because of an unfathomable chain of events. You are an amazing improbability. Life always presses on, goes forward, and sometimes it's difficult, but it just charges on ahead. Let yourself be part of it and let yourself be happy. I don't think you are made or designed or evolved to be an unhappy person. I was super unhappy and depressed through middle school, high school, college, and grad school (to the point of having thought of suicide far too many times). I finally just got tired of it. I realized I had been stupid for being sad for so long. It was like I had been living in a conspiracy theory of my own making.

Also there is a TED talk playlist on happiness. I found it comforting.
posted by yeahyeahyeah at 1:51 PM on January 18, 2014 [11 favorites]

The gym became a huge part of my life in grad school because it made me feel so good when otherwise I felt so bad. But it's really hard to find the motivation as someone noted.

Exercise seem more like a goal than something you little you could do right now. Even moving one's body really make one feel better.

I'd do a short set of stretches and breathing exercises in the morning, at lunch and before you go to bed. (Maybe google "gentle stretching.")

Something to think about in the future after talking to your doctor is using the gym. Move the stretches from your home to the activity mat in the gym. Once you get comfortable in using the space (I was really intimidated by going to the gym at first), you might try the bike or something. Good luck.
posted by vincele at 1:55 PM on January 18, 2014 [1 favorite]

Gratitude Journal: write down three things you're grateful for every day, no matter how trivial. It's the trivial things that make up most of life, and not taking them for granted is illuminating. There's a lot of good stuff going on.

Also, exercise, especially walking.
posted by Johnny Wallflower at 3:25 PM on January 18, 2014

I think you need a second opinion from a different psychiatrist. I am surprised they say this is the best recovery you can expect. In fact, that sounds like bullshit to me.

I suffered from major depression (and know others who have too) and meds made me feel a whole lot better than you describe. Other people I know found that too, once they found the right med and dosage. (My husband felt like you describe at the same dosage of meds that I was on: once his doctor doubled his dosage, he felt normal again).

I wonder if, since you still sound depressed, you might be misinterpreting what your doctors are saying. I know when I was depressed that I might have interpreted "Give it a bit more time and we'll see what happens" as "Stop whining. Nothing will change". Or if your psychologist is suggesting trying things like exercise, socialising and so on, it might be as an adjunct to experimenting with the meds, but you might be hearing those suggestions as "Your only remaining issue is that you aren't exercising."
posted by lollusc at 4:00 PM on January 18, 2014 [6 favorites]

I am in my 6th year of a PhD program, much of which has been a horrible experience. I can commiserate with major depression.

The only thing that has helped me (including therapy, medications, etc) is a daily yoga and awareness meditation practice. I started with the daily yoga practice and added the meditation in later. Seriously, this is the only thing that has helped me.

Can you try to find a recommended yoga studio near you (preferably a more active form of yoga, like power yoga) and try going 5+ times a week for the next 3 weeks? I truly truly believe it will make a difference for you.
posted by sickinthehead at 5:44 AM on January 19, 2014

Sure, eat right, exercise, do all the things we know we're supposed to do.

But, sometimes that's just not practical, or is too long-term a solution. How much of this have you discussed with your pdoc? Med needs change over time. Maybe some adjunct welbutrin would help?

I have a kind of similar case - stressful work, post holidays mood crash, etc. My doc gave me a short-term script for adjunct adderal as a way to subtly boost the effect of the various antidepressants while we work on longer term solutions.

Sure, live all healthy and stuff, but short-term med adjustments can be a huge help at particuarly difficult times.
posted by colin_l at 5:45 AM on January 19, 2014

Depression is hell. A few thoughts - try (or similar ;-S) for 'the doing' side of things.
Spend time around 'the right' kind of people. When I feel like shit I can't necessarily hack raging optimists.. anymore than they can probably hack me. Co counselling is a great resource (has been for me) of people with depth who will take you as you are. Yes there are idiots and toxic people in it, as everywhere. Most are not like that.
Long baths with candles.
An aggressive sport to release some repressed anger? Balanced with a soothing thing.. massage?
Kind touch.
Cuddle a baby or be around a little kid too young to know aching disappointments or battered esteem.
Watch a film that makes you laugh over and over so you can FEEL that again.

A quote a like. Don't mistake your current context for your permanent truth.
posted by tanktop at 7:35 AM on January 19, 2014 [1 favorite]

First of all, congratulations on posting this question-- it is an existence proof that deep down, you do believe you can care about your life again. If you didn't, you would not have asked how to start.

