What is my PROBLEM?
May 14, 2015 8:00 AM   Subscribe

Regular short periods of mild depression?/terrible procrastination/apathy about twice a month...therapist seems puzzled. What is this? Anything I can do to help me & my therapist address this?

For the last year and a half, I've been trying to address my 20-ish year problem with procrastination. In the last ten years or so, it developed into a monster that made the simplest of tasks (eg get out of bed, or get off the couch, or please just do something, anything) into a horrible ordeal. It sucked all the joy out of everything.... Nothing is really fun anymore, everything is a massive struggle. I've been doing yoga, seeing docs & therapists, and trying antidepressants. I was on Wellbutrin and am now on Zoloft. I find them very similar (switch is due to pregnancy, will switch back to Wellbutrin afterwards).

So that's the backstory, on to the actual question: I'm doing better, but only for about a week at a time. Then I have 5-8 days of being "bad"... it's hard to get up, I'm super late to work, I just don't really care about taking care of myself or my house or my loved ones. Then I swing back up to caring about my hygiene and taking care of my responsibilities for about a week, then the cycle repeats. This has been happening since I started antidepressants (prior, I was in a near-constant "bad" state, or the up swings weren't as distinguishable). WHY? What is this? My current therapist doesn't think it's depression because I'm not sad. I want to get this sorted in the next few months so I can concentrate on being a mom, but my therapist and I are both stumped on what's happening.

I have the mental and physical tools to deal with procrastination (i find it very helpful to label the "don't wanna" feeling as my monkey from waitbutwhy's description of procrastination, I love GTD, etc etc). I'm good at collecting and implementing these tools in my good weeks, when everything is just sort of difficult rather than impossible. But my bad weeks throw everything off track and are incredibly discouraging...and disturbing, since I apparently stop giving a crap. I had also tried adding Lexapro in with the Wellbutrin last year, but didn't see a difference. Any suggestions on what this is? TiA!
posted by Baethan to Health & Fitness (19 answers total) 17 users marked this as a favorite
 
I was just experience something similar and I was happy to hear there's an entire chapter on methods for defeating this in Feeling Good, the cornerstone of cognitive therapy. Definitely give it a read!
posted by Brainy at 8:06 AM on May 14, 2015 [2 favorites]


My current therapist doesn't think it's depression because I'm not sad.

Did your current therapist get the same animal husbandry degree as my dad? They seem to be similarly experienced in depression.

Get a new therapist who is familiar with psychology, and also start logging as much data as you can - food, sleep, exercise, allergies, physical pains, deviations in routine, period. Sometimes there are clues hidden in that information. Take that to your new therapist.

Are you a new mom, or new-ish? That's an extra layer. (Alternately - are you in your late 30s early 40s?) If you haven't had a full physical and bloodwork panel in the past 6-12 months, do that. All the therapy and antidepressants in the world won't touch your endocrine system, not in a helpful way anyway.
posted by Lyn Never at 8:08 AM on May 14, 2015 [10 favorites]


Two edits: take that information to your GP/GYN along with your new therapist. Also, if you are ovulating (or on a tricyclic pill) you should chart that along with your periods, because being fine for a week, off a week, fine a week, off a week sounds like a hormonal red flag.
posted by Lyn Never at 8:11 AM on May 14, 2015 [2 favorites]


Are you on hormonal birth control? If not, do these cycles track at all with your menstrual cycle?

My mental state is really sensitive to drops in estrogen (or relative increases in progesterone). So, I have 3-4 bad days toward the middle of my luteal phase. But, when I was on Depo Provera, pretty much all of the days were the bad days.
posted by melissasaurus at 8:13 AM on May 14, 2015 [4 favorites]


If OP is currently pregnant and still experiencing these regular swings, I am guessing whatever might be causing this is not related to her normal hormonal cycle.

OP, I second asking the doctors for bloodwork for the usual suspects (anemia, vitamin D, thyroid, etc.) if you haven't already.

Is there anything in your life that changes on a similar cycle? Shift work? Anything that could cause a sleep disturbance? Exposure to some allergen or anything else that might be related?

Do you have any other symptoms that happen at the same time -- poor quality sleep, low energy, joint pain?

Since it's a recurring cycle, it might be worth starting to chart out foods and beverages, places you go, people you see, things you do, exercise levels, sleep quality, etc. to see if anything obvious pops out as a potential trigger.
posted by pie ninja at 8:25 AM on May 14, 2015 [2 favorites]


Sadness is only one of many symptoms a person with depression can have, your therapist surely knows this. You're pregnant. How much? Your hormones are very probably affecting you now; ask your obstetrician for help. Have you seen a psychopharmacologist? And can you afford to hire someone to clean your home, something every pregnant woman deserves?
posted by mareli at 8:28 AM on May 14, 2015 [1 favorite]


This has been happening since I started antidepressants (prior, I was in a near-constant "bad" state, or the up swings weren't as distinguishable)

This is a bit of a shot in the dark, and I want to stress that IANAD, just someone who has taken a lot of psych meds.

