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Dr. Bob is Robert Hsiung, MD,
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Posted by SadWren on September 16, 2004, at 11:33:31
Hello,
I am in the midst of my first major depressive episode. I am a PhD student whose "job" is essentially to conduct research and write papers, and since July I have done virtually nothing at all because I cannot seem to concentrate and/or motivate myself to do anything (then I lie awake at night panicking about the fact I have done nothing). Because the writing requires pretty intense focus for 3-4 hour periods, I find it impossible (reading has also been problematic).
I am on Effexor 150mg, but it hasn't changed anything yet (only 4 weeks in). I was wondering if anybody had any non-medication suggestions for working on cognitively taxing projects during depression. I am ok having lower productivity but having none at all is not sustainable and I am not sure how long I will be feeling this way (and from some posts, I am not sure I will get my motivation/concentration back while on this medication). Really don't want to give up the work, God knows I can't handle the real world (been there and learned that having people boss me around is very irritating).
Any advice appreciated.
Wren
Posted by Emme on September 16, 2004, at 12:11:19
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
Hi there.
I think this thread will probably get sent over to "social". But I'll give you a bit of a start with a few random ideas.
First of all, this site can be a great source of support and information, but don't be discouraged by negative experiences you read. The people who have terrific success don't usually post on the internet. And if Effexor doesn't do it for you, it's quite possible that the next one will.
While you're working on meds, I think your goal should be to do things that break down the work into small discrete chunks.
Are you in the sciences? Can you write the methods sections of papers or your dissertation as these require a little less higher thought than the discussion sections? Collect any graphs or photos you might need? How 'bout typing in those endless references? If you need to, just spend a little time getting your notes hyper-organized since depression scrambles your thinking.
> motivate myself to do anything
Chances are one of your colleagues is a little low on motivation too. Maybe you can do the writing equivalent of a gym buddy.
> Because the writing requires pretty intense focus for 3-4 hour periods,
Try 1 hour.
> I find it impossible (reading has also been problematic).
Keep a laptop in front of you and type in important notes or ideas as you read. Even if you're not digesting as well as you should, you'll have "cliff's notes" to look at until you're up to speed.
Give yourself credit for whatever you are able to do and make sure you're not hard on yourself if you can't. You can do this, even if it takes you longer than it would have otherwise.
> I am on Effexor 150mg, but it hasn't changed anything yet (only 4 weeks in). I was wondering if anybody had any non-medication suggestions for working on cognitively taxing projects during depression. I am ok having lower productivity but having none at all is not sustainable and I am not sure how long I will be feeling this way (and from some posts, I am not sure I will get my motivation/concentration back while on this medication). Really don't want to give up the work, God knows I can't handle the real world (been there and learned that having people boss me around is very irritating).
>
> Any advice appreciated.
>
> Wren
Posted by partlycloudy on September 16, 2004, at 12:25:31
In reply to Re: Depression and Mentally Challenging Work » SadWren, posted by Emme on September 16, 2004, at 12:11:19
Wren, if the Effexor is starting to work for your depression (do you feel better than before you started it?), it does take many weeks to feel its full benefits. You might ask your doctor about adding Wellbutrin to the mix as it's a similar medication that is often prescribed to give you a boost in energy if you're still lethargic.
I am a poster child for Effexor. It has helped me maintain a full time job, albeit not a particularly challenging one.
Good luck, and definitely check the Social board.
pc
Posted by Racer on September 16, 2004, at 13:05:13
In reply to Re: Depression and Mentally Challenging Work » Emme, posted by partlycloudy on September 16, 2004, at 12:25:31
I'll just add to it:
1. If you can't really manage the actual writing, make the most detailed outline you can. Then, when you sit down to try to work, instead of a stretch of three to four hours in front of you, you'll have a stretch of individual assignments in front of you, discrete chunks of what you're trying to convey. Writing these separately may help you finish more easily, just because you aren't staring at a HUGE project, but a lot of much smaller projects.
1.a. My rule for writing outlines, by the way, helps me a lot -- and I've managed a few pretty darned good pieces during major depressive episodes. (The secondary benefit, by the way, to writing anything even barely passable during a depressive episode is that it does help boost your self-esteem.) I break everything up into threes: three main points, with three subpoints each, and generally with three supports for each subpoint. It may be a bit obsessive, but the result was always good enough for the purpose, and having that "rule" helped create a structure that made it easier for me to outline my piece.
2. Talk to your doctor about a medication to address the nightly guilt-panic-fests. If you're not sleeping at night, you're certainly not going to be working at anything like an acceptable level. Some choices are low doses of the second generation anti-psychotics, which my doctor says also help with speeding up response to the anti-depressants themselves; actual sleeping pills; Gabitril, which is an anti-convulsant used for anxiety as well; low doses of beta-blockers, which help head off the physical responses to anxiety; adding Remeron to your Effexor, which might improve your AD response and tends to be sedating; Trazadone, which is an older anti-depressant that tends to be sedating and is often used for sleep; and benzos, which are just basically anxiolytics. Addressing the sleep is very likely to help improve your functioning during the day.
