The Depression Symptom That Can Make Washing the Dishes Feel Like Climbing a Mountain
Brushing your teeth is just one teeny-tiny little task. It's important for your health! Having a clean mouth feels good! You actually enjoy how you feel afterward! And yet, you just cannot muster the energy to get out of bed and do it. Sound familiar?
"When you're depressed, it's just like, what the hell is the point of getting up to brush my teeth? I don't feel like it. I'm too low energy," says Rochelle, a 22-year-old student at Drexel University in Philadelphia. "That is the thing I struggle with the most. When depression gets really hard, it can just make [taking care of yourself] the most difficult thing," she says.
While struggling with mental health issues, these daily chores of being human can be unmanageable. It's a symptom seen in a variety of mental illnesses and referred to as executive dysfunction.
What is executive dysfunction?
"Executive dysfunction itself involves deficits of planning, organization, self-regulation, goal formulation, problem-solving, and time management," explains Holly Schiff, a licensed clinical psychologist based in New York and Connecticut. "Those with executive dysfunction experience a wide variety of cognitive and behavioral disorders and difficulties."
Depression is just one of the mental health issues that can incorporate executive dysfunction as a symptom.
"Depression and other mental illnesses frequently result in disruptions of daily habits," says Forrest Talley, a clinical psychologist at Invictus Psychological Services in Folsom, CA. "The specific reason why this occurs will vary according to the specific mental illness. For example, with depression it appears likely to be related to a disruption in the cortico-striatal network, part of the brain that unconsciously calculates effort versus reward."
For many, executive dysfunction isn't simply about being in a mental state in which you're unmotivated to take care of yourself. It's that your mental state makes you feel too fatigued to do so. This is often because fatigue itself is a symptom of depression.
"With depression, we usually see lower levels of neurotransmitters, specifically serotonin and dopamine, which impact motivation levels and can make it hard to get out of bed in the morning," says Schiff. "Lacking dopamine in the prefrontal cortex means the individual doesn't even have the energy to make decisions, solve problems, weigh their options or take action."
And the more you think about the task that's causing you distress, the more sapped your energy may become. "Fatigue and lack of energy can make even tasks that normally seem small feel really big, requiring a lot of physical effort," says Amy Nasamran, a licensed psychologist and founder of Atlas Psychology in Lansing, Michigan.
How do I cope when I'm too depressed to function?
Beyond receiving formal treatment for one's mental health, whether that be through therapy or taking medication or a mix of both, many of those dealing with executive dysfunction use simple methods of making the burden more manageable. One common tip is to keep a list of your daily tasks. Not only does this help you remember precisely what you want to accomplish, but it can also help make your goals seem more manageable.
"Divide up daily tasks into small chunks that can be easily accomplished. If one starts the day with a long list of items, it can seem overwhelming," explains Talley. "When the list is 'chunked' into two or three item groups, motivation is raised, and success much more likely to be achieved. For example, I often have very depressed clients start the day with the task of simply showering, brushing their teeth, and getting dressed. Each item on that list is crossed off and that cluster is done."
Another option is to combine these tasks with something you typically enjoy — even if you might be struggling to find pleasure in the things you used to. "Pairing a task with something pleasant can help," says Schiff. "Say you need to do the dishes or some house cleaning. Pair this with something like listening to your favorite music or having your favorite show on in the background while you clean," she advises.
This is something Rochelle has found useful even with smaller tasks, brushing her teeth included. "I set a timer. I put on a video so I don't feel the time go by and it's more enjoyable. It's a little easier to get it done," she says.
"Sometimes, doing the smallest possible task is a step in the right direction," says Nasamran. "Maybe just washing your face instead of taking a full shower is progress. If making a meal feels impossible, maybe having a simple snack or a drink of water; if getting out of bed feels hard, maybe just sitting up in bed. Doing smaller versions of tasks can make what feels impossible more doable."
Above all, though, forgiveness and patience with yourself is essential. "So much of depression is worsened by being mad at yourself about it," says Danielle Tcholakian, a writer who has experienced depression with executive dysfunction. "I think it helps if you can even just [think to yourself], 'Holy shit, you brushed your teeth? Dude, huge.'"
Rochelle has found strength in a similar attitude. "The biggest thing is really just being patient with yourself," she says. "Like, I know, when depression gets really, really hard, that's what becomes a tough part. Really take a second to be patient with yourself and just know you can always bounce back."
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