Discussion For those who were severely depressed (with executive dysfunction), how did you recover?

[Eudaimonic]

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforementioned

 

[JoysoftheEmptiness]

Heya. I stopped taking my depression meds 2 weeks ago, trazadone, if they don't work, they don't work, I'm on a dozen more meds for other (physical) conditions. The way I keep going is to take one day at a time, I have low levels of energy, vit d3 deficiency or something, plus an underactive thyroid gland. I don't really know how to answer your question, I just wanted to write something so you know there's someone out there listening.

 

[alienfreak]

The world, your life situation, your body and your mind will keep changing even if you were to do your best to keep it unchanging. Sometimes making it through each day one day at a time and waiting it out can be enough to make it through to a better period

 

[Eudaimonic]

The world, your life situation, your body and your mind will keep changing even if you were to do your best to keep it unchanging. Sometimes making it through each day one day at a time and waiting it out can be enough to make it through to a better period

Nothing is going to change. I have been like this for years now.

 

[-Link-]

@Eudaimonic complex problems call for complex solutions. If you're currently without the mental or physical energy to engage in this, then I think the next best thing is to try focusing on just getting through one day at a time. Or one hour at a time. Or one moment at a time.

With this, the idea isn't so much about "getting better" as it is about "reducing suffering."

You could also look at incorporating small steps and goals into your days. For instance, if you can't deal with washing a sink full of dishes, then try washing (or just rinsing, even) one plate and one utensil instead of the whole load. Or if you can't bring yourself to even leave the house, then try just standing out on your front porch for five minutes at a time.

When you're suffering so badly, even the smallest victories count for something.

Small, incremental steps while keeping your focus on what's right in front of you: one day, hour, or moment at a time.

 

[sximii]

Meds. It's all meds. I still don't consider myself fully recovered cus if I miss one day of meds I go straight back into the same pit

 

[przeciwwymiotne]

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforemen

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforementioned

I'm not really sure because what usually worked for me was getting into survival mode. Sso for example if I was really scared of dying with Alzheimer's when I had troubles with thinking and talking and just like overall cognitively it was s*** (cuz of anorexia and overworking myself) nobody helped me not even doctors and I was left alone and I was sure that I will die but somehow I found someone with whom I was able to talk for a while and they kind of like motivated me to try living again. So then I started do cognitive exercises for old people and I started to go out and basically had this fear of death constantly my head. I was able to schedule lots of appointments with people, to go to all the classes on university and most of the extracurricular activities. It worked for a while but now that I'm out of the survival mode I have no idea what helps meds don't help me. So in my view it feels like nothing helps besides fear and fear is also exhausting and it brings on illnesses so I don't know dude. I wish I could help:((((

 

[Eudaimonic]

@Eudaimonic complex problems call for complex solutions. If you're currently without the mental or physical energy to engage in this, then I think the next best thing is to try focusing on just getting through one day at a time. Or one hour at a time. Or one moment at a time.

With this, the idea isn't so much about "getting better" as it is about "reducing suffering."

You could also look at incorporating small steps and goals into your days. For instance, if you can't deal with washing a sink full of dishes, then try washing (or just rinsing, even) one plate and one utensil instead of the whole load. Or if you can't bring yourself to even leave the house, then try just standing out on your front porch for five minutes at a time.

When you're suffering so badly, even the smallest victories count for something.

Small, incremental steps while keeping your focus on what's right in front of you: one day, hour, or moment at a time.

I see what you're saying here - however, the thing is that much of my suffering stems from being unable to make substantial progress in my life. And getting better (at least better enough to make said progress) is absolutely essential for achieving this.

 

[CountOfTuscany]

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforementioned

I've gone from OK to suicidal and back a couple times. I'm currently in a state like you where I'm just numb and no longer interested in medications. Medications have probably stopped me from killing myself in the ultra short term, but you and I both know that they're no recipe for sustainable improvement and often just lead to more numbness.

The first time I was suicidal, recovery went something like this:

1. Quit toxic job
2. Move back in with parents (I am lucky, my parents are great)
3. Slowly start working on something (in my case, Leetcode problems) every day to build confidence back up
4. Get new job
5. Move in with fun roommates who would get me out and about / not let me fall into isolation

(3) is essentially the engine that keeps recovery going when you're just starting out. You need to identify a medium-term goal that is achievable and can be broken down into small enough pieces that you can make measurable progress each day without feeling intimidated or thinking "what's the point?". My first recovery was based around doing a couple Leetcode problems each day and ramping up the difficulty in service of getting a software engineering job (which I eventually did, after hundreds of applications). My second recovery was based around doing every single problem in an actuarial math textbook to pass the first actuary exam (which I also did). Do not let yourself stagnate.

