i'm on drugs and i'm tired

April 18, 2012 8:28 AM

I start grad school in four months, and I’m worried about my apathy and extreme fatigue that are possibly a result of my marijuana dependency and/or my SSRIs. What are some steps I can take to get these issues sorted out in light of my anxieties about changing meds and my reluctance to give up marijuana?

I’ve organized my question into paragraphs outlining the main issues. I put a TL/DR at the end of each paragraph.

My Situation
I’m a healthy female in my late twenties, about to complete my second undergrad degree and start a prestigious doctoral program in September. I’m really excited about grad school, but I’m worried about my long-standing problems with fatigue and depression, and my recent problem of a marijuana dependency. I really want to get a handle on these issues before I start grad school, and feel like I have four months of relatively low stress to maybe try adjusting my meds and working on the pot thing. I just don’t quite know where to begin!
TL/DR: Late twenties woman wants to cure fatigue and drug issues within the next four months.

Fatigue
Girl loves to sleep. For pretty much as long as I can remember I have cherished sleep and engaged in wayyyy too much of it. Especially in times of stress, my time in bed can go up to 16-20 hours a day. Much of this time is spent in a strange sleep state where I have disturbing dreams or nightmares, and some waking time is spent scrolling on my iphone or watching internet tv. Lately it’s felt really bad, where I want to get out of bed but just…can’t. I have even called my mom near-tears, asking if she was coming home soon so that she could try to pull me out of bed. I lie there with just absolutely no motivation or…ability…to get up. Obviously my muscles still work and I could if I forced myself, but even if I somehow propel myself heavily into the kitchen to try to make a sandwich, I quickly retreat back to bed before even getting the bread out of the bag. At school I spent hours napping on one of the lounge couches when I should be doing homework. My sleep schedule has been messed up lately – where I stay up until 5am and sleep until 6 or 7pm, but I can’t seem to break it. In the day all I want to do is sleep, but sometimes at night I feel almost afraid of going to sleep….I have to watch tv until I drift off. On my long days in bed I will often not eat well, and if I do eat it has to be something warm and mushy that doesn’t take more than 5 minutes to prepare (microwavable kraft dinner). I am so tired of this fatigue – I never get anything done, I miss out on social opportunities, and I feel almost paralyzed by my lack of ability to get out of bed.
TL/DR: I can spend up to 16-20 hours a day in bed sleeping, and even getting up to get a glass of water feels like too much effort/energy. I can’t get a handle on my extreme fatigue.

Marijuana
It is highly probably that my marijuana use contributes in some way to my sleeping problems, but on a day to day basis it is the only thing that seems to help. When I’m lying in bed comatose, I know that the one thing that can get me going is to have a little puff. Often I will lie in bed for hours just trying to get the energy to get up and put a pinch in my pipe. The effect of smoking marijuana is almost instant: suddenly I am up, fixing myself healthy food, cleaning things, wanting to socialize or exercise, and getting excited/motivated to do my homework. I don’t know why it has such a stimulating effect on me – I mean, I know it’s a stimulant, but it makes many people instantly lazy and munched-out. It makes me want to hike a local mountain trail eating fresh oranges and baked fish. It really just seems to perk me up completely, and so I’ve started using it a lot more often lately. I don’t smoke a large quantity, but I do smoke very often. I usually only take two puffs each time I smoke, and smoke between 1-4 times a day, so I probably end up smoking about a joint a day. A gram lasts me about a week. My pot-smoking friends often laugh at the teeny amounts I smoke – but I feel like it’s part of the secret to using marijuana effectively –too much makes me lazy, just a little makes me efficient.
I feel shame and worry about my pot dependency though. Recently I tried to quit for a week to show myself that I could, and I only lasted five days. I’ve been an occasional user for a long time, but I don’t really like the fact that I smoke by myself, or feel like I have to smoke to get through a day. I don’t like that I recently got pretty anxious when I was down to my last puff and couldn’t find any more anywhere. During the five days I did quit, thought, I did end up doing some things that I previously used to get high for (swimming, work) and was kind of surprised to see that I still enjoyed them without smoking it. The reason I gave in was because I had work to do and just couldn’t get myself to do it, and a lil puff did the trick.
TL/DR: I smoke modest quantities of marijuana a couple times a day, and it really helps with my energy/motivation/productivity, but I don’t like feeling dependent on it and it seems that’s where I’m at/headed.

