Constantly tired: like depression without the hopelessness. What gives?

October 28, 2013 1:37 AM

I'm constantly tired to the point of not being able to get out of bed until early afternoon, napping frequently and generally feeling lethargic, apathetic and kind of nauseous. I finished a contract job 5 weeks ago & assumed my tiredness was a result of wrapping up the project. Then I went on a very chilled 3 week holiday and put the exhaustion on return down to jet lag. I've seen my doctor and my bloodwork is fine. My diet is decent, minimal alcohol, one coffee a day, so I'm fairly sure this is a psychological thing. I take an SSRI for anxiety but was actually talking to my doctor about tapering off as I've been really well for the past year. Physically, it feels like the bout of depression I had four years ago, but my mood isn't low (more flat) and I don't feel hopeless, just like everything's a massive effort, even helpful things like exercise and socialising. Obviously, YANMD, but has anyone else been there? What can I do to shake this?
posted by rockpaperdynamite to Health & Fitness (21 answers total)

How did you feel during your holiday? My anxiety manifests itself in a similar way: I'm constantly tired and nauseous, but not hopeless or what I would think of as depressed.
posted by third word on a random page at 2:15 AM on October 28, 2013 [2 favorites]

A lot of women in their 30s in particular run into a point where, even if the blood tests look normal, an iron+b12 supplement makes a big difference between "bleahhhh" and feeling like a real live human being.
posted by Sequence at 2:27 AM on October 28, 2013 [11 favorites]

How extensive was your bloodwork? Did they check for vitamins? Look up vitamin D deficiency! Exhaustion, tiredness, fatigue and many other symptoms are linked to it. Luckily, there is an easy enough fix with prescription strength supplements and shots. Get it checked out if you didn't yet.
posted by travelwithcats at 3:10 AM on October 28, 2013 [7 favorites]

Seconding having your Vitamin D levels checked. Mine was super low...doc told me to get some OTC Vitamin D supplements (as opposed to him prescribing me some) and told me how much to take (it was more than what the bottle said to take, but it was under Dr. supervision) and for how long. It made a DRASTIC difference in how I was feeling....and 3 months later my bloodwork was back in the normal range.

Vitamin D levels aren't checked as part of routine bloodwork...it has to be requested separately on the lab form. I'd ask about it (or pop an OTC Vitamin D pill for a few days and see if it helps...you don't want to take massive amounts though, so bloodwork is necessary to make sure you don't take too much).
posted by MultiFaceted at 4:04 AM on October 28, 2013 [2 favorites]

This could be depression. Even if you don't feel sad exactly, depression can manifest as overwhelming apathy, inertia and constant sleepiness. If you think about it, you don't care about things, you can hardly move and you just want to sleep all day... That sure sounds like a depressed person!

So I would suggest talking to a therapist, but don't give up on looking for a physical cause too. There are all kinds of health problems that can make you feel sleepy and glum. You could have sleep apnea, diabetes, thyroid issues, anemia, a million things that doctors can and do miss all the time.

Are you out of work currently? The contract work/3-week vacation sounds like kind of disorienting situation. If you were busy and then suddenly you weren't busy and now you don't know what to do next, that's the kind of thing that can really screw with somebody's head.
posted by Ursula Hitler at 4:25 AM on October 28, 2013 [5 favorites]

Sleep apnea was the first thing I thought of too. Not sure how it can be ruled out without polysomnography, though.
posted by superelastic at 4:31 AM on October 28, 2013 [3 favorites]

Seconding getting a sleep study - this could be caused by obstructive sleep apnea, or one of a number of less common sleep disturbances.

(on preview: thirding getting a sleep study).
posted by penguinicity at 4:33 AM on October 28, 2013 [2 favorites]

Could also be thyroid, and they might not have run it. Seconding Vitamin D and B12. Can you find out what they ran?

Where was your holiday -- anywhere where you could have picked up a GI infection? Any GI symptoms beyond the nausea?

Generally when you see your primary care doctor and they run basic bloodwork and don't find anything, and then you don't go back, they assume the issue resolved itself. Yours obviously hasn't, so I think going back to your doctor and having then run more tests is the next step. There is a HUGE list of things that cause fatigue, and I really doubt they ran all of them. And it also could be depression, which is also a reason to go back to the doctor.
posted by pie ninja at 5:13 AM on October 28, 2013 [4 favorites]

I have idiopathic daytime sleepiness which is a lame diagnosis but for what it's worth, it means that my sleep is not restful enough for me. It's not narcolepsy and it doesn't matter how much sleep I get. The amount that I get, whatever that may be, is not enough.

I had a nighttime sleep test where they ruled out sleep apnea and a daytime sleep test where I demonstrated that I really just am tired all the time. The daytime sleep test was sort of fun - every two hours, they tell you to take a 20 minute nap to see how quickly you fall asleep. Apparently I could fall asleep very quickly - wasn't news to me, though.

