Pokemon content creator and influencer Stepho Wilson (@stephosaurawr) learned she had major depressive disorder after giving birth to her daughter. But her experience of depression, including suicidal thoughts and other symptoms, began much earlier in life, when Wilson was a teenager still living at home with her parents. While you might think of depression as a condition that primarily affects you mentally, Wilson has found it affects the way your whole body feels in ways that can make even the most basic, everyday tasks feel nearly insurmountable.
“[When I’m having a depressive episode,] my body just feels so heavy, and the effort to get up and do trivial things feels impossible,” Wilson says. “Mentally, my brain can be so foggy from depression that it doesn’t have the capacity to do anything other than bare minimum survival. It goes beyond just sheer willpower, and isn’t the same as laziness. There’s truly a physiological response as a result of the depression.”
Connecting Hygiene and Depression
Depression or major depressive disorder can come with a wide range of symptoms, including feelings of sadness, angry outburst, sleep disturbances, trouble thinking, and more. Even with treatment, finding ways to manage depression on top of the demands of everyday life can be challenging. It’s important to know your experience with depression may look different from someone else’s. Wilson found it can even look different from one day to the next.
While common, trouble maintaining basic hygiene is a lesser recognized symptom of depression. This symptom isn’t required for a diagnosis with depression, but it can be a sign of depression or a depressive episode that might signal a need for more help. Trouble with hygiene tasks including showering and laundry can come up as a consequence of other common symptoms of depression.
“Struggling with self-care is a common feature of depression,” says Carisa Kymissis, MD, a psychiatrist and vice chair of Mount Sinai Behavioral Health Center in New York City. “Core symptoms of depression such as fatigue, loss of interest, sleep disturbance, impaired concentration, and social withdrawal can make even small tasks and decisions feel overwhelming. As these symptoms intensify, routine daily activities may be neglected, including personal hygiene, upkeep of one’s living space, and engaging in hobbies or other meaningful activities.”
“Depression can look very differently for different people but usually involves less desire or interest in the world around us,” adds Wayo Garza, MD, a psychiatrist at UCSF Health in San Francisco, CA. “This can present as a decrease in hygiene when depression is very severe, although it usually presents with decreased interest in activities we enjoy.”
Set Goals
Some days Wilson says just getting up out of bed to shower or brush her teeth is about all she can manage. When that happens, she finds it can help to set achievable goals.
“I actually recently set a goal for myself to get out of bed, brush my teeth, and change my clothes first thing in the morning,” she says. “Those are my only goals for the day. Everything else is a bonus. It sounds small, but it requires so much effort when you’re someone who struggles with executive dysfunction.”
When setting hygiene goals, Garza suggests you start by selecting a single task. Consider one that’s especially important to you.
“It helps if you have some attachment to the task and if you have the materials needed,” he advises. “For example, if you are proud of your hair, choose brushing your hair; if you are proud of your smile, choose brushing your teeth if you already have toothpaste at home. Then, visualize the steps you need to take to complete the task. Break it down step by step, including standing up from the couch. Set a time during the day to complete the task; you can set an alarm to remind you. Then, whenever you feel up to it or the time you set has arrived, try to accomplish the task! It can help to remind yourself of why you are doing this task and to give yourself a cheer after completing it. Depression makes us feel like we are unable to do even the most basic things, so it helps to encourage ourselves when we are struggling.”
Wilson finds it helps to pair her goals with other things she enjoys. She’s also careful to set goals she can reach. For example, she says, “I normally brush my teeth right after I use the bathroom in the morning, since I’m already up. But I don’t force myself to wash my face, floss, or do anything further if it feels like too much. Sometimes I’ll even just brush my teeth for a very short period of time if I can’t do a full two minutes.”
To make the process more enjoyable, she likes to play her favorite list of songs. Afterward, she rewards herself with a hot cup of tea.
Get Support
While your mental health provider can help with hygiene strategies, they may be unlikely to bring it up with you early on, says Victoria Stewart, an occupational therapist at Griffith University in Brisbane, Australia. If it’s an area of concern for you, don’t hesitate to ask for help.
“As a practitioner, I would address personal hygiene once I had established a trusting relationship and when opportunities arise,” Stewart says. “The conversation should then be guided by the person and their reactions. Professionally, I have found that focusing on future goals and how to get there can be important segues into discussing grooming.”
In addition to other mental health providers, an occupational therapist may be able to assist you in building routines and breaking tasks into manageable steps, she says. Other useful strategies include celebrating small achievements and structuring activities around times of the day that work best for you. Aim for “just enough” rather than perfection while normalizing your experiences as a part of the illness. It also can help to connect basic hygiene to other larger goals including your work, social life, or feeling like yourself, Stewart says.
Kymissis advises reaching out to a trusted friend or family member for support. It can be helpful to involve them early, she says, perhaps bringing them along to an appointment with your care provider. Wilson notes that she leans on her husband for support whenever possible.
“Sometimes he has to physically pull me up and out of bed so I can just get going,” Wilson says.
Break the Cycle
Self-care and depression can become part of a vicious cycle, Kymissis explains. Depression makes self-care more difficult, while neglecting self-care can further worsen depression symptoms. The good news, she says, is that “even small acts of self-care can help interrupt this cycle by fostering a sense of self-efficacy, reinforcing progress, and restoring a feeling of accomplishment and forward movement.”
Remember that none of this is your fault. It isn’t a measure of your worth or character either.
“Struggling with self-care is not a sign of laziness or weakness,” Kymissis says. “Depression makes everyday tasks more difficult. When those around you understand this, they can offer more effective support. With professional help and the encouragement of others, self-care can improve step by step, helping you rebuild confidence and a sense of self-efficacy.”
Small Wins
Go easy on yourself, and gradually you may find you can do more.
“Be kind and patient with yourself,” Garza says. “Sometimes, being depressed can feel like walking through mud, so it doesn't help to compare yourself to when you were feeling your best. Start small and with things that are important to you. Then, after you get back to doing one task, you can add another after a week or two.”
Wilson says through basic acts of self-care, she tries “to rewire my brain and remind myself that when I can manage to get out of bed and do my bare minimum routine (brush my teeth and change) that I normally feel better than if I just allowed myself to stay in bed all day. It’s a process, and there are plenty of days when the depression still wins, but it’s the small wins and effort that I try to focus on.”
