Medical Leave - Depression & Anxiety edition
July 18, 2017 12:37 AM   Subscribe

If all goes according to plan, I will be approved for medical leave due to depression & anxiety today. My therapist has encouraged me to take time away from work, and my physician has (reluctantly) signed off on it. However, my therapist has not been clear on how I can best use my time for recovery.

I have major depressive disorder with a strong dose of anxiety peppered in for good measure. I relate to things I read about high-functioning depression and highly sensitive people.

My physician's unhelpful recommendation was to get a new job. My therapist insists I need to do less. I am worried that doing less will lead to a downward spiral into a deeper depression.

I will speak with my therapist in a week and will follow up with my physician in three weeks. Meanwhile, how do I spend my time with recovery in mind?

I have made every attempt to actively manage my depression. I practice yoga, meditate, and walk up to 10km per day. I eat a balanced diet, and have worked with a registered dietician. I've participated in workshops on self-love, anxiety, and specialized yoga practice. I see friends regularly, go to spin class from time to time, and am taking a kettle bell group fitness class. I limit my alcohol intake to about one drink per week.

I'm a big fan of Pema Chodron, Eckhart Tolle, and have read "Feeling Good" by David Burns. I have reviewed this question on what to do when going through a depressive episode.

Outwardly, my friends, family members and colleagues can't see anything "wrong". I know I am running on empty and need to take this time. But, I'm not sure how to respond to them when they inquire about my well-being.

I feel very grateful that I have the kind of job that allows me to take this kind of time. I am single and have no children, and acknowledge my privilege of being able to seek care and gather tools to support myself. But I'm at a loss. The professionals I consult with shrug and assure me I am doing everything right. Be patient, they say. But my employer is losing patience and this is my chance at improvement.

I want to get back to the point where I feel content and productive.

Here is my goal:
Trusting my self, and generally being content with who I have become. Being able to love others in a committed way, being engaged in meaningful work and being able to handle daily stress. To face disappointment and frustration without becoming destabilized. The ability to self-soothe without escaping into destructive thoughts.

And my motto: Healthy, vibrant, energetic self

To summarize:
How do I spend my time with recovery in mind?
How do I respond to people when they ask what is going on?

Thank you for your help.
posted by anonymous to Health & Fitness (9 answers total) 11 users marked this as a favorite
Are there any daily living tasks that you've fallen behind on or that you can do in advance to help you when you return to work? When I was depressed, all of my energy went to my job, and I had nothing left over for household tasks like cleaning or paying bills, and I fell massively behind on these things. It sounds like your diet is in good shape, but I'm thinking things like: prep meals in advance for several weeks, clean your house from top to bottom, paying all your bills and then putting them on auto pay, setting up and going to any doctor appointments (not just for psych, but anything). Any kind of research tasks, like finding a housecleaner now in case you fall behind again and need one later.

I agree with you that doing too little may lead you to ruminate and spiral further into depression. This is why I kept going to my job, despite the difficulties I had. Maybe set up several goals for each day (even for relaxing things, like reading a chapter of a book or calling one friend or setting up a dinner date with a friend) so you have some structure. At least one of these goals should involve interacting with other people and/or going outside. I find those two things particularly helpful for breaking out of rumination. Good luck.
posted by unannihilated at 4:32 AM on July 18, 2017 [6 favorites]

Can you do some of the following:

Sit in the sunshine (maybe near trees/water)
Go for a walk near trees/water
Eat tasty food
Spend time with friends
Read books that make you happy
Do laundry

If you have the mental resources, work through a CBT workbook.
posted by Murderbot at 4:48 AM on July 18, 2017 [2 favorites]

Are you able to get out of town for awhile? Like, maybe a week or even longer? I think being home, even away from work, it can be easy to still feel a weight of unspoken expectation from your social group, that window you've been meaning to fix, that one chair you hate, etc. But kicking things off with a mini-vacation, even just a week or so away from your usual environment, might be good for hitting the reset button and helping you get into a head space where, as your therapist mentioned, you can figure out how to do less.

Also, I'm not encouraging a backslide or anything, but you mention a lot of things that you've been doing (yoga, meditation, walking, cycling, meeting with friends, balanced diet, etc.) to try to address your depression with lifestyle changes. And they're good changes! But especially with the anxiety component, I almost wonder if some of the things that you mention have the potential to become another type of expectation that weighs on you, where you feel compelled to do them rather than doing them for the joy of it.

And I know it can be hard to tell the difference! But data point of one, I felt SO MUCH BETTER when I let some of my enforced habits die out and went where the mood took me rather than insisting that I couldn't go to bed unless I meditated or did Duolingo first. I am not sure if this is applicable to you, and I would not want to encourage you to stop eating healthy or doing yoga because those are both objectively great for you, but I would maybe use this break from work as an opportunity to really examine whether some of your habits bring you joy or if they are simply another obligation in your life. (With your therapist's help, of course!)
posted by helloimjennsco at 6:21 AM on July 18, 2017

Think about what your return to work looks like. I'd consider two weeks off, which you can treat as vacation, then a gradual re-entry. You can do two days a week or 3 hours/day and slowly work back up over 6-8 weeks.

If your task is to learn how to manage stress then the only way to do this is to manage stress. A graduated return to work program can do this for you.

