As some of you know, I recently received ECT. This worked very well for me; my depression has vastly improved. I'm not entirely out of the woods yet, but I hadn't expected that. In my mind, the purpose of the ECT was to help me break out of the worst of the depression and get me to a place where I can continue my recovery with more conventional methods. I feel I have succeeded in reaching that goal. Now I wanted to ask the folks here for their advice on how best to continue my recovery. I feel there is still a lot of hard work ahead of me, and I cannot lean back now, because if I do I will relapse without a doubt, and I am deathly afraid of that.

My current approach is as follows. First of all, I am starting up meds, in particular lamotrigine. I couldn't start that up before because lamotrigine is an anti-epileptic, so it interferes with ECT. Second, I think I have to do some psychotherapeutic work to deal with all of the traumatic stuff that happened during this past year-long episode, some of which still weighs pretty heavily on me. I am not quite certain yet how best to approach this. I hope I'll be able to figure that out with my therapist. Third, I am trying to schedule my week such that I take on more work and household responsibilities that I couldn't before, in addition to things like sports, family, and so on. Essentially, the second and third parts of my approach amount to IP-SRT, which I have heard highly recommended for bipolar depression.

My "trouble" is with the details of this approach. For example, I really want to take on some work responsibilities again. On the other hand, I don't want to do too much too fast, because I am still extremely low on energy, and I am still having cognitive issues. I'm afraid if I don't strike the right balance, it will be counterproductive. I feel like I need to start doing things again in order to continue my recovery, because that's the only way I see to hopefully regain some of my confidence and begin to feel like a useful human being again. On the other hand, it's hard to do these things without being fully recovered in the first place. I find it hard to escape from this chicken-and-egg problem, and I'm hoping someone here might have some advice on this. My current plan is to just persevere, start with a few well-planned tasks, and simply push through, hoping that I make things better and not worse by doing so...

Edit: I guess a major part of the problem is that this episode has basically completely destroyed my confidence. Now, on the one hand, I am extremely motivated to take on responsibilities again, but at the same time it brings me a lot of worry and anxiety that I can't do it because I'm not good enough. But doing it is probably the only way to start believing again that I can do it. I suppose there just is no easy way.