The past few years have been rougher on me than the average hell most people have endured. I'll spare everyone the details. Point is ... I am presently emerging from a sustained depressive episode and urgently need to tackle major changes to restart my career while repairing my physical and mental health.
However, despite knowing everything I need to do and having a vision of a daily routine written out, every day seems to go by without accomplishing anything, even while my stimulant medication is fully active.
The stimulant seems to be lifting my mood in the morning and for the day. Then it dips down again.
What can I do to get myself to start doing things at least during the time that the stimulant is active?
What works for reimplementing healthy routines after a depressive episode in someone with ADHD?
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addacademic
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I too have had real low mood, limited physical activity during the past 18 months.
I take a stimul*nt medication. I’ve lost the interest to get the tings done that don’t interest me.
This past year,I picked my sleep schedule to focus on. Bedtime at the same time, even on weekends. I have talked myself into making sure that I get up the same time seven days a week. And, a trick I use is as soon as my alarm goes off I say, “5,4,3,2,1” and stand up. It’s an brain interrupt that doesn’t allow me to go back to sleep. And standing up is essential. I love to sleep in. I found consistent sleep times have helped my mood.
I am eating blueberries every day and making sure that I am hydrated.
If I get little to nothing accomplished, I don’t bat myself up. Tell yourself, tomorrow is a new day.
I also asked myself, “would my 17 year old self be proud of the me I am today?” Not the part of me staying on my couch, but the part of me that has accomplished life skills, as well as my growth into a loving and caring individual.
The other item that has helped me climb out of my pandemic mode is to text my own cell number with messages that I send others. Those positive messages that I send to my loved ones, actually perk me up.
One message I texted myself in April, “You are loved”.
Another text, “Days off that are unstructured Can be overwhelming. You are not alone!”
“Breath in the “I” for self care, breath out the “O” for others.”
Ten deep breaths, hold each time and breath out slowly.
“Have a great Day!” Those type of messages.
I may do one per week!
My mind actually will read the message and I get dopamine hits! Such an odd concept to text positive messages to yourself. It works.
If you can't get going, then you need more therapy and an adjustment in medication. You're not fully out of the depression.
Are you on depression meds? Are you in therapy? When in serious trouble, we need them both.
If you're taking meds, sounds like you could benefit from an adjustment, a change in med (or multiple meds) and/or a change in dose. So I am not seeing that the depression is over.
And yes, you might need an adjustment in your ADHD meds as well.
BTW: there is a pattern and I noticed it with myself ... If you have been horribly depressed, awful, in deep deep with depression ... what can happen is ... you feel "better" ... way better than the awful period ... and people assume they're out of depression. No, they're not. They're just out of the worst of an awful and deep depression. You need to keep going with treatment.
Imagine a mood scale ...
-10 is awful depression and mood
+10 is feeling wonderful ...
To really function, you want to be at a +6 or +7 ....
Well what happens is people go from -10 ... to 0! ... and they think "I'm done." No way, not close to being done. Keep going with treatment. There's a lot more joy ahead!
I feel like I could have written your post myself. I have in the last week been able to get a little bit of momentum. For me what has helped is setting boundaries for myself with my to-dos, otherwise I get overwhelmed. Starting with my morning routine helps me a lot. Here is what mine looks like:
8:00 Wake-up, drink glass of water, 3 things I'm grateful for
8:05 Brush teeth, floss
8:10 Go for a run / walk
8:35 Shower, face cream
8: 45 Get dressed
8:50 Meditate
9:05 Make breakfast, coffee, water set up desk
9:15 Make days plan / to do list
My to do list has two categories: Things I need to do today and things I want to do today. I don’t let myself put more than three things on either list. If I get everything done, I can add things to it or I can actually take some guilt free chill time.
Good posts from everyone. MisoDashi, I have a rigid morning schedule like you, but it doesn’t matter what I do, I am always 15 minutes late to work. Not that big of a deal because I always work past 5 pm and at home in the evening. But, I have all of the things in my bathroom setup in a manner where I do the same thing in the same order every morning or I’ll forget something, like not putting deodorant on brushing my teeth. Here’s my routine:Up at 5:30 am, take meds and have 1 cup of coffee and watch the news.
6:30 I put on my contacts, shave, and brush my teeth. In the shower by 7:30, take the dog out and usually on the way to work by 8:15.
