In the last week, everyone I’ve seen virtually for therapy has voiced increasingly familiar complaints. They are bored; they cannot get motivated to work or study; they have no appetite or have put on pounds from mindless snacking; they cannot practice healthy sleep habits even though they know too much screen time before bed and staying up past midnight will make it harder to function at peak efficiency the next day.
A lack of interest and motivation, along with appetite and sleep changes, can signal depression. And, certainly, we all are experiencing what feels like a collective state of depression after nearly a year of living with the drastic changes raised by a global pandemic, a situation that appears endless to many of us.
So, if your mood is low and you are having trouble concentrating, take heart. You are not alone.
As we know from a large body of research on mindful self-compassion, acknowledging the struggle, rather than beating yourself up for going through a hard time, can help, especially when you can connect with a common humanity (“Life is different for all of us right now.”) Treat yourself with the same kindness you would offer a close friend or family member to ease the unpleasant feelings.
Other coping strategies include seeking out social interactions, even if they might be less satisfying through a virtual platform, and breaking out of the daily routine by creating some novelty. Try learning a language, experimenting with new recipes, or practicing a different exercise routine. If you have trouble pushing yourself to do anything right now, keep in mind a lesson psychologists have learned from behavioral activation for depression: just doing something – anything, in fact –can pull you out of the doldrums, even if nothing sparks your immediate interest.
That said, although your current feelings of ennui may be nearly universal, they still could signal the onset of depression. If you have had a history of depression, you may be more vulnerable than someone with no previous episodes. Be on the alert for warning signs: constant rumination, feelings of hopelessness, extreme changes in sleep and appetite, and persistent thoughts of self-harm or suicide. Please seek help if those symptoms persist or worsen.
If you are just weary from the daily dreariness and not clinically depressed, you might try observing your emotions through the lens of mindfulness. A common approach in meditation is to view your thoughts and feelings as transient, like clouds in the sky or a stormy weather pattern: they change from moment to moment.
I had the opportunity to practice observing my response to an actual meteorological event recently when I woke to a heavy snowfall. My first reaction was irritation at the inconvenience of it. “I won’t be able to walk the dogs without worrying about being pulled over on the ice.” “We’ll have to dig out the cars.” “It’s so annoying.”
But instead of continuing to wish it were different and getting upset about a situation I had no power to change, I decided instead to work on accepting the state of affairs. While I drank my coffee, I gazed out the window at the wooded path behind my house and noticed how peaceful it looked. I bundled up, took the dogs for a walk, and let them enjoy sniffing and digging in the soft mounds of snow. I laughed out loud watching Roland drag a shovel down the stairs and across the yard like a prized game specimen. I stopped my internal grumbling, and my mood lifted.
And, then, much to my surprise, the sun came out, it warmed up, and the snow melted. Of course, the puddles will freeze tonight when the temperature drops. And tomorrow, we will begin, again.
In my last post, I talked about strategies for managing anxiety during these harrowing times. I have added some new tips for boosting psychological immunity and staying on track with sound mental health practices while sheltering in place in a post I wrote for the National Alliance on Mental Illness (NAMI).
“Many People Taking Antidepressants Discover They Cannot Quit”
Does this headline concern you? If you read the accompanying article in the New York Times and you’re on medication for anxiety or depression, you might feel alarmed. And if you’ve decided to start a medication regimen, you might even change your mind.
The article reflects a bias many people still harbor towards mental health issues and medication: you should be able to deal with your problems by force of will; if you can’t just get on with it, you’re weak. As the Times article suggests, “Daily pill-popping leaves them doubting their own resilience…” Pill-popping? Seriously?
No medication is completely benign. Yet few would question taking drugs commonly prescribed for high blood pressure, seizures, muscle cramps, and infections, many of which can have discontinuation side effects. Clearly, a double standard applies to the pharmacological treatment of psychiatric conditions..
The writer acknowledges that “many, perhaps most, people stop the medications without significant trouble,” but then goes on to relate the personal anecdotes of a handful of individuals who attributed “all the symptoms of withdrawal,” including increased anxiety and insomnia, to medication discontinuation. He neglects to point out one of the most common reasons for deciding to go back on medications for anxiety and depression after trying to come off them: a resurgence of the symptoms being treated.
It’s true, as the article points out, that primary care physicians write the vast majority of prescriptions for antidepressant and antianxiety medications. Follow-up is not as rigorous as it should be, and office visits are typically too short for an adequate assessment of mood changes and side effects. But it’s very misleading to assume, as the writer does, that “a useless [my emphasis] prescription may be continued for years—or a lifetime” because “improvement…is based on the passage of time or placebo effect.”
I’m not in the pocket of Big Pharma. I can’t prescribe medication. I don’t get a kickback from my psychiatrist colleagues for referring patients to them. When someone in my practice expresses a preference for trying cognitive-behavioral therapy without medication, I’m more than happy to oblige—with the understanding that we’ll revisit the decision at a later date if the therapy yields less-than-optimal results.
I believe in helping people find the maximally effective treatment for them. If that means recommending a trial of medication, I’ll suggest a referral to a psychiatrist who can address their concerns fully, monitor them regularly, and work with me to provide the best care.
Medication isn’t a magic bullet. But it can be a powerful tool. Making any health care decision should involve weighing the costs and benefits–with the help of professional guidance and not anecdotal horror stories–to determine the course of treatment.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.