Some people, myself included, actually get somewhat destabilized by antidepressants. When I was taking an SSRI (Celexa), I experienced mood cycling along the lines of what you're talking about, although my good days include some times bordering on hypomania. Still, there was definitely that pattern of doing okay for a few days, and then unable to get out of bed for a few days. Rinse and repeat.

Anyway, I don't know if this is what's going on with you. It could well be hormonal. But, fwiw, I switched off of celexa and on to lamictal (lamotrigine). It's a mood stabilizer primarily used for bipolar disorder, but it's also pretty commonly used off label for depression that doesn't respond well to SSRIs for various reasons. It's worked a lot better for me than the SSRI. (I also used it in combination with Wellbutrin for awhile, before switching off Wellbutrin because it ramped up my anxiety.

I have no idea about using lamictal during pregnancy, especially since there is that (very, very small) risk of getting "The Rash", but I do know that I've had no negative side effects having been on it for 4 years or so now. Anyway, might be something worth discussing with your doctor.
posted by litera scripta manet at 8:28 AM on May 14, 2015


You have very closely described someone I know well. After 20+ years of frustration, she pursued the avenue of ADD. I am not a doctor, but I can assure you that re-framing her symptoms under the ADD "umbrella" has finally started producing life-changing results and finally offered more answers than questions. Again, I am not a doctor. YMMV.

Good luck!
posted by davidvanb at 8:32 AM on May 14, 2015


A couple of questions.

Is your therapist also your prescribing psychiatrist? If so, I would consider seeking another opinion. If this kind of cycling is only something that began with the new medication, you might need to alter the dosage or try a different one. Also, depression (and the accompanying anxiety) can manifest itself in different ways. I'd certainly consider the symptoms you are describing a form of depression and the fact that your therapist is classifying depression as only "sadness" makes me question their judgment.

How were your episodes of procrastination before this began? This could actually be considered an improvement if you were experiencing extended bouts of extreme anxiety/procrastination. I'm currently going through a cycling phase between feeling groovy and being depressed. However the stretches of depression have been gradually getting shorter over the past few months. A lot of people talk about feeling magically improved with medication but it doesn't work that way for everyone. (I'm also on medication and in fairly intense 2x week therapy so YMMV.)

Again this is something I'd really discuss with your psychiatrist and possibly a new therapist.
posted by joeyjoejoejr at 8:39 AM on May 14, 2015


sorry, totally missed the pregnancy bit, please disregard my comment
posted by melissasaurus at 8:39 AM on May 14, 2015


Response by poster: I'm going to threadsit cause I figure the more info the better... Plus I'm coming out of a bad week, which always means I'm frustrated and looking for answers!

I have Feeling Good and have read the section on procrastination, that's the sort of thing that's very helpful during my good weeks. Doesn't make much of a dent in the bad weeks!

I'm 26, nearly half way through my first pregnancy, physically healthy, all my (many) blood tests have come back great. Healthcare-wise, I'm on state insurance & go to a health "home" so everything is done in house. I don't have a PCP or OBGYN, just APRN midwives and the therapist I was assigned to. I know my therapist isn't the best, but honestly I've seen some terrible therapists in my area (one told me I had a substance abuse problem because I liked to have a beer most nights....) My current one listens, is consulting with other professionals in the practice, and is very nice so I'm really apprehensive about finding someone else! So first I want to see if there's any leads I can give her.

Prior to pregnancy, I had the Mirena IUD which was great. Between then and now (pregnant so no periods) the good week/bad week cycle has been identical.


Off the top of my head, nothing environmental seems to be connected as I'm very boring & have the same schedule every week... I work 9-5 M-F at a nonchallenging office job.
But tracking everything seems like a great idea, I'll look for or make a spreadsheet to fill out!
Mood cycling! Sounds like a good description, I'll do some reading about that, thank you.
ADD isn't something I was considering because I tend to be very calm and able to pay attention when I have to, but I'll definitely revisit that!
posted by Baethan at 8:42 AM on May 14, 2015


Have you had your vitamin D checked? That's not always included in a blood panel. I had a severe deficiency, and it felt exactly like depression minus sadness. It was confusing as hell, until a doctor at a walk-in clinic picked it up by chance and thought to order the test. (The key symptoms for me were overwhelming fatigue and difficulty initiating tasks.)
posted by cotton dress sock at 9:02 AM on May 14, 2015 [2 favorites]


This sometimes happens to me when I overdo the "goodie two-shoes" days. I get sick of procrastinating, so I finally push myself into getting stuff done, and I go! go! go!... and then I get frustrated and resentful that I don't have any time to just rest, dammit, and I switch back into couch-sloth mode. I don't think it's just a physical energy thing, because I'll do the same with sticking to a budget -- I'll save and save and save and then I get frustrated and resentful that I don't have any money to just blow on fun stuff, dammit, and I switch back into overspending mode.

