Why Self-Care is Hard for Depressed Individuals

Understanding how frontal lobe dysfunction impairs self-care.

Looking after yourself, or self-care, is vital to physical, emotional and mental well-being. Self-care is best defined as the ability to take proper care of your daily living needs, like eating, sleeping, grooming. But it’s also about identifying your own unique needs and taking steps to meet them—like making the time to do things that nurture you, as well as activities that keep you healthy.

In short, self-care is care provided for you, by you.

But when you live with depression, self-care can sometimes feel unattainable. You’re tired, listless, with feelings of despair and corrosive thoughts that push and shove in an endless tug-of-war within you. Often, depression leaves you feeling like your physical and emotional reactivity has been siphoned off, draining you of the ability to look after yourself.

Research says there’s a neurobiological reason for this—and it has to do with the brain structure known as the frontal lobes. This area is responsible for executive functioning—a set of skills that involves problem solving, judgment and reasoning, just to name a few. Depression has long been associated with dysfunction of the frontal lobes, so it’s not a surprise that people with depression find it hard to self-care.

Symptoms of Dysfunction in Frontal Lobes

Children and adults who are depressed frequently have trouble doing many of the following things listed below, all of which are executive functioning skills. It’s important that depressed people realize, as well as family and friends of loved ones who are depressed, that having trouble with self-care is not due to laziness, or not trying hard enough or from weakness. The issue here is significant brain dysfunction that impairs self-care success.

When dysfunction occurs in the frontal lobes, these skills become impaired:

Attention
Decision making
Emotional control
Emotional functioning
Foresight
Flexible thinking
Insight
Judgment
Planning and prioritizing
Reasoning
Recall
Self-monitoring
Willpower
Wisdom
Working memory

Develop a Self-Care Program

Long ago, the field of science believed the brain was a static and unchangeable organ, but technology has shown us that our brain is adaptive, and that new neural pathways can occur. When it comes to depression and the brain, recovery of the executive functions returns to a healthy level as depressive symptoms reduce.

One of the ways to foster this recovery is to create a self-care program. These are a few of the tips I offer patients, as well as ones that I’ve used myself when I was in the grips of serious depression.

1) Start small. Recognize that the symptoms of depression will make self-care very difficult. Aim for small goals like getting up out of bed, getting in the shower or sitting in a different room with some sunlight or fresh air. I remember when my depression was at its worst, I couldn’t get out of bed. I literally slept for hours on end, hardly moving my body at all. I set a goal of just turning over from one side of the bed to the other, then trying to sit up in bed for a while. Those goals were NOT easy to reach. But they led to bigger ones. And within days, I was out of bed.

2) Go from inactive to active. The key to self-care is accepting that you need to move from the hollowed numbness of depression to a more active state. Once you’ve made some small steps to do this, add other movement goals like a link in a chain so that your inactivity lessens. See if you can make a cup of coffee yourself instead of asking someone to get it for you. Get dressed in clothes instead of putting your pajamas on after you shower. Once again, adding bigger goals as you reach the smaller ones helps you heal. As your depression lifts, you’ll be able to do more structured activities like exercise or yoga and tend to issues in the house, school or work.

3) Feed your senses. I’m a big believer in making sure you feed your five senses when you live with any chronic illness. Depression is a state of complete and utter depletion, and recovery comes sooner when you take the time to see, feel, hear, taste and touch. Things like getting out in the sun, listening to music, taking in a lungful of fresh air, getting a hug or eating comfort foods all help to soothe you. But even more meaningful to recognize is how they help boost frontal lobe functioning. If your depression is so intense that you can’t makes these experiences happen on your own, ask someone to help you. I remember taking short walks with my sister during my recovery because I felt shaky and insecure. But as time went by, I was able to do this simple task alone—and then weeks later, was driving again and functioning independently; something I didn’t believe could or ever would happen months earlier.

4) Keep a routine. Once your symptoms of depression have reduced, be mindful about sticking to a routine that allows you to maintain your self-care program. Taking proper care of yourself is vital in so many ways, the most important of which is that it prevents a depressive relapse. I’m quite protective of my self-care plan, making sure my family and friends respect my catnaps, tea drinking and music listening. And I urge my patients to do the same.