Stimulants
I have tried stimulants to deal with this problem. I was once prescribed a low dose of Ritalin by a psychiatrist ( a few years ago) – but I didn’t like taking it and I can’t remember why (I have a really bad long term memory). Recently a friend gave me a handful of Adderall (20mgXR) – and I really liked it but didn’t like the side effects. The part I liked was feeling awake – for the whole day I would just go about my business like a normal person! I was awake and doing things! I would set an alarm for 7 am, wake up and take it, and get out of bed at 9 am with ease and anticipation for getting started with my day. On a normal day the only thing that can drag me out of bed is an unshakable commitment to be somewhere (and that doesn’t even always work). The part I didn’t like about Adderall was the personality and come down. I found my personality way too obnoxious/in your face (relative to my usual, easygoing, kinda quiet personality). I felt like I was annoying people with my happiness and excitement and inability to stop pacing/talking. So it brought me up to be a bit too energetic. I also get really bad cramping in my lower back and butt muscles in the evenings on days I’ve taken it. I’ve looked this up online and some people have this symptom but don’t know why. It’s REALLY uncomfortable and hurts a lot. (I don’t know if it has anything to do with the fact that I also get weird butt cramping during my period, which extends down the front of my thighs, and really hurts. Or with the fact that my whole childhood I had insane restless leg syndrome but didn’t know what to call it. My mom says I would just kick and kick my legs and say they were dizzy. Restless leg syndrome sounds flaky but I still sometimes get bouts of extremely uncomfortable antsy-legs). I try to stay hydrated while I’m on it, and maybe sit at a computer for a while more than normal, but this seems like an extreme reaction.
TL/DR: I’ve tried Ritalin and Adderall, and while they did help with my energy levels, I didn’t like Ritalin and Adderall gave me strange and painful cramping in my back and butt along with mild annoying hypomania.

SSRIs and Depression
I’m currently on 20mg on Lexapro to treat atypical (characterized by fatigue and increased appetite) depression. I’ve been on it for 3 years now, and although I had a lot of hesitations/resistance to feeling dependent on medication (just like on pot), I’ve accepted that it helps me immensely and that I want to stay on it. I’ve tried decreasing my dose a couple times (always gradually, usually with doc approval), and have had horrible experiences each time. The side effects I get from Lexapro are annoying, but the withdrawal is almost unbearable. I get brain shivers almost immediately after missing a dose (like, if I’m supposed to take it in the morning, by the evening I’ll know I forgot because I start getting brain zaps). This really freaks me out, especially because I can’t find a comprehensive scientific explanation as to what is happening in my brain during brain zaps. Is my serotonin being re-uptook, when the presynaptic neuron is not used to getting it or something? Are my synapses accustomed to having a certain amount of serotonin, and the gaps are the synapse reacting to a decrease? I just want to know because to be able to feel my brain giving off an electrical charge worries me.
Aside from the brain zaps, I get really emotional and depressed when I taper down my Lexapro, so I’ve always ended up going back to 20mg. For this reason I’m scared to tamper with my dose again or try another antidepressant. I also heard that tampering with good doses can screw them up, and I don’t want to lose a good thing by messing with it. That said, I don’t know if the Lex is working as well anymore, or if it is playing a role in my apathy/laziness, since that is a known side effect. My body just feels depressed, even if my mind mostly feels okay.
I tried Wellbutrin 100mg once for a couple months, but didn’t really notice a difference aside from some heart palpitations. It would be something I’d be willing to try again, but the anxieties about messing with my meds is making me hesitate. If I am going to tamper with this stuff, I want to do it in the next four months before I start grad school, because I know from experience that med-messing times are full of mini-mental breakdowns.
TL/DR: So Lexapro has worked for me, but may be contributing to my fatigue, and I don’t like the brain zaps. I’d be willing to change meds, but want to be stabilized on something by the time I start grad school in September.