Please disregard this advice if the stress is due to abuse, harassment, retaliation, other ethical and legal problems. In that case spend some free time with lawyers and take a next step.
posted by crazycanuck at 8:01 AM on July 18, 2017

Do you take regular vacations? It sounds like you're "doing everything" so I suggest doing nothing. Go out of town for 3 days, a week. To the beach or mountains. Skip yoga. Have a slice of pizza and a glass of wine. Watch cable.
posted by kapers at 8:39 AM on July 18, 2017 [1 favorite]

When I was on medical leave for anxiety and depression I was lucky to be provided with resources by my insurance company (I'm in Canada so options may differ depending where you are) to help manage my time and goals. One of these was a gym membership to ensure I got some exercise a few times a week. Another was a coach who encouraged me to set up a structure for each weekday. So from 9-5 I had a schedule which would include things like achievable goals such as 'clean one room of the house', '20 minute walk', and structured but not goal-oriented things like 'ipad time' (videos, reading or web browsing), 'lunch', etc. This a) made sure that I didn't just spend the whole day doing nothing, and b) prepared me for the structure of a day going back to work.

Having said that, it sounds as though you're already doing a lot of very positive things and like others have suggested, maybe you need to step back a bit from some of your regular activities. Keep walking but go for shorter distance and really walk with a purpose rather than plain exercise - notice the birds, flowers etc. Perhaps stop at a coffee shop for a break and sit with a book for a while?

I worked through a couple of workbooks (which were part of my structured day) on depression and anxiety which really helped me deal with some of the bigger issues that had been causing me difficulties for a long time - if you wanted to MefiMail me I'd be happy to dig them out and make recommendations.

I notice you don't mention medication, and maybe it's not an option for you, but working with my doctors I went through something like 7 different ones (mostly with awful side effects) before finding one that helped (with therapy and everything else) get me to a place similar to what your goal sounds like. This took time and patience and appointments with a specialist who could make more drug recommendations than my family doctor.

For part of the time I was off I had a 'check in' buddy (maybe an accountability buddy?) - not a close friend but somebody who knew me well enough to understand where I was at. We would Skype/Facetime 2-3 times a week to see where I was at and to make sure that I was doing the things I was supposed to be doing, and to see if they could suggest things I could do differently. That really helped me a lot.

I was lucky enough that my workplace and my doctor both didn't want to rush me back to work until I was ready. The three weeks you mention may not be enough time given the symptoms and feelings you describe. If you need more time, take it. You say your employer is losing patience. Depending where you are your job may be well protected and/or they may have to accommodate things that you need to make it a viable situation for you. Do your research (if you can, or ask somebody else to do it for you) to find out what the regulations are where you live.

And as others mentioned, if you can do a gradual reentry, so much the better. In the time before going back I made lots of food for the freezer so I didn't have to worry about meals for a while once I was back at work.

Best wishes as you go through this. Your goal is realistic and achievable. MefiMail me if you want to chat in more detail with someone who has been through it.
posted by valleys at 9:59 AM on July 18, 2017 [1 favorite]

Intensive Outpatient Programs (OIP) are what most major insurance groups call services that might be beneficial to you.

They are specifically geared towards folks with acute depression and anxiety. They're like a bootcamp to get your footing in a situation like this. They often go for 4-6 hours a day, 4-5 days a week. Your GP might be able to help you find one, as might your therapist. Your insurance company will be able to do so as well.

But if you have PTSD, I don't suggest them, they're not typically tailored to the anxiety and depression stemming from PTSD, and certain aspects of them can exacerbate those symptoms.
posted by furnace.heart at 10:10 AM on July 18, 2017 [1 favorite]

I agree with the above. Where I live (Chicago area), IOP is generally half a day (like 9a-12p) and partial hospitalization (PHP) is longer (like 9am-3pm). Every time I've had to leave work for a period of time due to my depression, I've gone to PHP or IOP. It has been tremendously helpful for me. The only drawback was that I waited until I was basically a subhuman flesh-lump before going for treatment, so I'd be there for 5-9 weeks rather than the two weeks that most people do. Don't become a lump. Sounds like right now would be a great time for you to go.

Another downside that I didn't realize going into PHP for the first time was that I would not be able to see my own therapist while doing PHP. The insurance considers it double-dipping because you will see a therapist while you are in there. The therapist I had at the time would give me a couple 15-minute calls per week to catch up, and it sounds like yours might, too.

PHP/IOP in my area is a lot of group work. You'll see a therapist individually a few times per week, but you'll have groups the rest of the day. I freaked out the first time because I did not want to talk to other crazy people about my problems, but by about the second or third week I loved it. If you are a group-hater, give this a chance before you decide not to go.

Another idea: don't do too much. It sounds like you are filling every second of your life with stuff right now, and maybe you just need to lay on the couch and watch Judge Judy a few times per week. Sometimes your brain just needs a break, and not everything you do has to be related to improving your life/depression.
posted by catwoman429 at 1:38 PM on July 18, 2017

In the spare time, you probably can read some books related to anxiety and depression. Here is the one I recommend. Though it is for teen, it works for adult as well.

Conquer Negative Thinking for Teens: A Workbook to Break the Nine Thought Habits That Are Holding You Back

Alvord PhD, Mary Karapetian
posted by mysunshine at 12:06 PM on July 19, 2017

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