How many of you have uttered these phrases during a bout of depression?

"I don't want to get up."

"I can't do it."

"I don't feel like doing anything."

I have a very clear memory of a major depressive episode from my young adulthood which left me without the desire or ability to do anything except to lie in bed.  I laid in bed for an entire weekend during which time my boyfriend at the time asked me if I was:  A.) Ever going to get out of bed and B.) Take a shower.  In order to take a shower I would have had to get out of bed so logically the answer to both questions was a definite, "No!"  My depression had left me wilted and lifeless.  I simply didn't care to do anything which required any movement into action.

Make no mistake.  Depression can be a debilitating illness.

So why does this happen?  What makes us feel like we can't get out of bed in the morning when we are in the midst of an episode of depression?

• Depression makes us feel physically exhausted.  Depression is not just a mental disorder.  Depression has biological roots.  The low levels of serotonin associated with depression are also what cause us to feel run down and lacking in physical energy.  This is a negative feedback loop as well.  The more tired we feel, the more depressed we become.  And the more depressed we become, the more tired we feel.  We can't seem to win.

• Depression affects our eating and sleeping habits.  Two of the major symptoms of depression are great changes in eating and sleeping.  For some people depression can cause overeating and subsequently feeling bloated and tired.  For others a lack of desire for food can make one low in the supply of glucose as fuel to the brain (hypoglycemia) which results in exhaustion and possible cognitive impairment.  Disruptions in your sleep cycle can also take a toll on your motivation and energy.  If you sleep too much you feel slow and sluggish.  If you sleep too little you are weary and irritable. 

• According to Elizabeth Bronolo Ph.D. and Xavier Amandor, PhD., authors of the book, "Break the Bipolar Cycle:  A Day-By-Day Guide to Living With Bipolar Disorder, people with depression have both information and memory problems which hinder motivation to complete certain tasks.  Things like paying bills or calling to make appointments seem like insurmountable challenges when you are suffering from depression.  There is a reason for this.  We understand intuitively that our brains are simply not up for the task.  While in the state of depression we tend to be forgetful, we cannot hold large amounts of information, and we have difficulty processing what is said to us.  This can make things like having a conversation on the phone seem overly frustrating.  Tasks which are usually completed with ease when we are not depressed are unusually cumbersome if not impossible when we are depressed.

• We have an idealized version of ourselves from the times when we are not depressed.  This is so very true and especially true for those of us who are on the bipolar spectrum.  Think about all the amazing things you can do when you are feeling good.  Then we fall into a depression and find that we cannot do the simplest of activities, even taking a shower.  This idealized vision we have of ourselves causes us to feel guilty and ashamed when we cannot live up to our idealized expectations.  When I am feeling energetic I make all sorts of plans for fun activities.  When I am depressed I cannot imagine doing any of these things I was so eager to do prior to my depression.  The lack of ability to get out and about makes us feel even more depressed at the thought of letting ourselves and/or others down.  We tend to feel we are so far from normal that we can't get up again.

• When we are unable to get up and do things it reminds us of other depressive episodes.  For those of us who suffer from chronic depression, we have a lot of memories surrounding our sad times.  When another bad time comes, it is easy to get into negative thinking as in, "Here comes another depression, I am always going to feel this way."  It greatly decreases our motivation to think that what we are feeling now is never going to change.  We may think to ourselves, "Why bother trying?"

Depression is a major contributor to a lack of motivation and action.  We simply don't feel like doing many of the things which used to give us pleasure.  And when depression is severe we also feel incapable to complete the tasks essential for daily living.  This makes it incredibly difficult to work, to take care of ourselves, and to live.