However, since you mentioned lifestyle, that's what I'll talk about here. After (2), I, much like you, didn't believe lifestyle improvements would be sustainable or that they would even address my problems. I was wrong.

Happiness/sadness are just neurotransmitters fitting into receptors in your brain. You can play games to optimize them. Make lots of checklists with small, achievable goals and accomplish them. Walk in the early morning sunshine. Focus on a reliable sleep schedule. Eat a balanced diet. Get some exercise. Eventually try going to some social activities, preferably based around a hobby you enjoy, etc. You would not believe how much better it's possible to feel once you have these things dialed in. A person in your situation can break these processes down into arbitrarily small pieces and tackle them one-by-one to slowly recover if that's the goal. But be patient. It takes time.

In my case, I've gone through that process a few times and I know I can slowly dig myself out of horrible mental states. I've just gotten tired of putting in inordinate amounts of effort for the "reward" of being OK for a year or so before inevitably winding up back here. I've definitely had chances to make progress in life after these recoveries, but so far, I've blown them all. It feels like I've been treading water this whole time, getting nowhere, even though I know logically that I made nonzero progress and became more resilient in the process. So here I am in a "last-ditch" state as well. Lately, my focus has been on learning more about the endocrine system and ordering lots of bloodwork to see if there's anything else I can do.

Depending on the results of my most recent hormone panel (pending), I am considering injecting responsible amounts of testosterone and HCG to observe how it affects my motivation levels. My testosterone is 430 ng/dl at 25 years old. This is low, abysmal compared to our grandfathers, but not low enough for a doctor to prescribe anything. I am experiencing some symptoms that would typically be associated with low testosterone, so I figure it's worth a shot. At this point, I simply must figure out the extent to which my happiness is dictated by my thoughts versus the distribution of hormones present in my blood.

I hope you find my ramblings helpful, or at least interesting.

 

[Unspoken7612]

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforementioned

I was in a very similar situation a few weeks ago (for at least four months solid, and quite often before that).

I was depressed. I would get up, bring my breakfast back to bed, eat it, think "I should go to work (from home)", lie in bed not working, get up in the evening to walk the dogs, eat dinner, make breakfast, and go to bed. I lacked the will to live, I was socially anxious, I wasn't washing or changing clothes or brushing my teeth. I felt disdainful towards my main antidepressant, often forgot to take it, and didn't especially mind that I wasn't taking it. The main source of pleasure in my life was rewriting my suicide notes.

Occasionally, I would do things like go to the shops or the gym, but didn't feel better. I had previously made lifestyle changes for no real lasting benefit and was very sceptical that they would make a difference. My depression was a response to hopelessness: I was never going to feel better (which would require impossible changes - finding a secure home, a romantic partner, fast friends, magically enjoying my job more).

I was convinced not to try and "solve it all at once", but instead do things that made life slightly more bearable. I was formally signed off work and told to stop trying until I got better. My doctor told me to make sure I kept taking the antidepressants every day, even if only to avoid withdrawal, which imo is usually much worse than the side effects. Aside from that, the only real change I made was to try and watch an episode of The Boys every morning in the living room. I also looked more closely into two experimental depression treatments, rTMS and ketamine infusions, which are offered fairly near where I live, with the idea that if I didn't get better I would try one of them in the New Year before my planned suicide in late March.

Honestly, a transformational change. It makes no sense, but I feel hugely better. There no longer seems to be a point in trying the rTMS or ketamine, because I am better.

So, I'd say that you should try asking yourself "what can I do to make the next hour more enjoyable?" and then do that, ideally once a day. Perhaps the exception is if your idea of a good time is alcohol or cocaine or anything else that causes a crash (and of course, don't do anything that would harm others, like if you're a kleptomaniac then don't go out shoplifting). Just do something different to make life a little better, without worrying about whether it is the "right" thing. For me it was going to another room to watch television. For you it might be gaming, or cooking, or masturbating in the shower.

My problems are still real, difficult, and a little anxiety-inducing, but they're far less daunting. Suicide no longer seems the only viable option. Admittedly, I haven't tried to go back to work yet.

 

[-Link-]

I see what you're saying here - however, the thing is that much of my suffering stems from being unable to make substantial progress in my life. And getting better (at least better enough to make said progress) is absolutely essential for achieving this.

Like in a marathon, each individual step may feel almost pointlessly small, but each of those steps (goals, if you will) progresses you towards the larger goal at hand.