Thank you (all three for your replies). There's actually more helpful tips in there than i would have expected.
I sent my primary care doctor a message about the continued depressive symptoms and asked about a med change. Unfortunately, my poor insurance means there are no options for a psychiatrist or psychotherapy in my region. (All the more reason to get well enough to get a new job with better insurance.)
I think a morning ritual or routine together with some of that positive self-talk and moderate daily goal setting is probably the solution ... particularly if it finally gets me back into exercise.
I've managed to fix my sleep schedule finally so perhaps i can make it a goal to start that morning ritual within the next week. Then build on that.
Your primary care provider should be able to respond to you. One, the meds are not that complicated ... two, they can call a psychiatrist for recommendations if they are confused. Good luck. You should be able to get good help with the provider. No need to feel bad that you can't afford a psychiatrist right now. You're doing OK!.
Hi Addacademic,Sorry to hear about your current situation that does sound awful. I've been really struggling with acute anxiety at the moment and have had my fair share of depressive episodes in the past, I can imagine how hard it is.
Don't beat yourself up though, every day is an achievement just if it feels like you're not going backward. It's good to start with baby steps.
Maybe reintroducing one or two healthy changes revolving around things you enjoy, such as leaving the house for a nice walk somewhere you'll probably like, or to treat yourself to a coffee. Or even joining a social club based on your interests.
I find that leaving the blinds/curtain open is a good way to wake up in the morning. The sun stops you from falling back to sleep but is also much nicer than waking up to a blaring alarm.
It might be worth talking to your GP about trying a different medication if you're not feeling any different. I do hope the stimulants start to work for you though, hang in there.
Thank you. I bought a light therapy lamp which I'm putting on a timer to go off every morning. I'll open the blinds as well. I do have delayed sleep phase disorder (a circadian rhythm disorder often found in ADHD) so this is essential.
Pleasurable activities. Getting out of the house. Yes.
I'll start with the sleep hygiene. Build a better morning routine off of that, including getting to the gym. And use small pleasurable rewards and positive self-talk to get momentum on growing this.
I use a light therapy box myself ... to back up, having a late sleep schedule (delayed phase in the technical lingo, "night owl" in the real-world lingo) is one of those conditions, like depression and anxiety, that often accompanies ADHD.
I also, like you, have morning lights on a timer. Otherwise, especially in the winter, I just can't get up and if I do get up, it's like my body is still asleep ....What also helps is to gradually turn down the lights in the evening. For years, I'd have lights on full blast and my computer on ... and then I'd wonder why I had trouble feeling sleepy ...
The only way I've ever been about to get myself to change the lights at the right time is to automate it with timers! It's so silly, isn't it! But important
I think enjoying your waking hours no matter what you fill them with should be your goal for now whilst ensuring you have the meds you need.You've lived your life overcoming obstacles and it's been a learning process acquiring and adopting both positive and negative adaptive thoughts and behaviours.
Those can't be changed overnight.
Whilst enjoying your time, using whatever you find easy to recall or have seen as something you would enjoy if you had the time or other resources you have now you will relearn better thought and feeling patterns.
Let it happen. Don't set yourself up for failure aiming too high. You have time.
You are right. Giving oneself the time to enjoy things is an important part of recovering from depression. In fact, it's one part of avoiding relapsing later on, so it's good to practice now.
I do think in my case i need to balance that against pushing myself to build productive and healthy routines. There SHOULD be time for both each day, right?
I've been here before and didn't fix that part of the problem last time. That might be part of the reason i ultimately fell back into a new depression.
Hi Mate, I'm sorry to hear of your challenges. As you can see from the responses to your OP you're in good company here.
I thought I'd share how I've started to come to terms with, and start to establish traction and momentum through what has been the most challenging period of my life.
5 years ago I lost a job, the experience triggered a whole heap of emotions that I didn't know how to deal with. Undiagnosed at the time, my recreational drug use, tipped over into habitual use, and very nearly became an addiction. During this time I slipped into a deep depression and tried to take my life twice.
1 year ago I was diagnosed with adult ADHD, and started taking concerta. The pshyciatrist I was seeing started me on 56 mg, and worked me down to 18 mg. None the less, the experience on concerta exacerbated my anxiety. I stopped taking it, leaning into my cocaine habit for my dopamine needs.
