I'm having a nervous breakdown

The Rolling Stones knew a girl who was heading for her “19th nervous breakdown” and, about a year ago, Oprah Winfrey told People Magazine that she experienced “the symptoms of a nervous breakdown” while getting her Oprah Winfrey Network off the ground.

But what, exactly, is a “nervous breakdown”?

The term has been around for a great many years, but it’s generally not used by psychiatrists and psychologists. It’s simply too vague, and merely refers to a certain level of stress with distress – a mix of anxiety and depressive symptoms.

Though formal diagnostic systems don't include the term (and there are few proper studies of this condition or status), we can recognise the shape of what is usually meant by it. Within current diagnostic systems there is, however, one condition that quite closely resembles it: “adjustment disorder”. 

What people usually mean by this is an unpleasant distress reaction, which is time-limited and which often includes anxiety and depression – a sense of being unable to perform ordinary life tasks, of having at least temporarily lost your ability to cope. For some, it could be tempting to give up or hibernate, to retreat from the world, and not be expected to cope for a while.  

One of the rare studies in recent years found that around a quarter of the time a “nervous breakdown” is related to problems with close personal relationships, including break-ups, separations and divorce. The next commonest cause is problems at work or school, followed by financial problems. 

This could mean that you’re able to cope with some parts of life, but that the number of things you need to handle doesn't correspond with the number you can imagine dealing with right now. In other words, you're overdrawn on your account at the “psych wellbeing bank”. You feel overwhelmed and exhausted.  

• Try not to panic or become too alarmed when you feel you’re heading for a “breakdown”. Rather think of the situation as being akin to extreme physical exhaustion, which is likely to improve with rest.  

• Share your concerns with someone you can trust, including your spouse and close family members. If the problems that started this off include aspects that need urgent action, you can delegate to this trusted person the authority either to act on your behalf or at least to negotiate a delay until you’re feeling better.  

• Check in with your GP, at least, or your psychiatrist and/or psychologist, for an urgent assessment of the situation – you might be in need of more specialised treatment and you may need to take a few days off work.

• Your doctor will decide if you need medication.

• Don't start on an antidepressant unless depression has been properly and carefully diagnosed. If your doctor does prescribe it, it’s important to take the medicines seriously and for at least a few months. Don't imagine that a small dose will be needed – you'll either need none at all or a proper and effective dose, otherwise you'll be paying a high price for side effects without benefits. These drugs can help in a true depression, but they don't treat sadness or regret, or the many aspects of just being thoroughly upset.  

• Don't put your life aside for too long, or it may become unnecessarily difficult to face going back to work or school. However, it’s important to give yourself maybe four or five days to rest. 

• Make good use of your rest time: don’t plunge into busy activities, but use monotonous chores to keep your mind busy. Tidy your cupboards, throw away old clothes, indulge in some easy-going gardening and go for long, easy walks.

• Expect to recover soon. If you've exhausted yourself physically by running a race, for instance, you'd neither give up running nor start a new race the very next day. Don't be hard on yourself for having come to a grief standstill – it can happen to most people. Recognise that it’s possible to become temporarily overwhelmed, neither taking the situation too seriously, nor not seriously enough.

After maybe taking a day or so to re-assess the situation, you should return to your normal life feeling slightly refreshed. Start planning a new approach to stress, assisted by the advice of family and friends, as well as the help of a personal counsellor or psychologist.