It was 2016. I was in my second year of medical school, and two days before the end-of-semester exams, I was near-catatonic in bed. The slow slide into depression went almost unnoticed for months, but chronic stress and a weird incident with a stalker gave me that final shove into a dark hole.
Lying half-paralysed with unplaceable weariness, I spread my notes on my bed, opened my laptop and tried with all my will to do something.
This isn’t a story of resilience. I failed that paper. That winter break felt like slow torture, with no one to talk to and no idea how to get back on my feet. I kept thinking, “Isn’t there someone who can tell me what to do?”
In the years that followed, I became intimately aware that the people pulling the strings of power (at your school, university or job) have little sympathy to spare for you. Even your closest peers don’t always understand what you’re going through or know how to help. It doesn’t matter that you don’t mean to shirk your responsibilities or ghost your friends. The world expects you to show up regardless of whether you have the energy.
So, what do you do when you’re feeling grey but don’t want to waste your day? Let’s talk about depression and some things I wish someone had told me in those early years of illness.
No time to read the whole article? Read the summary here.
Table of Contents
What is a depressive episode?
A depressive episode is two or more weeks of a sustained low mood that causes significant distress and impacts your ability to function in your daily life. You may experience most of the following symptoms:
- A loss of interest in things that you previously enjoyed (anhedonia)
- Changes in appetite or unintentional weight gain, or weight loss
- Changes in your sleeping patterns (sleeping too much or too little)
- Others tell you you seem restless or slower than usual
- Fatigue almost every day
- Feeling worthless or experiencing excessive guilt
- Having difficulty concentrating or making decisions
- Thoughts about death or suicide
A depressive episode can be mild, moderate or severe depending on how many symptoms you experience and how much it affects your daily functioning. If you suspect you may be suffering from depression, you can take this free test (Beck Depression Inventory). It isn’t a replacement for professional diagnosis, but it can help you identify a problem and seek help.
If you or anyone you know is at risk of suicide, please visit this link to find your local suicide hotline or seek immediate professional help.
What is executive dysfunction?
Executive dysfunction is not unique to depression and is a feature in many mental disorders (e.g. ADHD, anxiety disorder, bipolar disorder), and even significant stress can cause some impairment. Broadly, executive function refers to the cognitive and behavioural processes that help us perform tasks. Executive dysfunction happens when things like memory, attention and concentration are disrupted.
In a study done on undergraduate students, depression was associated with difficulty performing and maintaining goal-directed tasks. It was also related to emotional dysregulation, making it difficult to participate in activities that promoted positive emotional states.
Examples of executive dysfunction include:
- Impaired attention and concentration
- Problems with short-term memory
- Cognitive slowing (delays in information processing and decision-making)
- Lack of inhibition (ruminating on negative thoughts, problems with self-discipline)
- Cognitive inflexibility (difficulty adapting to change, switching tasks or coming up with alternative solutions)
- Difficulty planning
- Difficulty with motivation
How to Get Things Done During a Depressive Episode:
Now the question stands: how do you overcome executive dysfunction during your depressive episode and get things done? The answer lies in the systems and supports we implement to make important activities less effortful.
Make Checklists
Big tasks seem impossible, but they feel less overwhelming when you break them down into smaller parts.
When I was struggling to even get out of bed in the morning, I’d make small to-do lists and begin to bargain. I’d tell myself, “If you do just this one thing, you can get back into bed after.” That’s how I built a morning routine that stuck for years, regardless of what was happening around me. The checklist looked something like this:
Every morning, I would wake with my alarm and roll myself out of bed onto the floor. Like that, task one was complete. Some days, washing my face would mean crawling to the bathroom. It all seems so silly in hindsight, but every action seemed like a warfront at the time.
I would feel accomplished if I’d managed to get through my short checklist on a bad day. Usually, I had a bit more energy once I was clean and could sometimes coax myself into having breakfast. Some days, I wouldn’t be able to do much more, but checking those small tasks off my list alleviated some of the guilt of doing nothing.
This method can be extrapolated to bigger tasks. Let’s say you have a 2000-word essay due. Even if you break it down into an introduction, body, and conclusion, there is still a lot of blank space to fill. But what if you allocate 250 words each to your introduction and conclusion and break the body of your essay down to six paragraphs?