The idea with smaller, incremental steps is to build yourself up to a point where you can start realizing the substantial progress you wish to see.

@CountOfTuscany goes into this a little further:

However, since you mentioned lifestyle, that's what I'll talk about here. After (2), I, much like you, didn't believe lifestyle improvements would be sustainable or that they would even address my problems. I was wrong.

Happiness/sadness are just neurotransmitters fitting into receptors in your brain. You can play games to optimize them. Make lots of checklists with small, achievable goals and accomplish them. Walk in the early morning sunshine. Focus on a reliable sleep schedule. Eat a balanced diet. Get some exercise. Eventually try going to some social activities, preferably based around a hobby you enjoy, etc. You would not believe how much better it's possible to feel once you have these things dialed in. A person in your situation can break these processes down into arbitrarily small pieces and tackle them one-by-one to slowly recover if that's the goal. But be patient. It takes time.

This process can be excruciatingly challenging, so you really do want to exercise patience with yourself and give yourself credit for any goals you meet, no matter how big or small they may be. You'd also want to allow for setbacks by keeping in mind the progress you're making in the bigger picture: Two steps forward, one step backwards, is still forward motion.

 

[LittleJem]

Have you tried Adderall? As you have ADHD so you could get it…Apologies if you have tried already…

I am personally doing a small amount of C a day and it helps me get out of bed. I'm not sure if it would do that for others.

Shrooms worth trying maybe

 

[Eudaimonic]

Have you tried Adderall? As you have ADHD so you could get it…Apologies if you have tried already…

I am personally doing a small amount of C a day and it helps me get out of bed. I'm not sure if it would do that for others.

Shrooms worth trying maybe

I tried it briefly years ago. The ones I've tried in recent years were Vyvanse and methylphenidate. Maybe I didn't take the Vyvanse for long enough, but I used a very low dosage and it still seemed to heighten my anxiety. Maybe it would be worth taking an anxiolytic in combination with a stimulant, idk. I'm considering trying guanfacine and adding a stimulant like Dexedrine if its not enough; though, if I did that, I might need an anxiolytic. I suspect I also have OCD (based on what my therapist has said), which presents an additional complication. It's very possible that the avolition and anergia are due in large part to the untreated ADHD, so it's probably worth tackling that first.

 

[qwertyuiopasdfghjkl]

Exactly this, longstanding executive dysfunction (from as early in my life as I can remember and gradually worsening to ruining my entire academic life and career) is probably the root cause of my depression. Still trying to work it out, fluoxetine (generic prozac) hasn't done anything for me despite being on it for a month. Vyvanse worked for a week, then stopped working (granted I was on a trial, and is now back at 30 mg in a second trial and feeling no effects). Getting out of bed is definitely the hardest part of my day.

I feel like atypical depression specifically targets executive function and energy levels more than anything else. Which is especially bad for me as I base my entire value and worth on executive function and "success" in a way.

 

[Ashu]

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforementioned

"Executive dysfunction"?

 

[JoysoftheEmptiness]

I haven't recovered, I've worsened

 

[Ashu]

Exactly this, longstanding executive dysfunction (from as early in my life as I can remember and gradually worsening to ruining my entire academic life and career) is probably the root cause of my depression. Still trying to work it out, fluoxetine (generic prozac) hasn't done anything for me despite being on it for a month. Vyvanse worked for a week, then stopped working (granted I was on a trial, and is now back at 30 mg in a second trial and feeling no effects). Getting out of bed is definitely the hardest part of my day.

I feel like atypical depression specifically targets executive function and energy levels more than anything else. Which is especially bad for me as I base my entire value and worth on executive function and "success" in a way.

Oh I see, "executive dysfunction" is the lack of will to do anything.

 

[Overwhelmed52]

I tried it briefly years ago. The ones I've tried in recent years were Vyvanse and methylphenidate. Maybe I didn't take the Vyvanse for long enough, but I used a very low dosage and it still seemed to heighten my anxiety. Maybe it would be worth taking an anxiolytic in combination with a stimulant, idk. I'm considering trying guanfacine and adding a stimulant like Dexedrine if its not enough; though, if I did that, I might need an anxiolytic. I suspect I also have OCD (based on what my therapist has said), which presents an additional complication. It's very possible that the avolition and anergia are due in large part to the untreated ADHD, so it's probably worth tackling that first.

I had the same issue with Vyvanse. I took it for two days shortly after starting Lexapro for depression and it completely spiked my anxiety, which was already made much worse by the Lexapro. I would really love to take something for the ADHD, but anxiety is so bad for me that I don't want to risk it.

