Self-Care in Depression: When Showering, Eating and Housework Become Hard

Why does self-care in depression become so hard? Realistic, shame-free steps for days when showering, cooking and tidying the house feel beyond you.

On some days the hardest task can be filling a glass of water. Walking as far as the bathroom door and turning back; opening the fridge and closing it again without taking anything; looking at the dishes piling up in the sink and moving to another room. To someone looking in from outside, these are ordinary tasks; but to someone with depression, each one can look like a mountain. Struggling with self-care in depression is one of the least talked-about experiences, yet one of the most shaming. People can describe their sadness and their tiredness; saying that they have not been able to shower for three days, or have not done the laundry for two weeks, is much harder. This article was written precisely to break that silence and to show you a realistic way forward on hard days.

What Does Struggling with Self-Care in Depression Mean?

Self-care is the set of routine tasks a person carries out to meet their physical and everyday needs: washing, brushing teeth, changing clothes, eating and preparing food, keeping the home liveable, paying bills, keeping track of doctor's appointments. In healthy periods most of these tasks are done almost automatically; we do not even think about them.

Depression can disrupt this automatic quality. The person knows these tasks are necessary and may even want to do them; but they cannot get started. In mild depression this may show up as a few tasks slipping, while in severe depression it can reach the point where even basic needs go unmet. The important thing to know is this: it is not a weakness of character, dirtiness or indifference. It is a recognised and common symptom of depression.

Struggling with self-care can show up in several different ways:

• Personal hygiene: Not being able to shower for days, skipping brushing your teeth, not combing your hair, sleeping in the same clothes you sit around in during the day
• Eating: Skipping meals, living only on ready-made snacks or, conversely, eating uncontrollably, forgetting to drink water
• The home: Dishes, laundry and rubbish piling up, a room becoming hard to live in
• Admin: Putting off bills, rent payments, official correspondence and appointments
• Health care: Missing check-ups, neglecting the care a chronic illness requires

Why Does Self-Care in Depression Become So Difficult?

"How hard can it be to take a shower?" is the question that someone who has never experienced depression struggles to understand. Yet there are several concrete mechanisms behind this difficulty.

Energy and physical fatigue

Depression is not only a mood; it affects the body too. Many people describe waking up in the morning feeling exhausted, as if they had been doing heavy work all night. With this fatigue, a shower that requires standing, waiting under the hot water, then drying off and getting dressed genuinely feels like a large expenditure of energy.

The invisible steps of a task

What looks from the outside like a single task actually consists of many small steps. To take a shower you need to go to the bathroom, wait for the water to heat up, undress, wash, find a towel, dry off, choose clean clothes and dry your hair. In depression, mental functions such as planning, sequencing and initiating slow down. So the person feels they are facing not one task but a chain of steps, and the whole chain is daunting.

Loss of meaning and reward

Normally we feel refreshed after a shower and relaxed in a clean kitchen. In depression these small rewards are not felt, or are felt only very faintly. The thought "What's the point of washing, I'll still feel bad" makes the effort seem pointless.

The shame cycle

This is perhaps the most insidious mechanism. The person cannot look after themselves for a few days; then they feel ashamed of it. Shame brings the thought "Look what I've become", and mood drops a little further. As mood drops, self-care becomes even harder. After a while the person begins not inviting anyone round, not answering video calls, not opening the door. Hiding reduces shame in the short term but deepens loneliness and depression.

The days when you cannot look after yourself are the days when you most need to show yourself compassion.

Familiar Scenes from Everyday Life

Let us imagine a woman in her late twenties living alone in a big city. She can get to work on weekdays; but when she gets home she lies down on the sofa without even taking her shoes off. When her parents say they will visit from the village at the weekend, instead of being pleased she panics. Because the flat is full of dishes that have piled up for two weeks and clothes lying on the floor, and she thinks she will not be able to bear her mother's look that says "My girl, what state is this?" She postpones the visit with an excuse; and then blames herself for postponing it.

Another scene: a university student living in a shared student house sees his housemates keeping the communal areas clean, but cannot do it when his turn comes. His friends' silent reproach leads him to shut himself away in his room even more.

Or a married father of two who, after coming home from work, has stopped looking after himself; he neglects shaving, eating regularly and his check-up appointments. His wife interprets this as "letting himself go" and gets angry, and he falls silent.

In our culture, cleanliness and order are seen not just as a personal preference but also as a sign of respectability. Sayings such as "What will people say?" and "It's shameful for whoever comes through the door" make the depressed person's struggle with self-care even more shaming. Situations such as the big clean before a religious holiday (bayram), preparing for guests, or a neighbour dropping by unannounced for tea can be an additional source of anxiety for someone who is already struggling.

Minimum Self-Care: Realistic Suggestions for Hard Days

The aim here is not a perfect routine but a minimum level of care that keeps you going on hard days. Allow yourself to say "even a little" instead of "all or nothing".

Intermediate steps instead of a shower

If a full shower is too much, choose a smaller step: washing your face and hands, wiping your arms and neck with a damp towel, washing only your hair at the basin, changing your clothes. If you do decide to shower, using a stool so you can wash sitting down, or putting your clean clothes in the bathroom beforehand, makes the job easier. Remember, partial cleaning is better than no cleaning at all.

A toothbrush by the bed

If you cannot get to the bathroom to brush your teeth, even putting a toothbrush and a glass of water next to your bed, or rinsing your mouth with mouthwash, is something. These small tasks prevent bigger problems later on.

