The storm passed. The huge trees fell beside our house. My angry, blaming depression spent itself in a fury of hard work cutting up the fallen timber, hauling branches into heaps, lifting and shoving back in place every wind-strewn planter and potted tree that had rolled away under the force of a 60 mph north wind. And then for a couple of weeks, the other side of depression emerged, imposing its quieter and more destructive character. I was full of bleak thoughts, hurting inside, carrying around a weight in my chest that was trying to pull me down into some dark lost place in a hidden underworld. My mind stopped working, settled into a fog of slow motion thought where every intention to do anything emerged only dimly in the mist. Life comes close to a standstill.
What can you do in the midst of that fog?
It’s hard to get to step one in thinking about how to fight against it, how to start pulling myself back to the light of day and its energy, focus, action. I can see two different things going on when my mind gets this bad. One is the endlessly repeated insults my mind is pouring out about how wretched and inadequate I am – and there I have the ability to talk back, tell that grim voice to shut up, contradict all the negativity with the awareness that I’m in a phase of illness that will pass. And these CBT-related tools really work. But the mental fog is different. I have found nothing to dispel that. It comes, it goes on its own. A few days ago, I woke up in the morning and realized my mind was alert and alive again, and I was full of energy to do the twenty things I had let slip while down with this illness. So I made the most of it. The next day, I was back in a dense of cloud. I feel completely helpless about maintaining the basic vitality of mental life and energy.
While I haven’t yet found the answer, here are the things I’ve tried:
- Lists I rely on to-do lists and calendars I’ve put in place beforehand to get the minimal things done at work or at home.
- Writing I write down exactly what I’m going through and thinking. At times, this has actually helped me get through the day, as I described in an earlier post.
- Meds-1 At times, the slow-down of mind turns up as a part of the cycle of going through the day. It occurs to me that this problem has gotten worse over time, but when it was confined to just part of the day I used medication. A doctor had me take different stimulants, ranging from generic ritalin to adderall. These are short acting drugs, exactly the kind used for people with Attention Deficit/ Hyperactivity Disorder (ADD and ADHD). That helped for a while.
- Meds – 2 A longer lasting medication-based treatment came later. A different doctor substituted Strattera, a newer drug that addresses dopamine, to be taken with a serotonin/norepinephrine reuptake inhibitor to act on multiple neurotransmitters. Lately, and most effectively, I’ve switched to Emsam, that uses an older class of drug, a monoamine oxidase inhibitor. This acts also on the three key neurotransmitters, but its particular action and delivery system make it much more effective in helping me maintain mental energy and focus.
- Exercise The drugs, though, do not prevent the deepest plunges into the mind-numbing version of depression that is most destructive of my work life. I try vigorous walking and exercise when I can push myself into it. That provides a short-term brightening that I then try to build on.
- Start Simple Tasks This is where my to-do lists and project schedules play a key role. If I can’t think well, I can at least remind myself of exactly what I’m supposed to be doing. I start by tackling the more mechanical tasks first and then force myself to the phone to call someone I need to talk to, make an appointment, schedule a meeting for another day when i just hope I’ll really be able to focus, react to the flow of email, make sure the most urgent things have been done. Then I try to start on the more substantive issues requiring original thinking and strategizing.
- Habits of Mind If I’m lucky, by this time I’m starting to be in the mental groove for working, and the old habits come back. Thank God that key work skills do become habitual – there is always a core of directed action I know has to be set in motion, and it is second nature to follow certain tried and true thought patterns.
So far, that’s the best I can do with this most insidious side of depression.
What have you found effective against this mental shutdown?
Some Right Reserved by Dimitry Kichenco