3 months ago things came to ahead, the drug use, and assocaited fall out resulted in my wife of 15 years asking me to leave our home. This meant also saying good bye to my 12, 10, and 8 year old kids. My kids are my greatest source of happiness. Not seeing them everyday was achingly painful.
I moved into my parents house, who had endursed adolescent me. They braced themselves for their drug using, borderline alcoholic, depressed, and anxious 41 year old son to come back home. They anticipated me continuing my self destruction under their home as I struggled to come to terms with everything positive in my life crashing down around me.
I had finally hit rock bottom, and my life was at the cross roads I'd heard so much about.
As I surveyed the wreckage of my life, I knew I had to change, if I didn't I could see a third, succesful suicide event on the horizon.
During this time I had signed up to a mens group that challenges men going through trauma to face into that trauma, address it through establishing a daily discipline, and hold yourself accountable by posting evidence of these new positive daily habits online. If you don't post, the consequence is 200 burpess, timelapsed and posted online. If you don't do that, everyone in your group has to do 200 burpees, and if you still fail to do that, you're asked to leave. This group of men, once strangers, now 3 months later - friends, almost brothers, meet weekly to celebrate our successes, and support each other during our weaknesses. It has been literaly, a life saver for me.
I changed my pshyciatrist. I'm four days into daily dose of 30 mg of Vyvanse and can feel the benefits. This coupled with my antidpressants has kept the drug use at bay.
I've started to exercise everyday, journal, meditate (mindfulness of breath, and loving kindness) while celebrate my wins, large and small.
When the inevitable challenges of life hit, I've started to develop the capacity to be at peace with my losses, and condition my mind to see them as lessons and insights, and not examples of my flaws. The book "Mindset" by Carol Dweck really hit home. I listened to the audiobook which is available on Youtube.
My wife still doesn't want me to come back home, and unfortunately, after 15 years of living with me seems to be marking time so our seperation will eventually lead to divorce. My kids miss me dearly, and I do them. I see them everyday.
Without the discipline from this mens group, the tangible compassion, and accountability from these same group of men,my best friend, and my parents along with the aforementioned daily disciplines, and my new better prescribed medication I don't think I'd be here typing this message.
What the last 3 months have taught me is that I need:
- People to hold me accountable
- People to support me
- A daily set of disciplines that focus on cultivating consistancy
- Medication
Some days are easier than others. But the progress is real.
You can do it mate. You haven't come this far, just to come this far.
Wow. I am flabbergasted, humbled and impressed by your story and so thankful that you are willing to share it so openly.
It doesn't surprise me at all that your drug of choice was cocaine. I've often thought that there must be tons of recreational cocaine users who are unknowingly medicating for undiagnosed ADHD.
I tried it twice twenty years ago in my early 20s and know that my reaction to it - calmness - was atypical, but didnt find it that this was because I have ADHD until many years later. I also binge drank quite a bit in those years, but who doesn't in London and New York? It did calm my anxiety and release some of the tension that often surrounds my inattention. These days, it is just my meds and occasional legal cannabis after the Vyvanse wears off on some days. I might still be self-medicating slightly.. So I can relate to your story, even if I don't think it rises to an addiction level. We take relief where we can get it, until we find a better way.
I also can relate to the midlife fallout portion of your story. There's no family or spouse in mine. (I've never seen myself ss capable of a sustained relationship.). However, the life I had been building around a very ambitious and high achieving career finally came to a total crash. My bad coping mechanisms for undiagnosed ADHD just didn't work anymore. I collapsed into suicidal depression and left my tenure-track job as a professor in the humanities at a tier one research university, a goal i had dedicated myself to for fifteen years or so. (I joke sometimes that my name should have been Icarus.). Losing a career is a different kind of loss than being distanced from your family, but the pain is very real in both cases.
Since then, I've been living with my parents, underemployed, trying to heal and reassess life while also caring for my elderly parents. My sister-in-law spent the pandemic dying of cancer as well, so things have been grim around here. Thus, the latest depression episode.
But I'm climbing out of the hole now. I am ready to move forward in life wherever it takes me next. Hopefully, with a few pills and some hard work on developing routines and accountability (and being kind to myself) it will be better than before.
Thank you all for your tips. I'm feeling the slightest bit of optimism.
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