Typing that all out, I realize it sounds like bipolar swings, but they are nowhere near that severe for me and I don't meet the criteria for mania/hypomania. The triggering thing for me is the resentment at "having to be good all the time." So I'm working on the cognitive part of that by reminding myself that I'm choosing to work toward a balanced, sustainable life (rather than being "forced" to do it, somehow), and the behavioral part of that by moderating myself by not pushing too hard on my good weeks (I don't need to do every single healthy productive thing every single day; I can pick up one or two new good habits a week) and pushing myself a little harder on my bad weeks (maybe I can do five minutes of dishwashing and clean-up a night rather than none; my mantra has become "I don't have to want to do the dishes, I just have to do the dishes," which somehow takes off a layer of pressure and makes things easier), and the emotional part of that by reminding myself that it's reasonably normal to rebel against too much restriction, even if that restriction is self-imposed, but that if my inner three-year-old starts having a tantrum about not being allowed to do exactly what she wants, I can honor that feeling but not necessarily let her have her way.

I don't know if any of that is at all applicable to your situation, but I'm throwing it out there in case it helps. It's certainly worth checking whether your swings are severe enough to be hypomanic episodes triggered by the medication, but I think it is also normal for people to swing between (nonpathological) extremes when trying to learn new behaviors or ways of being. The most successful way of tackling that, in my experience, is to slow down on the new behaviors so they don't feel like such an overwhelming imposition.
posted by jaguar at 9:32 AM on May 14, 2015 [8 favorites]


Response by poster: This on/off thing is definitely an improvement (though right now it doesn't feel like it!) Vitamin D levels should be fine, my prenatal has 100% of the daily recommended value apparently.

ADD only fits me in the chronic lateness, chronic procrastination category... I'm great at reading and listening and I tend to be detail-oriented. One thing that did fit was stopping or not starting tasks that seem mentally challenging--oh yes, there's a definite feeling of "nope, that requires effort". Good weeks, I can deal with that because it's like dragging a 50 lb weight. Bad weeks, it's like dragging an elephant or something. I'll bring it up with my therapist!

@jaguar: Spot on! I don't think I get hypomanic so mood cycling might be out as an explanation. It's half reassuring and half super depressing that this might be a natural response to changing my life. It's a weirdly regular cycle and I don't think I've been stuffing in a ton of improvement in the good weeks (guilty of that in the past) but perhaps everything is an ordeal for my inner monkey and he can only deal with it for a few days before taking back control...
posted by Baethan at 10:01 AM on May 14, 2015


It's a weirdly regular cycle and I don't think I've been stuffing in a ton of improvement in the good weeks (guilty of that in the past) but perhaps everything is an ordeal for my inner monkey and he can only deal with it for a few days before taking back control...

For me, I think it's almost more of a mindset than a set of behaviors -- If I focus too much on telling myself how well I'm doing, the inner monkey/inner three-year-old starts kicking up trouble.

There's a theory (this will get relevant in a second) I once heard described (the person sharing it said it was from transactional analysis, but I haven't read the source texts so I can't confirm that) that we all have three parts, the child part, the adult part, and the parent part. The child part can be fun and spontaneous but also rebellious and irresponsible. The parent part can be nurturing and encouraging but also authoritarian and rigid. The adult part is the rational part that receives and transmits information without judgment.

It seems to me that when I'm engaging my inner neutral adult, I'm able to stay on track pretty well. "I am washing the dishes because clearing the counters makes it easier to cook dinner. I am not buying that expensive gadget because I feel better when I have a bit of money in the bank." Neutral, nonjudgmental statements about myself. When I engage my inner parent, however, even if it's the nurturing helpful encouraging inner parent -- "It's so good that I'm washing the dishes! Look at me, washing the dishes! Go, me! And I haven't spent any money today! That's awesome, me! I'm being so responsible!!!" (let alone any sort of rigid scolding "Do the dishes now or you're a bad person!" parent) -- that somehow kicks the inner child into gear after a few days and I start rebelling.
posted by jaguar at 10:18 AM on May 14, 2015 [5 favorites]


Vitamin D levels should be fine, my prenatal has 100% of the daily recommended value apparently.

Sadly, 100% of the US RDA is basically useless for some people. I personally am one of them. The RDA is 600 IU -- I take almost 4x that, 2,000 IU/day, to keep my Vitamin D levels in the correct range.

Moreover, many multivitamins contain D2 instead of D3 (D2 is cheaper, but D3 is easier for your body to absorb and use) and do not include oil (D is absorbed better with some fat).

I wouldn't add a D supplement without talking with someone (since you're pregnant, and since it's possible to be SO low on D that the over-the-counter supplement doesn't work). I would ask for a D blood test. It's not uncommon to be low on D.
posted by pie ninja at 11:08 AM on May 14, 2015 [2 favorites]


Mirena fucked up my mood and so did pregnancy. Anyway, how's your sleep? I have reflux and crappy sinuses and I tend to sleep poorly if both of those aren't attended to. Then I'm a giant exhausted lump.
posted by internet fraud detective squad, station number 9 at 11:21 AM on May 14, 2015 [1 favorite]


Can you see a different therapist?
posted by NoraReed at 3:57 PM on May 14, 2015 [1 favorite]


Maybe try reading this and see if it resonates with you. I relate to you HARD on the things you're describing and this author has changed my life.
posted by hannahelastic at 12:35 AM on May 16, 2015


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