How do I find my stride again when my anxiety and possible ADHD have derailed me?

I'm a middle-aged female veteran diagnosed with anxiety, depression, and ptsd, and I'm 90% sure I have ADHD. I have a good family life, but it takes up so much of my energy. I've fallen out of so many good habits and routines this winter. My depression is spiking, as is my anxiety. My motivation, self-esteem, and energy are very low. I'm struggling to engage with activities I enjoy, and I feel like if I could just START doing ANYTHING that matters then I will find my stride again. But I can't seem to start. Any advice would be appreciated.
Asked by kat

So as a veteran you have likely experienced situations that were very stressful. However I do not want to make the assumption that is where you developed your PTSD presentations. I would wonder where the PTSD came from? Did it come from your military work or did it come from another aspect in your life. What sort of current treatment are you doing to help you with PTSD? Making sure that you are currently in the correct therapy for PTSD including working with a prescriber if appropriate can really help. I hope that it is something you are in the process of getting appropriate therapy and treatment for. If it is not it would be a good idea to look at options for getting the care that you need.

I am sorry for hearing about the anxiety diagnosis. I wonder what specifically makes you anxious? Often times anxiety can look differently for different people. I highly suggest if appropriate assuming you are medically cleared and safe making sure that you exercise regularly. Regular exercise can help with anxiety and PTSD. The best type of exercise is the type that you will actually do on a regular basis. Also it can help if the exercise is somewhat fun. Do you have any activities that you will regularly do that you find are somewhat fun? I highly recommend starting small and working up to regular exercise. As with PTSD and depression talking to a prescriber may be an option.  What do you know of mindfulness? Cultivating a mindfulness practice may help you with some of your struggles. It may inspire you to be more present and challenge yourself to get more done. Everything you are describing are internal events and challenges that may make it hard to actually get things done especially in the middle of winter. Mindfulness should be something that we cultivate. It is a present orientation to life. It is challenging ourselves to be in the here and now. To do with and accept ourselves for what is in front of us. It is shown to help with both anxiety and depression. I highly suggest doing your own research into mindfulness. Mindfulness can help you deal with the daily challenges of feeling deflated in the middle of winter. It is something that should be practiced regularly. It is evidence based.

I am sorry to hear that your depression is spiking. If you can cultivate a mindfulness practice and regular exercise then it should improve. I highly recommend considering those two things. I would wonder what are your thoughts around depression? Often times examining and challenging depressing thoughts can help. This can be facilitated through talk therapy. One specific type of therapy that can help is CBT. I highly recommend considering talk therapy to help you with these issues. I know that reaching out to therapist questions is a step in the right direction, but really a regular therapist that you can talk to is more likely to help. We would need to talk about the specifics of your depression to try to get to the root of it and understand your personal nuances. This would likely help you with your motivation and ability to get things done.

As far as coping with PTSD there are approaches that are evidence based. One thing that can help with PTSD is EMDR. I highly recommend doing research into EMDR and finding someone who can provide it if you are interested. It is an evidenced based approach for treating victims of trauma. If you research the technique and it is something that you want to do, then you should explore your options for getting the treatment. There are other approaches for PTSD. Talk therapy can help too.

One thing that is challenging is that you present with a few diagnoses. I think it is important to keep in mind that the process of diagnosis is imperfect. Depending on who you talk to you may get different diagnosis. I am in no way saying that your diagnosis is incorrect. But they are not destiny, but rather diagnosis is a description. Often diagnosis can be a lacking description. This is why it is so important to consider a long term relationship with a therapist. It might really help to have someone who understands your individual story and the nuances of your situations. Basically behind all your diagnoses is one common variable and that variable is you. You deserve to be understood and treated holistically. Likely all these diagnoses are interacting and when you start to work on one you are actually going to be working on another one.

This is another reason why it might be difficult to tell if your perceived ADHD is an actual diagnosis. PTSD, anxiety, and depression can all sometimes lead to shortened attention span. While an actual formal ADHD assessment may be interesting to do and helpful, that would take someone trained in that. Again adding another diagnosis may or may not actually help your motivation. I personally would rather know than not know. It will require getting a proper evaluation. Starting to work on any of your problems, because they are all interrelated, its likely going to lead to improvements overall.

Winter and depression can be a hard combo to deal with. Many people feel a much lower mood during the winter months. You may just have a harder time of the year. Getting outside when you can and exercise can help. Sounds like you would likely benefit from regular exercise.

I would consider that at the end of the day motivation follows action not the other away. Once you get moving and get proactive about solving some of your issues you will gain motivation. Taking one thing at a time builds up over time. You might find if you make a list of what needs to be done and take on the easy parts first that it will help. Do not give into not trying. Keep trying and stay in treatment and things should get better.