3. As Emme said, remember to give yourself credit for what you *do* do. Here's a possibly helpful story for you: during my last depressive episode, I ended up in the hospital with something liver related that acted like mono. Everyone knows the after effects of mono, right? I was wiped out for *months* after that, between that and the drugs that I was taking at the time. For an idea of what "wiped out" meant, I didn't have the strength or energy to eat for a couple of weeks after I got out of the hospital. My ex-bf, who took me in during that period *after* we broke up, would feed me, because I couldn't hold the cup or bowl. I could only manage things like tomato soup, and one can lasted me four or five meals. Got the picture? Now, in that case, I wasn't pressuring myself to *do* a lot, as you can imagine. (Honestly -- I watched Teletubbies every day, because it was about as challenging as I could manage. Other than that, I slept.) Depression is as *real* as that was, but I still find myself pressuring myself to accomplish more than I am managing. You're probably growing familiar with this phenomenon yourself, right? Well, that's a place to start.
You use up energy applying that pressure to yourself, and that energy could be put to better use by applying it to your work. So, my advice is to learn to give yourself credit for everything you do do, no matter how little it seems, because some part of you is too sick right now to manage more than teletubbies and a few swallows of soup.
3.a. More advice on this subject: Write down *everything* you do, every day. If you wash the dishes, write it down. If you write an outline, write it down. If you go to the grocery store, write that down, too. Even if they're the routine things that you know you have to do, and you know you will do, write them down anyway. One of the worst parts of depression is that it lies to you: it reminds you of all the things you haven't done, all the ways you disappoint yourself, but it hides from you those things you've actually accomplished. Having a writen record of what you've actually accomplished can help you recognize those lies.
4. Again, repeating what Emme said about the stories on this board: the nature of Psychobabble is that we come here when we need support, or to complain about our meds, or to find suggestions for alternative meds. Those of us who have been here for a long while tend to disappear when we stabilize and go on with our lives. The stories you read, as a result, are likely to give you a rather skewed picture of the effectiveness of these meds. Many of us have tried so many meds over time that we're even more sensitized to problems with them, and in some cases -- like my own -- to be pretty danged gun shy about them. We're not unbiased, so don't expect that our experiences will be predictive of your own.
Best luck to you, and best luck with Effexor. Remember, you mileage will vary, and this is a great place to come for support and information.
Posted by SadWren on September 16, 2004, at 13:22:54
In reply to Emme had good advice, posted by Racer on September 16, 2004, at 13:05:13
This is good advice, thanks. I will see what I can do with an outline-driven format to break things up. I also checked out the social board (so many boards to consider). I have Trazodone, but it knocks me out a little too much so I use it about every other day. I personally haven't felt an improvement yet, but my therapist said this week she thought she saw one...here's hoping.
My gratitude and warmest wishes.
Wren
Posted by Emily Elizabeth on September 16, 2004, at 18:45:54
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
Wren,
I just wanted to drop you a line to let you know that there are others out there who share your struggle. I too am a full-time PhD student dealing with depression and anxiety. PhD programs are hellish under the best of circumstances and with depression, it can be a pure nightmare.
I don't know if it would be helpful or appropriate in your situation, but it might help to talk to your advisor or other faculty member about your condition. Remember, this is a medical problem--just like if you were too sick with cancer to be productive. It might help take some pressure off and s/he might be able to help you set small manageable goals.
A number of faculty memebers in my department know my situation. Oddly enough, I am in a psych dept and in some ways that has been helpful and in some ways it has made things harder (everyone thinks that they know how to figure out you and your problems!)
Best of luck!
Posted by Sebastian on September 16, 2004, at 20:17:57
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
Try zyprexa. Sorry its the only thing I can honestly say was a god send for me in college. Straight A's!
Posted by CatFanatic on September 16, 2004, at 21:00:40
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
So glad you are hanging in there. I suffered from sever depression, social anxiety and avoidant personaity disorder all thorough high school and college. Even after getting good grades, and toughing it out and struggling as much as I could, I dropped out 13 years ago. Never worked or had friends since. I didn't even know what I had until 6 years ago. Too bad I wasn't born 10 years later. Didn't have the internet when I was in HS or college. That is how I found out about social anxiety, by accidentally stumbling upon it on the web. THe professors and deans at my college wre extremely harsh and cold. It was obvious I was suffering from depression....you should see my face. unremitting tension.
Hope you hang in there. I was supposed to be doctor. Imagine that. So much disappointment from my parents. I think I caused my dad's cancer in a way.
Take one thing at a time is the only thing I can think of. Literally one thing.
Posted by Emme on September 16, 2004, at 21:14:23
In reply to Re: Depression and Mentally Challenging Work, posted by Emily Elizabeth on September 16, 2004, at 18:45:54
Emily Elizabeth has a good point. When things got nasty I chose not to tell my advisor because it was close to my defense and I just wasn't comfortable about it at that point. But one of the other students in my lab group told our advisor when she had problems w/ depression and she was supportive. It helped with pacing work expectations. You will have to judge the situation for yourself, but it's worth thinking about.