If OP has access to it, try a therapist for cognitive behavioral therapy. Something separate from the medication. It can help to have someone to talk to you once a week. It might take a few months to build a rapport, but once you get to know each other it can be really great to have someone to talk to.

 

[yowai]

I'll use some tips from this thread myself and hope I can get diagnosed with adhd soon... I'm self medicating with street amphetamine and it helps with functioning a lot but it's not clean and I don't want to feed my addiction, I want to be sober and take proper meds

 

[qwertyuiopasdfghjkl]

Oh I see, "executive dysfunction" is the lack of will to do anything.

I would even say it's just the inability to get anything done or fufill your plans. You could have the "will" or want to do something really badly and be almost physically unable to do it. You could make elaborate plans and try a million strategies to get out of bed and be simply unable to move when it comes time to do it. Feels almost like paralysis, except scientifically your body works fine. At least that's my experience and something I've heard others describe too.

 

[ForgottenAgain]

I really could use some advice here. I don't have the mental or physical energy or motivation atm to make lifestyle interventions or anything of the sort sustainable. I don't want to try taking more antidepressants that don't work--or if they do, lead to some awful side effects. I'm at a loss here and this is effectively a last-ditch effort.

i think the issue in my case is that my (main) problems stem from a complex interplay of things.
namely: avolition, anergia, anhedonia, executive dysfunction, anxiety, ADHD-PI and/or (likely) CDS/SCT, and dysphoria which exacerbates the aforementioned

I didn't know what "executive dysfunction" was. After reading this thread and checking online, seems like my problem too. I may plan things, which I do a lot, but when it comes to it I feel physically unable to act on those plans, it takes a huge effort to do the simplest things like getting up to drink a glass of a water. Some days are a bit easier, others harder, every day is the luck of the draw.

It looks like you're saturated of the small steps, because you feel like they aren't working towards anything meaningful whilst at the same time, you can't face doing a big significant change as you lack the capacity to do that at this time. I can relate, it sucks to be on that position.

I wrote a thread the other day about my experiments with positive conditioning, it did work for me on that day rather well. If you're a very rational person who likes to be able to measure progress/success and want to try and rewire your brain, maybe it can help you too. When I did it the other day, I was feeling poorly as usual but on those days that I had the tiny bit of energy to start a task. Today, and since then, I've been incredibly down. I did the clicker trick again yesterday, to get me to pick up and fold laundry, put more clothes washing, etc. It did work but it felt more empty...

Do you know how exercise is great but you need to be at a certain mood level to be able to do it and benefit from it? I'd say that the clicker thing also requires a certain mood level but I'd say it is much lower than something like exercise, changing your diet, etc. The barrier to entry is much smaller so I think this may be an option if you wish to try it.

You struggle with seeing progress when you're working on smaller tasks. Another user spoke about dividing a big task into smaller pieces and that is great advice, you may already know this but maybe you can't really see the progress still. Let's imagine your objective is to read 1 book from start to finish and that's a big task. You could write down the following tasks:

Task: Read 1 book
a) Open the book
b) Read 1 page
c) Read 5 pages
d) Read 1 chapter

If going from task b) to c) or even a) to b) is too much, that's not a problem, because you still did task b) or a), you still made progress. Task b) may seem meaningless since a book has many pages, but do enough of task b) and you'll eventually have completed task c) and even d). Now pair that with a reward system:

- You do task a)
Immediately:
- *click*
- Reward yourself with a treat

And now, even though you haven't yet read the whole book, you still got a reward and it's not instant gratification because you had to put in effort and actually do the work to complete the task. I think that, if you can break down your big objectives into smaller, executable tasks and then pair that with a reward system to help feed your will to keep going, it may help you get where you want. If you want a recommendation for a clicker, I recommend this one that you can wrap around your finger. It's not as loud as others and you can type on the PC with it and do all sorts of things without it getting in the way.

I know you mentioned several conditions you have, unfortunately I'm very far from being a doctor and this is all just the experiments of a random depressed person, so please keep in mind that your results may vary from mine. I just thought it could be worth sharing in case it may work for you too.

 

[Unspoken7612]

Oh I see, "executive dysfunction" is the lack of will to do anything.

It includes that, but is broader.

Executive dysfunction is the inability to control the mental functions used to accomplish tasks, like concentration, planning, or perception. This can be caused by depression, in which case "lack of will" ("what's the point?") is a reasonable shorthand, but it can also be caused by intellectual disability, ADHD, thought patterns associated with autism, paranoia, anxiety...

Executive dysfunction - Wikipedia

en.wikipedia.org