Why Can't I Concentrate?: Paying Attention To Inattention
anonymous Asks ...
I am on luvox. My depression has lifted but my concentration is still a mess. I will be lucky if I can stay with this paragraph for long enough to finish it…So where was I??? Oh yeah – concentration. I am 9 months into Luvox and I have mostly really good things to say about it. I have heard other people say that it helped them with concentration but honestly mine is as bad as it was at the worst of times. I used to do coding and I took a breather but I have enough goodwill to get some work – unfortunately I just can’t focus enough to trust myself to handle a complex job. So what do I do?
Dr. Richard Schultz Says ...
Hello and thank you very much for addressing your important question to me.
I certainly appreciate the frustration and discouragement you are experiencing as a result of your difficulties with concentration. The task of focusing one's attention on a particular activity of one's choosing, and sustaining mental effort thereupon is a basic aspect of daily functioning for us humans, and yet this endeavor can be negatively impacted by many factors.
In order to better master this challenge, it will be important for you to first understand what is actually getting in your way. I will therefore describe a few of the most basic factors that commonly disrupt concentration and attention, and this will hopefully be of some use to you in addressing this struggle.
1. Anxiety, Depression and Anger: Even mild levels of any of these common emotional states can cause disruption in the ability to concentrate and attend on tasks and activities, unless of course that activity is being anxious, depressed or angry. When we are triggered by any of these feelings, and the thoughts that accompany them, a significant degree of preoccupation can occur, thereby limiting the brain's central processing unit's capacity to focus on anything else.
With particular regard to anxiety, this preoccupation serves an evolutionary purpose; if you feel/believe that you are at great risk due to Stimulus X (say, a lion in the jungle staring you in the face), it would be maladaptive to then be able to easily redirect your focus to the beauty of the trees and foliage surrounding you, the weather, your feet, or the pretty color's of the lion's eyes.
With regard to depression or anger, the invitation to dwell ruminatively on that which has hurt you, discouraged you or pissed you off, can also be quite hard to resist, although this likely serves a less developmental function, and is more likely a result of simply having such a darned sophisticated brain and cerebral cortex. This is supported by the fact that lingering anger and depression are rarely observed in non-human species. This is why zebras don't get ulcers. Thanks, brain!
Underlying Attentional Deficits: Another common culprit in the disruption of attention and concentration is a baseline level of under-activation in the frontal lobe, sometimes called the "executive functioning" area of the brain. This anatomical structure is responsible for helping us to think through complex concepts, generate necessary steps and sequences for problem solving, and execute upon these. When such under-activation is present, distraction is far more likely, and abrupt stopping and starting of these processes can occur, thereby limiting one's ability to follow through on one's goals. The role of stimulant medication (such as methylphenidate) in such a condition is to activate these under-active areas and thus bring functioning to within normal levels. You did not specify a pre-existing vulnerability in this area, but I cannot take that to mean it is not the case.
Drugs and Alcohol: To state the obvious, the use of substances, sometimes in even very small quantities, can erode our ability to attend to, and focus upon on tasks, ideas and activities. The threshold of disruption varies greatly among individuals and substances, so it is not possible to make broadly generalizable statements here. Even prescription medications can, in some cases, impair attention and concentration in some people (I'll not mention specifics here as I have no desire to negatively feed into the suggestibility of humans and their medications).
Luvox, which is an SSRI that has been around for 20 years, and which was initially touted for its effectiveness in treating obsessive-compulsive-disorder, is relatively unlikely to be the cause of your attentional problems. Your description of pre-existing concentration problems supports this. In addition, as an anxiety disorder marked by intrusive, preoccupying thoughts, the underlying condition of OCD may be related to the difficulties you are experiencing (although you did not mention whether you had ever struggled with this, in addition to depression). The medication may be helping with some of the symptoms of the condition, but not all.
Based on what I have written thus far, I would make the following recommendations to you:
1. Pay attention to your inability to pay attention. Yes, this sounds a bit paradoxical, but I am intending to suggest that you gather more information about your difficulties with concentration. When, where, and under what circumstances does this manifest? Where doesn't it? What helps and what makes it worse? Is there a time of day, a location, or fluctuations in energy level or other physiological factors that correlate with instances of inattention? Write down your observations in this regard and do some detective work. You may have some useful realizations. Further, are there any areas of particular focus at the times when you are unfocused (this goes back to the CPU example above)? Where does your mind go when it goes? Are there any particularly popular areas of preoccupation (sorry for the alliteration!) that are sucking up your bandwidth and your focus? Identifying and addressing these can be extremely useful. Further, you may wish to read Hallowell's "Driven to Distraction" to determine if you have underlying attentional problems (although most individuals who do would have likely experienced related previous obstacles during their education). Of course, you can also consult a qualified psychologist or psychiatrist with this question.
2. Get some tools. As they say, those who fail to plan, plan to fail. Given the complexity of current life, and the fire hose of data coming at us every moment, we ALL need ways of de-cluttering, prioritizing, and managing our time and resources. Failing to do so can be overwhelming for anyone, depressed, anxious, angry, attentionally-challenged, or not. There are many good resources available for improving attention and concentration, and you may wish to peruse books or programs recommended by the American Psychological Association (www.apa.org). One book that I have used successfully with patients is "Mastering Your Adult ADHD" by Safren et al. This volume describes a multi-prong approach for dealing with problems with attention and concentration that involves some basic education on the subject, practical strategies for planning and managing your time and tasks, and cognitive methods for dealing with the frustration and hopelessness that often accompanies such difficulties. I don't know anyone that wouldn't benefit from this material, whether they have ADHD or not.
3. Consider mindfulness. As a central component of the Third Wave in cognitive behavioral therapy, mindfulness (aka attention training, mind training, etc.) has been identified as an empirically supported intervention for a wide variety of clinical challenges. If you Google "mindfulness and concentration problems," you will learn about how this technique might be useful to you.
4. Consider a medication change. Although I would not suggest this as a first step (since you seem to be otherwise fairly content with the benefit you are receiving from the Lenox), you may wish to speak with your psychiatrist (and if your meds were not prescribed by a psychiatrist, you may wish to consult one) about other options for treatment your depression, or augmentations to the Luvox that might help with the attention issues.
5. See a psychologist. Yes, I know it's odd that I saved this one for last, especially since I AM a psychologist, however it may be helpful for you to spend some time working with a qualified cognitive-behavioral therapist on this challenge. If you were to work with me, I would help you to navigate all of the options listed above, and to implement these and other strategies. You don't have to go it alone, and medication on its own is rarely the treatment of choice for ANY psychological difficulty. Just let me know if you need me to steer you in the direction of qualified providers in your area.
I hope that my response to your question has been of some use to you. I wish you the best of luck with this challenge, and please feel free to keep me posted on your progress, or to direct any additional follow-up questions or responses to me.
Richard E. Schultz, Ph.D.