The other stuff I know you’ll ask:
I don’t get nearly enough exercise, but plan to change that once I move to a town next month that offers dance lessons.
I see a therapist when I need to, but don’t feel that I need to right now.
I don’t eat that well, because I hate cooking, but I don’t eat awful, either.
I do really well in school, so somehow I manage to maintain an appearance of functionality despite my internal feelings that I am unable to get almost anything done.
I hardly drink alcohol, and don’t smoke cigarettes.
I have not had bloodwork done in a while, as I can’t get it together to get the bureaucratic stuff together enough to go see a doctor.
I don’t know if I have thyroid problems, but I am slim and have a low blood pressure.
Hope me!

posted by anonymous to health & fitness (20 answers total)

You are aware that you addicted/getting there and you "don't feel like therapy"? Reconsider.
posted by MinusCelsius at 8:33 AM on April 18, 2012 [1 favorite]

You are full of symptoms of depression and drug issues and you don't feel you "need" therapy? What would it take for you to change your mind? You're in school, so it seems like the "bureaucratic" issues behind getting a doctor's appointment involve... a phone call? If you can't do that, you really, definitely, seriously need therapy.
posted by brainmouse at 8:38 AM on April 18, 2012 [1 favorite]

Get exercise and start eating right. Do it now. Don't wait. Do it hard! I don't mean overwork yourself at the gym off the bat but rather, don't let yourself even *consider* skipping the gym, or skipping that healthy meal you had planned and getting fast food, etc. Grit your teeth and do it. After a few weeks it will be easy and you'll enjoy it.

Those 2 things alone will make a significant difference in your life.
posted by imagineerit at 8:48 AM on April 18, 2012

"Don't feel like therapy" really sounds like the depression talking. And re: exercising, remember, it doesn't have to be some fancy all-out workout. Make yourself take a 30 minute walk everyday.

Please reconsider therapy because when you say things like "I can spend up to 16-20 hours a day in bed sleeping" I worry. I'm just finishing a masters program (not even a doctorate) and I'd say I average 60-80 hours of work a week (more leading up to finals). The doctorate students I know spend more time working. Your feelings of "somehow I manage to maintain an appearance of functionality despite my internal feelings that I am unable to get almost anything done" will be magnified exponentially in grad school. I'm surrounded by ridiculously bright, well-organized, productive people without your challenges, and they're finding it a real push to get through.
posted by smirkette at 8:49 AM on April 18, 2012 [2 favorites]

Yes, this just screams "you have a drug problem." You're not headed there, you're there there.

Often I will lie in bed for hours just trying to get the energy to get up and put a pinch in my pipe

Is that who you want to be? Really?

I don't know what other factors may be playing into your fatigue and other issues, but cutting out the weed seems like a very good place to start. Adding stimulants etc on top of your existing drug use does not sound like a good place to start at all.

I am not a Nancy Reagan type. I like pot. Pot is fun. I strongly dislike the use of the term "addiction" for drugs that create no physical dependency, so I'm not going to use the word addiction. But girl, you have a real drug problem.
posted by ook at 8:49 AM on April 18, 2012 [3 favorites]

Have you had a sleep test? Depression causes fatigue in many cases, but poor quality sleep also causes depression. Sleeping as much as you do is not normal. You want to rule out things like sleep apnea (and yes, the young and thin can have it) which cause unrefreshing sleep. Get thee to a sleep lab!
posted by Rosie M. Banks at 8:50 AM on April 18, 2012 [5 favorites]

Listen, I only have anecdata, but it says that pot and SSRI's are just a super bad news combination. If it were me (and it was) I'd give up at least one of them.

Have you considered food and diet as a path to wellness? Maybe you are one of those people for whom wheat and grains put your system all out of whack, leading to constant fogginess and fatigue, and you may find more natural energy from paleo eating.

Also, look into things that people with Seasonal Affective Disorder (SAD) do for self-help, like light therapy, omega 3 oil supplements, etc.