Many of the above suggestions are good, especially exercise. Think of it as self-generated medication, and do it, preferably working towards something that involves cardio (that can start as a brisk walk for now, and I'd suggest going outside if possible in your climate, rather than a treadmill... but anything works, really). If the idea of "going to do exercise" is daunting (and it might be-- hell I find it daunting sometimes and I'm just generically lazy), break it into pieces-- just put on your exercise clothes, then put on your sneakers, then go to wherever you were going to exercise... concentrate on the next little step until they add up into an action.

Now, the important thing: are you getting actual talk therapy in addition to the meds? Is your counselor really helping you work through some of the negative experiences you've had? I was depressed for many years, took medication, and thought "oh, it's all chemistry-- there's nothing else I can really do about it because it's not causally related to my life circumstances". Then I met a therapist and started talking about some of those life circumstances, and in our first session he told me "I don't know why you think your depression and anxiety come from nowhere! Listening to some of the things you've had to deal with makes ME feel sad and anxious, and they didn't even happen to me!" I had had counseling for years, but no one previously had really helped me untangle the Christmas lights of how I'd gotten to that point. It made a world of difference-- I eventually stopped taking medication and most of those problems are gone now, and when they rear their stupid heads again I have tools with which to fend them off. It sounds like you have had a really hard time-- I'm an academic and getting a PhD is no joke, even under the best and most supportive of circumstances.

In short, doing the little things to gently nudge yourself back on course is great, and you should do anything that makes you feel better... but it sounds like you need another therapist to help you sort things out.

Finally, if it's any consolation, know that lots of people have been at the bottom of the same well you feel you're in, and have made it out and back into life. You might enjoy this.
posted by shaka_lulu at 8:59 AM on January 20, 2014 [1 favorite]

This is a big thing, not a little thing...if you can swing it financially I'd recommend trying rTMS. I only did one course of treatment because it wasn't covered by my insurance and that shit is expensive, but it really helped a lot on top of meds and therapy.

I wonder too if this misery and meaninglessness will recede a little after you graduate and get out of there.

This is also not a little thing I guess, but are you a dog person? Having a dog can be really good for depression, because you have someone else to live for and they rely on you to get up and take them outdoors for a walk every day. It's a lot of responsibility but that unconditional love is pretty amazing.
posted by snailparade at 12:48 PM on January 26, 2014 [1 favorite]

Thank you everyone for your responses. Most of them were helpful, its just that my mind seems to have detached from all these things - it knows all these things should help, but it believes it won't help me, or that its no use whether I get better or not.

I marked some answers as the best, because in this state, these small things felt like they might help me reconnect with my past self, with the one who cared about stuff, or at least start out with small changes that I could make and step on with some optimism in my days.

, that link you posted was incredible. It could have been me in that animation and just made me chuckle. It helps me to remember this isn't me being lazy because I'm trying really hard, but I just feel indifferent about stuff, which is scary.

Its more difficult to cope with people around me because they cannot fathom how meaningless everything seems to me, and putting up the charade is just excruciating. Telling my husband and mum about this apathy has helped, but even they have a hard time understanding and it pains them to see me aloof like that, when the truth is, I feel like the life around me is just make believe, the kind little kids play without real consequences that matter eventually.

In the meantime, this article about apathy helped me a little over the last few days. Just posting it here in case others find it useful too.

Again, thanks everyone.
posted by greta_01 at 4:29 PM on January 26, 2014

Greta_01: I am also a PhD student who takes meds for major depression. For me, the whole world changed when I got the RIGHT combination of meds. I needed Celexa to curb my anxiety and hopelessness, and Wellbutrin to give a bit of a lift. When I had the right combination, it was amazing to finally feel JOY again! I was on meds (just Celexa) for a few years and it helped me cope, but I was still in the gray fog you describe. Not the same at all!

Interestingly, being on the right combo gave me the freedom to re-explore the things I do like. It also gave me the clarity to rid my life of some things that were dragging me down - specifically I gained the confidence to leave my husband who was a major drain on my self-esteem and a constant reminder of feeling trapped in a life I did not really love. Making those changes led to me being able to go off the meds!

From the wording of your question, you are clearly still suffering. Feeling OK is not the same as feeling good. None of the soul-searching, "What lights you up?" kind of questions will help unless the light is plugged in! Go to another psychiatrist. Get your needs met. THEN, the question will resolve itself.
posted by JanewayJunior at 8:20 AM on February 24, 2014 [1 favorite]

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