Almost a year after my earlier post about my experience of depression in grad school, I wanted to discuss some of what I’ve learned about recovering from depression. I expected that recovery would be nonlinear, with good days and bad, and that’s been accurate. I also expected that at some point, I would pass an obvious milestone labeled “fully recovered,” and would go on feeling happy and engaged with the world without needing to consciously work towards that goal. This doesn’t actually seem to be the way that recovery functions. I’ve come to find that preventing relapses of depressive symptoms requires consistent and active work on my part, and I suspect that it always will. I wanted to share this in case it might be useful for anyone else in a similar position.
The Half-Life of Depression
One thing that really surprised me during the earlier stages of my recovery was that even after I’d dealt with some of the underlying problems which were leaving me depressed, I would still have days when I felt inexplicably sad or unable to focus. I suppose I’d assumed that I would bounce right back to my usual self once my stress levels had gone down. However, I’ve noticed three ways in which the effects of depression can persist beyond an immediately stressful situation.
First, untreated depression changes your brain. In the short run, it shrinks the hippocampus and makes it more difficult to form new memories, although these effects appear to be reversible once the depression improves. In the long run, it increases inflammation in various parts of the brain, including the prefrontal cortex, which helps to govern executive function and reasoning skills. I’ve found that while I can still produce high quality work, I can’t maintain intensive focus for quite as long, and I need to take breaks more consistently.
Second, depression can lead to shifts in your habits which require some effort to undo. At my worst, I was ignoring my email, letting all the dishes go unwashed for days, and so forth because I couldn’t get out of bed. I’ve had to consciously work to re-develop all my previous good habits of time management and organization. This has also led to some interesting new challenges. For example, if I’m consistently washing the dishes and keeping on top of my email, this helps me to focus on my other work. If I let the dishes pile up a bit, however, I’ve found that this sets off an anxiety klaxon in my brain saying “Look at this mess! You’re getting depressed again! You’ll never recover!” Over time I’ve learned to acknowledge that klaxon and then think about all the ways that I am recovering, rather panicking over it, but that was another totally new habit to develop.
Third, the process of recovering from depression might also bring up other mental health challenges that you hadn’t previously dealt with. For me, a big part of my recovery was journaling about my emotions, and trying to figure out why I was feeling sad or stressed rather than just ignoring those feelings. In the process, I realized that I’ve probably had a mild-to-moderate anxiety disorder for most of my life. It’s ultimately been good to address this more openly, but at the time it felt like a big setback as I tried to reach my goal of Being Mentally Healthy, and led to a relapse of depressive symptoms for a while. (As it turns out, most of the steps for dealing with depression also work on anxiety, at least for me.)
Rethinking Recovery and Productivity
The other thing that’s struck me about recovery is how much more sensitive my moods are to my general level of self-care. If I’m getting enough sleep, exercise, and time to journal, then I can bounce back from stressful events pretty quickly. If I’m not, stressful events can quickly lead me to feel depressed again. I’ve come to think about self-care not as something indulgent, but as a process of investing in resilience.
This has required some fundamental shifts in how I think about my productivity. There are strong narratives within American academia and American culture more broadly about how productivity can only be achieved at the expense of one’s physical and emotional health. When I was younger, before my period of severe depression, I absolutely lived into this. I was regularly overcommitting myself at school and at work, and skipping sleep and social events so that I could finish my projects.
In some ways, that mindset has been the biggest reason why I don’t think I’ll ever arrive at “fully recovered” — because my idea of what being fully recovered looks like is actually an unhealthy one. I’ve held on to the perception that “recovery” means being able to work extremely long hours without ever having to take care of myself, and without suffering ill effects. Uprooting this deeply held belief is still a work in progress for me. In particular, I’ve had to really work to not compare my current rate of productivity to the unsustainably high rates I could produce in my teens and twenties.
One thing I’ve found helpful here is trying to focus more on process than on outputs. If I get too focused on how soon I’m going to finish a report or an article, I end up falling back into unsustainable habits, like working late or skipping the gym. I can do this for a few days, but I’ve found that I inevitably crash after that, and will then lose the next few days to another wave of depressive symptoms. Conversely, when I prioritize meeting my standards for self-care, this leaves me feeling rested and focused for the rest of the day. I’m trying to remind myself that working consistently is more sustainable in the long run than working intensely, if the latter pattern forces me to alternate between working intensely and not working at all.
Here are the aspects of self-care which I’ve found most helpful during my recovery. Everyone’s experience is different, and I don’t mean to claim that this is the royal road to mental health — simply things that have worked for me. Also, I’ll note that I haven’t to deal with very inflexible work or caregiving responsibilities, which would definitely have made this more challenging.
- Getting enough sleep. I cut down on caffeine and stopped using an alarm clock if I didn’t have any early meetings, both of which help me to get the amount of sleep my body actually needs. (The tea in the photo is caffeine free!)
- Regular exercise. Doing some moderate cardio every other day helps me to feel much more focused. Being outside for a workout also seems to help, although if I’m working out indoors I’ll try to spend a bit of time outside at another point during the day.
- Journaling. If I wake up with something on my mind, I’ll write about it right away, so that I’m not worrying about it for the rest of the day. I try to use the journal for immediate problem solving during the week (like “how should I handle this challenging conversation I’ve got coming up?”), and take time to write about bigger issues on the weekends.
- Solving small problems right away. If I notice a small issue that I need to resolve, I try to handle it promptly, so it’s not distracting me. This seems trivial, but I’ve found that I otherwise get stuck in a cycle of being distracted, then blaming myself for being distracted about something small, then being even more distracted. Something about the experience with depression means that I have a hard time snapping out of these cycles if I get into them, so I try to just avoid them.
- No mind-reading. Lots of people hesitate to bring up difficult topics with their partners or colleagues. When I do this, I find that I often end up trying to guess at how the other person feels, or imagining worst-case scenarios for the conversation, and that’s a definite trigger for depressive symptoms for me. Raising difficult topics directly and trying to resolve them helps me avoid that outcome.
Also, lots of other things haven’t worked for me! Among them are giving up alcohol, cutting back on screen time, and meditating, none of which seemed to have any correlation with my mood. I also haven’t tried any medication, although I’m open to that in the future if my current set of self-care practices no longer seems to be enough to keep depression at bay. Recovery is definitely a trial and error process.