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.

What an outstanding accomplishment! You worked double-time to get the ECT, and your work has paid off. I understand the need to continue striving for stability - just be sure to stop and give yourself a well-deserved hug for all you've achieved so far.

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.

Sounds like a smart plan. Is an antidepressant not a possibility?

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.

A very good idea, imo. I believe you are scorched from the trauma of this past year. I'm delighted that you're facing it head-on, and will be talking with your therapist. I suggest you bring the subject up, start talking, and it'll take off from there.

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.

What is IP-SRT?

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...

My first thought when I read about your plan to take on more responsibilities was, "Uh-oh- that's great...but not too much all at once." So that's a for-sure.

Make lists. Perhaps one or two tasks that are top priority for the week, then a few tasks that are flexible...don't need attention right away. Use lines, draw boxes around certain tasks, anything you need to do to organize the list and make it easier to read and remember. If you're a color person, use colored pens or pencils to differentiate various tasks or chores, and their priorities.

I suggest paper lists, written with your own hand. That helps to establish connection between yourself and your memory.

I think it's essential for you to have 1 or 2 days (the week-end, or whichever days work for you - maybe not consecutive days, but just 2 per week) in which you either do very light work/activity (whatever that work/activity is), or none at all, but have at least 1 "off" day that you enjoy and relax - do some kind of activity that is easy on your mind. Remember that you are in recovery from a bad bout of illness.

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.

Mental illness tends to destroy our self-confidence. Actually, any illness does.The answer is baby steps, FluffyD. That's how to regain your confidence. One or two small tasks, let yourself rest. One or two more, rest. And all the while, being actively involved with therapy and, of course, taking your medication.