I understand the reluctance for talk therapy, but are there other kinds of pros you could access, like having a gp do some bloodwork TO SEE if you are anemic/deficient? Nutritionist to actually look at what you are eating? Study or motivational coaching or CBT to see if there's something about your approach or technique that could change to make things easier and more rewarding? Best of luck.
posted by Rube R. Nekker at 8:51 AM on April 18, 2012

Graduate school itself is a major CAUSE/FACTOR in depression - a lot of people develop depression due to the situation (high stress, low support, and in some fields very lonely/socially isolated).

If you go to graduate school without dealing with your fatigue and depression, you will find it almost impossible to finish. Delays in finishing will seriously disrupt and possibly derail any academic career.

You are much better off putting off graduate school until you are fully mentally healthy.
posted by jb at 9:03 AM on April 18, 2012 [3 favorites]

Drug problem?! Are you fucking kidding me? You're smoking a gram every fucking week.

We can talk about a "drug problem" when you're burning through half an ounce a week and you can count the number of hours per day that you're sober on one hand.

Don't listen to this shit. It's more likely that you're seriously depressed (and you clearly need to get some help).

But christ, you're smoking nothing -- telling yourself that you have a drug problem will only worsen things by increasing your self-pity/self-loathing.

I'm not saying you don't need help -- you do. But when it comes to your so called "addiction," you need to take a step back, stop beating yourself up, and get a fucking grip.
posted by lobbyist at 9:39 AM on April 18, 2012 [12 favorites]

Do you live where you can get medical marijuana?
I have way too much to say about what is going on with you according to what you have written.
Mail me and we can talk.
Do you have any access to health care?
How old are you?
There are too many questions to write here.
posted by provoliminal at 10:08 AM on April 18, 2012

By age I mean history not current age. Ugh, talk about TL.
I am not focused enough to adequately ask what i need to know. Anyway, what I said.
posted by provoliminal at 10:09 AM on April 18, 2012

Seek help.

I advise these things:
1. Therapy
2. Blood test (might have some crazy chemical imbalance).
--> Especially when you say “I am slim and have a low blood pressure”
3. Exercise (helps a lot)
4. Eat better (we are what we eat and it does affect our mental state)
5. Get on a schedule of some type and stick to it.

You sound like you’re suffering from depression and need assistance on getting through this.

Good luck,
posted by WestChester22 at 10:29 AM on April 18, 2012 [4 favorites]

Has anyone checked you for narcolepsy?

And yeah, I wouldn't worry about your pot use (beyond maybe being drug tested). That's a pretty minuscule amount.
posted by fshgrl at 10:41 AM on April 18, 2012

lobbyist,

Quantity of use isn't the standard for addiction - people's tolerances vary greatly, and she has deliberately taken steps that prevent her for building much of a tolerance. It wouldn't surprise me to find out that there are genes that make people more or less sensitive to marijuana's effects.

If you can't quit, and what you're doing is significantly affecting your life, you need help, whether you want to call it 'addiction' or not. I wouldn't be surprised if it's tied up in the depression, but she's using pot to cope with her dysfunctional daily life. That's pretty much what addiction *is*.
posted by zug at 10:42 AM on April 18, 2012 [2 favorites]

We can talk about a "drug problem" when you're burning through half an ounce a week and you can count the number of hours per day that you're sober on one hand.

I hear where you're coming from here -- but regardless of the absolute quantity she's smoking, the OP is pretty much ticking every available box on the dependency checklist. I mean seriously:

I know that the one thing that can get me going is to have a little puff
smoke between 1-4 times a day (smoking four times a day doesn't leave a heck of a lot of sober hours)
I feel shame and worry about my pot dependency
I tried to quit for a week to show myself that I could, and I only lasted five days
I don’t really like the fact that I smoke by myself
I have to smoke to get through a day
I recently got pretty anxious when I was down to my last puff and couldn’t find any more anywhere
During the five days I did quit[...] was kind of surprised to see that I still enjoyed them without smoking

None of those are what I would describe as, y'know, good signs.