Maybe you can trick yourself into spending ten minutes writing a topic sentence for each section. Then, write a few sentences on the topic you know best. It may not happen at lightning speed – you may not even make your deadline – but slowly an essay will materialise before you. Sometimes that sense of accomplishment is enough to change your day around.
Celebrate Small Victories
In his letters to Felice, Franz Kafka wrote, “I could have built the Pyramids with the effort it takes me to cling to life and reason.”
We have to give ourselves some credit. Sometimes, all our energy reserves are used up to keep us alive. There isn’t any to spare for anything else. Of course, on those days, even a feat like brushing your teeth deserves celebration.
I like to build a rewards system into my “bad day” routines. When we tag behaviour with a reward, our brains reinforce it as a positive action worth repeating. By increasing the subjective value of a behaviour, we are more likely to maintain it. For example, if you love chocolate and you get a piece every time you finish a page of reading, your brain perceives reading as a trigger for a desired outcome/reward, i.e. your favourite treat.
Accountability partners
Once you’ve created your checklist and built in a rewards system for your tasks, find someone to hold you accountable. This person must know you well and understand when to push and when to yield. Choose someone you trust to help you overcome the discomfort of progress, but who also knows your limitations.
An accountability partner is an ally who can help you keep your head above water. They can provide support and motivation. Good accountability partners will work with you towards your targets or even check in with messages and phone calls. Open communication about expectations and honesty about the results is key to maximising the positive effect of an accountability partner.
Safety nets
Safety nets are the systems we use to protect us when something goes wrong. In the context of a depressive episode, this can look like missed deadlines, unexplained absences, emotional crises and communication breakdowns. You might need help with the following:
Navigating red tape
Most of us are beholden to some institution, whether a university or work. Each institution has its rules, and most of them aren’t very friendly to your mental health.
Familiarise yourself with your company’s HR policies on sick leave. Understand your university’s stance on extensions and late submissions. Know who to go to if you anticipate difficulty in performing at your best. Using official channels will get you the most bureaucratic results, but you may also experience discrimination and encounter confusing paperwork.
That’s why reaching out to peer mentors, teaching assistants, trusted superiors, and even your most immediate seniors can help you navigate these confusing systems more easily.
Finding Community
Depression thrives in isolation. Use your social network as a resource. People who truly love you will help you cook a meal or clean your room occasionally if it makes your life a bit easier.
If you’re too tired to go out to the library, ask a trusted loved one to bring the library to your bedroom. Go out and interact with people even when you lack energy. Good friends will notice you need help and rally behind you to find a solution.
Self-care is key
People discussing self-care often refer to skincare routines and long baths, but self-care is more than that. It’s looking after your whole self, physically, mentally, emotionally and spiritually. You can do this by:
- Investing in important relationships
- Moving your body (even if that means rolling around on the floor or dancing in the dark)
- Learning calming techniques like breathing exercises and meditation
- Building routines
- Getting enough sleep
- Nourishing your body
- Spending time on your hobbies
Summary
Depression is a difficult illness to navigate. The psychological symptoms only scratch the surface. Many people underestimate the physical and cognitive difficulties that accompany an episode.
Depressive symptoms involve a low mood, loss of interest, changes in sleep patterns and feelings of hopelessness. Depression also affects our executive function – a term used to describe our ability to organise and execute plans, concentrate and use our memory. This change in functional ability makes it difficult to get things done.
Here are some ways to get things done during a depressive episode:
- Make a checklist – write down a short list of tasks you want to get done, no matter how simple or silly. Then, break those tasks down into smaller sections and reward yourself for each task you complete.
- Find an accountability partner
- Use your community
- Set up safety nets
- Prioritise self-care
Conclusion
Depressive episodes slow us down and make everyday tasks feel enormous. Luckily, there are tools we can use to be productive even on those bad days. Simple activities like making checklists, prioritising self-care and tapping into your social network as a resource can help you overcome your worst days.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Berkman ET. The Neuroscience of Goals and Behavior Change. Consult Psychol J. 2018 Mar;70(1):28-44. doi: 10.1037/cpb0000094. PMID: 29551879; PMCID: PMC5854216.
Warren, S. L., Heller, W., & Miller, G. A. (2020). The structure of executive dysfunction in depression and anxiety. Journal of Affective Disorders, 279, 208–216. https://doi.org/10.1016/j.jad.2020.09.132
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