Posted by King Vultan on September 16, 2004, at 21:33:26
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
I had similar issues in grad school and wound up dropping out after a year (and I actually quit going to my classes a couple weeks into the 2nd semester; although, I did continue with my TA duties). My problem was very poor concentration and related high levels of anxiety, along with depressive tendencies. Unfortunately, I never sought out any help until years later, when I first saw a psychiatrist and finally began trying different psychiatric meds. I don't know how similar our fundamental issues are, but I found Effexor to be an effective antidepressant but not so good for concentration. Wellbutrin was better for concentration but IMO is not as robust an antidepressant for most people. If you have any sense that you may have ADD, it might be worth checking into. I have some ADD symptoms myself, but I really do not have enough to qualify as actually having Attention Deficit Disorder. It is really a secondary problem related to my depression; however, in my case, my depression appears to be fundamentally dopaminergic in nature, and ADD also has a lot to do with dopamine.
Todd
Posted by sb417 on September 16, 2004, at 23:28:06
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
Hi SadWren,
Are you able to objectively assess whether you were better able to concentrate before you began Effexor? Are you better or worse on Effexor than you were a few months ago? Have you ever had any depressive episodes before? How did you manage them? Have you ever taken an antidepressant or any other psychotropic medication before? If so, how did you do on it?
Are you also in talk therapy? If so, it might be helpful to talk with your therapist about what you've told us. And one other question. . .Are you nearing the completion of your studies? Sometimes when students have difficulty completing a course or a degree, the most difficulty with studying and "writer's block" occurs towards the end, and this can happen for various reasons (fear of success, fear of failure, fear of "growing up" and actually getting a "real" job, and breaking away from the relative safety or illusion of safety that the academic world provides, etc. etc.). Finishing school and endings in general mean different things to different people, and it might be worth considering whether some of those fears and resistances apply to you.
Now, getting back to the medicines. . . Some people do well on Effexor. If you are one of those, it may take a while longer for you to see the benefits. Unfortunately, there are others who do very poorly on that medication. If you find that you are in that group, there are other medicines that your doctor should be willing to prescribe. If your doctor is either unimaginative or unwilling to come up with either a single drug or a suitable medication combo for you, then do some research about the best pdocs in your area, and switch doctors. If, in time, you find that the Effexor helps a bit but doesn't quite give you the motivation you need, then I hope your doctor will consider adding on a more motivating medicine, such as Wellbutrin or a stimulant. Some people find Provigil motivating; others don't.Please let us know how you're doing.
Posted by cache-monkey on September 17, 2004, at 14:03:37
In reply to Depression and Mentally Challenging Work, posted by SadWren on September 16, 2004, at 11:33:31
<<
I am in the midst of my first major depressive episode. I am a PhD student whose "job" is essentially to conduct research and write papers, and since July I have done virtually nothing at all because I cannot seem to concentrate and/or motivate myself to do anything (then I lie awake at night panicking about the fact I have done nothing). Because the writing requires pretty intense focus for 3-4 hour periods, I find it impossible (reading has also been problematic).
I am on Effexor 150mg, but it hasn't changed anything yet (only 4 weeks in). I was wondering if anybody had any non-medication suggestions for working on cognitively taxing projects during depression. I am ok having lower productivity but having none at all is not sustainable and I am not sure how long I will be feeling this way (and from some posts, I am not sure I will get my motivation/concentration back while on this medication). Really don't want to give up the work, God knows I can't handle the real world (been there and learned that having people boss me around is very irritating).
>>For the last 8 months, I've actually been in a very similar position to what you describe. I'm also in a PhD program and am in the research/writing stage. No classes that I'm taking or teaching, so that all I'm left with every day is this huge daunting task. Thing is that it can become a vicious circle. You don't do anything for a couple of days, which feeds into anxiety/panic at night, and then its that much harder to work the next day.
I'm actually a bit better now, which I attribute to the combination of meds and therapy. The meds help to stabilize my underling mood, but I see the therapy as what's helping me to make (slow) progress on my patterns of thought. I.e. how I rationalize my mood. It's also helping to make (equally slow) progress on my work and life habits.
So, if you're not in therapy, I would highly recommend it. And it's important that the fit be right. My university maintains a list of therapists who regularly deal with grad students and our specialized concerns. And even in that universe, there can be variation in the subjective quality of your match with the therapist (equally important). I went and met with about 4 people on the list until I found someone who seemed right for me.
Another thing: How far along are you? If you aren't planning on heading on the job market this year, try not to worry too much about what "work" you're not getting done. You are doing valuable work on your mental health. If you are actually trying for the market this year, it might not be a bad thing to postpone that until you're in a better place.
Depression is serious, and it takes a while to overcome. Trying to rush the recovery can add to the anxiety/panic and actually make the processs take longer. I had to postpone my completion for a year. And I did have to end up borrowing to finance myself this year. But the since the "hurry up and go" constraint has been relaxed, this has allowed my slow progress to cumulate into something more substantial.
Well, I hope this helps a little. Good luck!
Peace,
cache-monkey
This is the end of the thread.
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