I don't think you can point at a specific quantity of a drug and say "this much is too much for all people; that much is fine for all people." It's not how much of a drug you consume, it's how much of an effect that consumption has on your life. And based on this poster's own words, it's having a pretty damn pervasive effect.

I know in my own past I've had periods of what I would describe as overuse of pot. The quantities I was smoking were relatively small -- nowhere near a half ounce a week or even month; much closer to the OP's current usage level -- but it still fucked with my sleep schedule, eating habits, and general level of happiness. The absolute amount isn't that important; the lifestyle effect it has is what matters.

Will quitting pot solve all the OP's issues? Probably not. (My armchair diagnosis is that the pot use here is self-medication for some other underlying condition.) Is the OP an "addict?" Well, as I already said, I have a real problem with that term; strictly speaking it shouldn't apply to pot at all, only to drugs such as nicotine or heroin that produce a true physical dependency. Given all those caveats, would I still say the OP has a drug problem and should stop using, at least until her other issues are sorted? Hell yes I would.
posted by ook at 11:00 AM on April 18, 2012 [1 favorite]

OP, there's a lot going on in your life, and it's great that you're ready to get a handle on them.

Eating right, sleeping right and moving your body will all help your mood. You know this. Enlist some help from your friends or your mom to get yourself on a functional schedule of eating & sleeping. Start small - wake up, take a shower and talk to people in the morning. go through the ritual. Go back to bed afterwards if you must but get up and eat a proper lunch. Be tired, but move your body. Every day, go for a walk (schedule it with a friend). After dinner, brush your teeth and go to bed at a healthy hour. When you're going to bed for the night, evict the glowing screens... They confuse your eyes & brain. Read a boring book if you must do something other than lie there.

Commit and plan to eat better. If I ate Mac'n'cheese while a sleepy depressed mess, that's how I would stay. You need veggies & protein (have you met cheese? Nuts? Lentils?).

All these mythic rituals are part of the structure that keeps many people moving in a forwardly diirection. Walking, Eating & Sleeping a demonstrably good for your health. (have I mentioned? :)

You totally need a therapist rather than internet strangers to help you through this. And you should probably talk to your doc about what s really going on with you - including the pot and get your thyroid levels checked again, cuz they can change.

I hear your pain, I am still in my workout clothes 4 hours after coming home, and I ate snacks for lunch rather than take a shower and get to my own work. But the gym & the activities do improve my mood and the positive actions flows from there.
posted by Heart_on_Sleeve at 11:38 AM on April 18, 2012

Good job on getting into grad school and having two degrees already, that alone is a lot of work!
Sounds like you should see a doctor concerning your health. 16 to 20 hours is an awful lot of sleeping! Could be something physical going on. Anyways, therapy isnt a terrible idea, and its helped me in the past, and it has also been useless.

One gram a week is very little. Shit, I probably smoke that every day or two and I am taking three classes in grad school, and probably sleeping about 4 to 5 hours a night. It can be pretty useful for staying sane, and to be honest thats hardly an "addiction". I have no shame in my game, but in your case, something isnt working out right. Anti depressants had an odd effect on me, and after trying a handful I gave up and therapy helped. Gotta find a good therapist.

Speed is great, and I enjoy it as I can get a bunch of shit done, but it does what you mention, making me more enthusiastic. I hate the crashing feeling, and it really can be counter productive.

Check your diet, see a doctor, cut out the drugs, you can always restart smoking whenever, and get things together. You have a ton of hard work in front of you, and you should be in good health.

/i really dont think the calls of "omg, you have an addicition" are in order nor necessary , problems =/= addiction, and hardly at a gram of week,
posted by handbanana at 12:53 PM on April 18, 2012 [2 favorites]

Put with those who think you have a drug problem. But not a pot problem. The withdrawal from your SSRI meds worries me considerably more.

You need exercise. Maybe just long walks, but you need to move and breathe. The question is how to get yourself out the door? Maybe you can convince a friend or family member to violently drag you out every day? I don't mean violently violently, but somehow get someone to not take any no for an answer, short of you legs having been severed in an unfortunate lying-in-bed-browsing-the-iphone accident.