After the daytime sleep test, I got a prescription stimulant. It doesn't make me jittery (usually ...), it just helps me stay awake. So while IANAD/IANYD, that is a possibility.
posted by kat518 at 5:49 AM on October 28, 2013 [2 favorites]

From my gf/fiance's experience, a lot of doctors will look at t4 & thyroid counts and go 'its in the normal range. Low normal, but normal' and move on. However, this 'low normal' seems to not work at all for many thyroid patients. Thus, they are consistently under-treated and continue to have the fatigue symptoms.

Also possible: SAD, pregnancy, depression, allergies, menopause, diet, illness... other stuff. IANAD.
posted by Jacen at 6:22 AM on October 28, 2013 [5 favorites]

Sorry to hear that you are feeling tired! In addition to what the other mefites suggested, I recommend getting tested for the following:

-mono
-lyme disease
-Epstein Barr
posted by emilynoa at 7:39 AM on October 28, 2013 [1 favorite]

I wonder what SSRI you're on. I had debilitating fatigue when I was on Celexa, which is pretty commonly given for anxiety--it's what I was taking it for. I went through every kind of blood test imaginable as my doctor tried to figure out what it was. Eventually I saw someone on the internet--possibly here on Metafilter--describing their symptoms when on Celexa, and they fit perfectly with mine. I couldn't stay awake more than about five hours at a time, and when I was awake I was constantly exhausted. Walking from one end of my (small) house or up a single flight of stairs took all my energy; I could barely stand long enough to load the dishwasher. After reading about someone else's experience, I tapered off the Celexa (very slowly!) and the fatigue resolved.
posted by not that girl at 7:49 AM on October 28, 2013 [2 favorites]

Nthing vitamins! My doctor just put me on vitamins D, B12 and B6. I have a noticeable increase in energy and focus.

And following what not that girl said, I switched from Celexa to Effexor at the same time I started the vitamins. The difference in my energy and attitude is night and day! If the vitamins alone don't do the trick, talk to your doctor about switching the SSRI.
posted by mibo at 8:12 AM on October 28, 2013 [1 favorite]

Third-ing getting your Vitamin D levels checked, as well as iron. I had very similar symptoms when I was very low in D.

Because my D was so low, it took months for me to get back to work again.
posted by Ms. Moonlight at 8:13 AM on October 28, 2013

Low blood sugar can also cause these symptoms, including the nausea, and doesn't always show up on bloodwork. Try making sure you're eating often and lots of fat/fibre/protein.
posted by whalebreath at 8:30 AM on October 28, 2013

Any chance your eggo is preggo?
posted by St. Peepsburg at 9:05 AM on October 28, 2013

I would also suggest you have a pregnancy test. I know a number of women who discovered they were pregnant because they had about 4-8 weeks of being "tired to the point of not being able to get out of bed until early afternoon, napping frequently and generally feeling lethargic, apathetic and kind of nauseous".

unless, of course, you're male, as your profile does not say
posted by crush-onastick at 11:28 AM on October 28, 2013

Just a data point- I was feeling this way and things pretty much went back to normal when I started taking a B-vitamin supplement. (34 year old woman)
posted by bearette at 11:55 AM on October 28, 2013

Probably not unless there are some additional symptoms you're not identifying, but give it a read: Autoimmune Disease
posted by skermunkil at 12:46 PM on October 28, 2013

Response by poster: Thank you all so much for your advice! It's also nice to know I'm not the only one! Off to the pharmacy for vitamins, then back to the doc for a follow up chat about my SSRI and further tests.

(And let's hope I'm not pregnant, because an immaculate conception is just too spooky, even for Halloween!)
posted by rockpaperdynamite at 2:59 PM on October 28, 2013 [1 favorite]

There are so many things that can cause this. Pregnancy, Seasonal Affective Disorder, Vitamin D deficiency, Vitamin B deficiency, too much sugar in your diet, too much caffiene in your diet (too much sugar or caffiene will raise insulin levels in the bloodstream which may cause a lot of fatigue so just sum it up to too much insulin), depression, sleep apnea...etc, etc.

Since this is a recent occurrence it's likely Seasonal Affective Disorder.... a name I never liked, because it's not really a disorder. This is just a fancy and scary name for your biological circadian rhythm being out of whack. SAD can happen suddenly to people who've never had it before. Sometimes it just goes away on it's own after a few weeks of your body getting used to the change in daylight that happens this time of year. Other times it doesn't go away and you can end up spending the whole fall and winter season being unable to get up in the morning. Two things can help. #1: an SAD lamp. You have to sit in front of one every morning for at least 30 minutes and after about a week you will be able to get up in the mornings. On Amazon you can get some really great SAD lamps. If your case is a little more serious you can go to a psychiatrist and see if a drug called Wellbutrin is right for you. It's an antidepressant, but it's generally prescribed for morning depression or SAD. After about a week on this drug you will see enormous results... although I'm not sure if it's recommended for people with anxiety which is why you'd need the input of your doctor.
posted by manderin at 4:40 AM on October 29, 2013 [2 favorites]