Depression and Indecision: Trouble Making Decisions

Little is known about what causes depression and indecision (one of the cognitive symptoms of depression) but it is known that people have trouble making decisions when they are depressed. In fact, chronic indecisiveness is so common that it is considered diagnostically important and is mentioned in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – the book in which mental illnesses, like depression, are defined. People with depression both avoid decision-making and tend to be slower when making decisions.

Chronic Indecisiveness Affects Everyday Life

While you may not be aware of it, you make hundreds of little decisions every day such as:

• When do I get out of bed?
• What do I wear today?
• What should I eat for breakfast?
• Should I take a shower today?
• How should I comb my hair?
• Should I take an umbrella with me?
• Which route should I drive to work?
• And many, many more

Most people make these decisions without thinking about it but a person with depression may have trouble making even the smallest of these decisions. Decisions weigh on people with depression to the point where they often feel incapable of making them. This can freeze a person and lock them in a state where they don't even get out of bed for fear of making the wrong choices. (More on how cognitive deficits affect people with depression)

Why Are People with Depression Indecisive?

One reason people with depression may be indecisive is that they lack motivation. Motivation is impaired in depression and without it, the rewards of making a decision are reduced. This may account for the slowness in decision-making as well.

Impaired decision-making in depression is thought to be a physical problem. One study has linked gray matter loss in the medial and ventral prefrontal cortex areas of the brain to reduced motivation and impaired decision-making ability. This gray matter loss is seen in people with depression.

Finally, people with depression also often exhibit a high degree of anxiety (and, in many cases, comorbid anxiety disorders) and this anxiety may also make it difficult to make decisions.

What Can Be Done About Depression and Indecision?

It's hard to combat depression and indecision but one way to do it is to break the choices down into smaller parts. For example, instead of simply being overwhelmed by trying to decide what groceries to buy, one could break that choice down and ask:

• How would you start that task? (Getting a pencil and paper.)
• What is the next step in that task? (Checking the cupboards to see what I've run out of.)
• And so on

Another way to fight indecision is through therapy; like cognitive behavioral therapy (CBT) for depression. Therapy can help you analyze choices and help you see the possible outcomes so you make the best choice for you.

You can also work to eliminate some of the choices that you find difficult. For example, you could eat the same breakfast every day or judge you route to work based on the traffic patterns reported on the news. These decisions become much easier to make because you've formed a decision-making pattern for yourself.

Finally, making decisions takes practice and it takes positive self-talk. Instead of worrying obsessively about wearing the "right" clothes to work, try to remember that nothing bad will happen if your clothes aren't perfect. You need to realize that most choices have no "right" answer and that any answer (often your gut reaction) will work out fine.

When you start to make small decisions in this way, you will find that your confidence grows in making decisions and the more difficult decisions are easier to tackle.

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