"Good enough" when it comes to food

For someone with depression, cooking is often not realistic. During this period the aim is to be nourished, not to be a gourmet. Keep foods that need no preparation at home, such as yoghurt, cheese, bread, fruit, boiled eggs and nuts. On a day when you feel more energetic, making a big pot of soup or bulgur pilaf and dividing it into small containers is an investment for the hard days to come. Putting a water bottle somewhere you can see it also reminds you to drink.

"Five minutes" and "one area" for the home

Thinking about tidying the whole house is paralysing. Instead, set a timer for five minutes and deal with one area only: just the top of the bedside table, just the rubbish bag, just taking the glasses to the kitchen. When the timer goes off you are free to stop. If you cannot wash the dirty plates, using paper plates for a while is not something to be ashamed of either; it is an adaptive strategy.

Use the time of day when your energy rises

In depression, mood and energy can fluctuate during the day. Some people feel very heavy in the mornings and a little lighter in the late afternoon; for others it is the other way round. For a few days, observe at what times you can move a little more, and put the self-care task that feels hardest into that slot. You do not have to wait for the morning to shower; a shower at nine in the evening does the same job. Instead of forcing yourself into a routine that does not suit you, building the routine around your own rhythm makes tasks achievable.

Bundle your admin

Where possible, set up direct debits for bills and payments. Write the official tasks you have been putting off on a piece of paper and place them, one at a time, on the day of the week when you have the most energy.

Count what you do

Noting at the end of the day "I washed my face, I ate a meal, I took two glasses to the kitchen" stops you from closing the day with "I didn't manage to do anything". You can find more detail on how to approach yourself more gently in the article on self-compassion.

How Can the People Close to You Help?

The thing that helps least for someone who cannot look after themselves is criticism. Words such as "Look what state this house is in" or "Pull yourself together", even when said with good intentions, increase shame and hiding.

Instead, these things work:

• Offering concrete help without judgement: "Shall I come round on Saturday and we tidy the kitchen together? You sit, I'll wash, you dry."
• Bringing food, or eating together
• Doing a task together: even brewing tea in the next room while the person showers lets them feel they are not alone
• Noticing and appreciating small steps
• Talking not about the problem itself but about how the person is feeling

If you share the same home, it is important to keep an eye on your own limits while helping. Silently taking on all the housework may seem easy in the short term, but over time it can create anger and burnout in you. Instead, agreeing together on a small share the person can manage that day, for example just asking them to take their own glass to the kitchen, both shares the load and lets them feel they can still do something. The aim of helping is not to live for them, but to accompany them as they begin to live again.

I discussed how to support a loved one with depression more comprehensively in the article on supporting someone with depression.

When Should You Seek Professional Support?

Struggling with self-care can be one of the signs that depression is becoming more severe. I recommend seeing a professional in the following situations:

• If basic care tasks have been regularly slipping for several weeks
• If you cannot eat enough and are losing a noticeable amount of weight
• If you are neglecting the treatment or check-ups for a chronic illness
• If leaving the house and seeing people has become almost impossible
• If hopelessness, worthlessness or thoughts such as "It wouldn't matter if I didn't live" come with it

If thoughts of ending your life are crossing your mind, or you do not feel safe, please call 112 (emergency services) without delay. When symptoms become this severe, an assessment by a psychiatrist is often also necessary; psychotherapy and psychiatric treatment can be carried out together.

These signs do not on their own mean a diagnosis. But struggling with self-care in depression, that is, everyday care slipping, is a strong signal that getting help should not be put off.

How Are Self-Care Difficulties Addressed in Therapy?

In therapy, the first step is to create a setting where the person can talk about this without shame. Many clients begin with "I'm embarrassed to say this, but...". Understanding that this difficulty is part of depression often brings relief on its own.

In cognitive behavioural therapy, self-care tasks are addressed within the framework of behavioural activation. Which tasks feel hardest and which are more manageable are identified together. Big tasks are broken into small steps, and these steps are placed according to the person's energy fluctuations during the day. For example, for someone who feels a little more energetic in the evenings, the shower can be moved from the morning to the evening.

At the level of thoughts, ideas such as "If I can't look after myself, I'm useless" or "It has to be completely clean or not at all" are noticed. They are replaced with more helpful ones: "Today I managed to wash my face, and that is a step." Working with shame and self-criticism is an important part of the process, because as shame decreases, the person becomes more open to asking for help and looking after themselves.

Sessions can sometimes be held online as well; this makes it easier to keep going with therapy during periods when leaving the house is hard. You can find information about working with depressive symptoms on the depression and mood page.

Frequently Asked Questions

Is it normal not to be able to shower when you're depressed?

Personal care slipping in depression is a common and recognised symptom. It does not show that the person is dirty or careless, but that their energy and ability to get started have decreased. If it goes on for a long time, talking to a professional is helpful.

My home is very messy and I can't invite anyone round. What should I do?

Instead of trying to tidy the whole home at once, you could start with the single area where a guest would sit. Asking someone close to you whom you trust for help is also possible. Sometimes accepting the mess and inviting someone round anyway is an important step in breaking the cycle of hiding.

Is using paper plates or eating ready meals a bad habit?

During a difficult period these are temporary adaptive strategies. The aim is to meet your basic needs with the least energy. As your energy increases you can reorganise your habits; for now, making choices that make getting through the day easier is more important than blaming yourself.

I'm afraid people at work will notice I'm not looking after myself. What can I do?

Set a minimum list of things to do before going to work: washing your face, deodorant, a clean top. This short list reduces the burden of decision-making in the morning. If the situation has started to affect your work, talking to a professional can guide you both on the symptoms and on how to handle things at work.

• #self-care in depression
• #personal hygiene
• #depression and housework
• #shame
• #daily care

Yazar

Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

Eğitimler