On Sunday I woke up not very late and made pancakes, brewed a thermos with green tea and drove on a highway to a park to build a snow woman. Yes, it was specifically a very shapy lady, not a snowman. Today after I got home from work I felt that I couldn’t move. I couldn’t move because of overwhelming emotional pain – it was a sense of grief, a feeling that my personal world has collapsed, that there is nothing to look forward to. I am not going to say that on Sunday I was extremely happy, but it was clearly a more normal and stable day. What has occurred to make today different? I’m sure the answer lies in biochemistry, but at this point we don’t have the tools or knowledge to know what exactly should be measured and when. My last period started on February 15th. (I suggest to record start dates in order to understand whether the cycle affects your mood – at least in the case that you usually feel worse in the first few days before/during your period – you can remind yourself that this is not permanent and it will pass as it did before).
Today it is March 14th, could my serotonin levels be dropping? WebMD suggests that “as many as 90% of women experience unpleasant symptoms before their periods“, it has now been almost a month since my period, therefore today is supposed to be close to the “before period” time.
My thyroid antibodies also continue to be high, Anti-TPO at 250 and Anti-Tg at > 4000. TSH is abnormally high as well. My CT scan also indicated “partially imaged polypoid mucosal thickening in the right maxillary sinus”. What does that mean, does that have anything to do with depression? It seems to mean chronic sinusitis. I don’t know whether this ever has any effect on your mood.
The information above leads to some guesses about why I started to feel more severe emotions, but I can’t say that I actually know. I believe I have already made the changes to my lifestyle that I could – cutting out gluten and cow dairy because of celiac disease, avoiding processed foods, eating a lot of whole grains, fruits, and vegetables. I drink a lot of green and black tea, never drink or smoke, I go to sleep a bit before 12am and sleep for 8 hours. I walk to the subway instead of taking the streetcar, on a grey day I use my daylight lamp in the morning. I got an unlimited pass to a yoga studio and go there during lunch. No caffeine after 6pm. I call my mom and my grandmother. I try to avoid scrolling through Facebook. Therefore I would say – I’ve really done it all, what I could.
So what if you feel you’ve been as healthy as you can, you see your psychiatrist regularly, but the depression still sets in? Currently I am waiting for the IVIG procedure which is supposed to be done in April. You might be waiting for your next appointment to talk about switching medications, or you just started an antidepressant and the psychiatrist said that the positive results may take effect only after four to six weeks. I think the only strategy in such a situation is to think of activities to pass the time. Doing something even though feeling depressed. Even if your brain is dissuading you from it, it’s telling you to sit still, to not move, that any action you take will make it worse.
In DBT therapy there is an idea of opposite action and I believe this is a useful technique. “In DBT, the opposite action skill is a deliberate attempt to act OPPOSITE of your emotion urge. If your emotions are doing more harm than good, try acting opposite.” My thoughts are telling me that I am in too much emotional pain to do anything, but doing nothing will prolong the sense of time and I will just suffer more while waiting. For example last Thursday while sitting at work, I felt that I feel too depressed and lethargic to do anything expect stay seated during lunch and that trying to do any activity would make me feel worse. In this case my emotions and thoughts were only harming me because continuing sitting, after already three hours of sitting, would definitely not make me better off. I would be wrapped in my thoughts, prolonged sitting is not good for blood flow and chronic pain, time would also go very slowly. I had to use opposite action and I forced myself to go downstairs, change, and attend a yoga class. The 45 minute class passed quicker than 45 minutes of sitting would be and because the classroom was hot and I had to keep focusing on switching poses, my negative thoughts were less persistent. I am not saying that I went to yoga and felt delighted and blissful for the 45 minutes, I am saying that I was better off by going there instead of following my emotions and doing nothing.
Another example where following my emotions would make me worse off is often when I start feeling lonely I get wrapped in thoughts that I don’t have any close people and not many people to spend time with. Next, I start to think that I am the only one with no plans for the evening/weekend, and therefore it is pointless to ask anyone whether they want to meet. Clearly in this case acting as my thoughts and emotions tell me to would only harm me as I would end up not reaching out to anyone and of course then I will have no plans with certainty. Here opposite action would be texting/calling someone and proposing to make plans. Preferably be specific with an activity, place, and time. Refer to Sheldon’s friendship algorithm for instructions.
Sheldon’s Friendship Algorithm
Suggestions for passing time with depression are listed below. What works for me are simple activities, not trying to follow some life changing goals or saving the world. Depression is a real illness, and if all I was able to do during a bad day is coming out to convenience store to buy plantains, I will say – good for me.
- See an old friend, talk about your feelings, or talk about nothing in particular – remember a dumb high-school story, laugh about it
- Talk on the phone to someone you think is a good person, call them even if your brain is telling you that you are better off not speaking to anyone
- Cook/bake something that you know how to make and enjoy eating, I make crepes because the recipe is simple and this activity passes time as I have to fry each crepe separately
- Walk to a store nearby to buy something small – tea, eggs, apples, etc.
- Jump with a skipping rope at home, or on a porch, or outside. Aerobic exercise is healthy
- Get the lyrics to a song that you know and sign the full song, even if initially you really don’t feel like it. It will help pass the time and singing will not hurt you
- Walk around the block while listening to a podcast
- Watch CollegeHumor or Big Bang Theory
Notes of a Neuropsychiatry Amateur 