And you do need a mental health professional to handle both therapy as well as managing / weaning you off the pharma. Maybe the grass too, but definitely the pharma.
posted by bumpkin at 12:59 PM on April 18, 2012 [1 favorite]

I have never smoked pot, but I HAVE had the exact same symptoms as you, except that I slept only maybe 10-13 hours. Nicotine (cigarettes) was my drug of choice in self-medicating, but I had the same relationship to it that you do with pot-- I was so miserable, exhausted and unproductive without it that quitting actually seemed self-destructive. And it wasn't an addiction loop, because I feel now, post-quitting, the same way I did before starting, and the only thing that helped the whole time was smoking.

What has helped moderately for me as a non-smoker is Wellbutrin. If it didn't do anything for you, you might want to ask your doctor about trying a different generic (or name brand if you can afford it, or a generic if you were previously on name brand). One Wellbutrin generic makes me feel furious and dead inside, and another makes me feel stable and more connected to my body and emotions (and it is more gradual).

I don't know what to say about sleep hygiene because I have the same problems as you, but I try incredibly hard to get to bed before 1:00 AM every night, and if I can live at home or get someone to give me a wake up call there's a better chance I'll get out of bed. Sleeping enough (and not interrupting sleep with false "wake up" times) is super important, as is a routine. Going to bed early enough that I can loll around a bit after my alarm goes off is super essential because otherwise I'll be late. I just can't drag myself out of bed on the first alarm. Other considerations:

1) Is your bed super uncomfortable? I realized last time I was home that I needed less sleep because sleeping on a thin mattress and board at school was not very restful.

2) Does drinking coffee or tea help? I recently bought an electric kettle that I literally have to keep in my room, next to my bed, so I can drink tea and eat breakfast (breakfast bars and shakes) in bed, or I just don't have the energy.

Being addicted to cigarettes was no fun, but it really helped me get by when I needed to get things done. But there is not as much stigma about cigarettes as there is about marijuana as a capital-D drug. Your marijuana "addiction" sounds less influential on your life than mine as a light smoker, tbh. And it's not obvious that your problems are being caused by marijuana, because mine weren't. It's possible you have a problem, but I think the reason you can't break your "addiction" is that it seems like a low-impact way to make yourself feel like a human being. It's improving your life, and even you say you can enjoy normal activities without it, it's just needing a bump out of bed. (Pun intended I guess.) If it were a pill instead of weed, it would be doing exactly what it's supposed to do.
posted by stoneandstar at 1:06 PM on April 18, 2012 [1 favorite]

1. Please contrast this statement "I see a therapist when I need to, but don’t feel that I need to right now" and this statement,"lately it’s felt really bad, where I want to get out of bed but just…can’t. I have even called my mom near-tears, asking if she was coming home soon so that she could try to pull me out of bed. I lie there with just absolutely no motivation or…ability…to get up." I'm confused about how this kind of feeling doesn't clearly alert you to the fact that you therapy and you need it now. Do not wait for it to get worse, take action now. I know it's easier said then done, but seriously - 16 to 20 hours of sleep?! Not healthy and warrants immediate treatment.

2. >>> But christ, you're smoking nothing -- telling yourself that you have a drug problem will only worsen things by increasing your self-pity/self-loathing.

I'm not really pleased with the overall tone of that comment, but I agree with the sentiment. A gram a week does not equal the joint a day you're saying you smoke. There's something off about this to me. Either you're not being truthful (with us and/or yourself) about the amount your smoking, or your benefiting from the placebo effect. So I don't really know what the story is with this, but it's pretty hard to swallow.

3. You seem like a really intelligent person who has quite a few awesome academic achievements under their belt. That's awesome that you've accomplished so much. It's a big deal to be accepted into a PhD program, congrats! In order to ensure your success you need to get yourself healthy. So see your primary care physician and your therapist ASAP so you can keep on climbing that ladder!

Please take care of your self immediately. Like today if possible. The 16-20 hours thing is pretty scary to me. If a friend of relative told me they were sleeping this much it be off to urgent care that day.

Best of luck to you!
posted by OsoMeaty at 1:11 PM on April 18, 2012 [2 favorites]