Guidenice on being tired/depressed and steps to take.

July 19, 2007 11:07 AM

MedFilter: Looking for guidance on general chronic lethargic feeling (both physically and emotionally). (wordy)

I hate medfilter, long posts, and people who don't do their research first, and as such, I apologize for breaking two of these rules, but I have read every post related to depression. I have insurance. This is a long time lingering problem (6+ years) that I would seriously like to fix, and I have tried the normal channels and failed.

This is more of a 'who do I talk to, and what do I say' type of question, as I have seen both a psychiatrist and a doctor multiple times over the years to no avail.

I am chronically tired physically. I wake up exhausted, I feel tired to the point of exhausted at work, and in social situations. I don't have an overly stressful work situation, nor do I feel like I am over-anxious about social outings (specifically, though I am frequently over anxious about things, to the point of casual OCD, like checking creditcard bills online multiple times a day, knowing they wont be updated, etc). I have also for quite some time felt extremely depressed (to the point of regular suicidal thoughts), which I have attempted to address through both talk therapy, as well as medication (various SSRI's) which I am currently on (only medication).

I feel almost abandoned by 5-6 therapists who have more or less said you are fine mostly through my own omission, or not reading into things enough, or pushing hard enough even when asked to. But at the same point, I am there because I don't know what to address, or what the issue is.

The physical exhaustion/lack of energy seems to have its easiest explanation in a depressed mood, but could it be something else? I am overweight, and had a typical college kid whos moved out and lives on takeout and pizza/beer diet, but have slowly been organizing my life. I took the list of "things that make you less depressed" to heart as much as possible, and have worked up to running 5k's (from not being able to run at all!), bike ~50 miles, and lost 30+lbs. I watch what I eat, and have slowly and sanely been losing weight. I sleep normal hours (7-8 hrs a night, standard bedtime/wake up time). I have tried a variety of diets (ie, less carbs, less refined sugars, no caffeine, none of which were 100%, but used as guidelines for a few weeks to see if they had any effect. Recently I've cut out all meats (vegetarian) and been doing that for 2-3 months with no ill effects. I have lived healthily for the last 2+ years (balanced diets, lots of water, getting out quite a bit).

I feel as though I shouldn't feel exhausted ALL the time, and be more motivated with this energy to do things (complete a few final classes, clean my apartment, be social), but all I feel like doing is sleeping most of the time, or feel like a zombie when im out and about, not really thinking more just observing.

So whats a depressed, but intelligent twenty something supposed to do? My doc is quick to put things off as normal (HMO syndrome?), and therapists seem useless.

posted by anonymous to health & fitness (40 comments total)

Go to a doctor and be insistent. Go to a therapist and be insistent. What else do you expect to hear?
posted by xmutex at 11:16 AM on July 19, 2007

First, a few questions:

Have you tried getting a solid 8-9 hours? How often ar you running and biking? It may be your activity level means you need a bit more recuperation (though from the sound of it, the exhaustion predates it?)

Did your doc run you through standard blood tests, and ruled out physical causes?

If you really feel your doc is not listening to you, find a second opinion.

I feel almost abandoned by 5-6 therapists who have more or less said you are fine mostly through my own omission, or not reading into things enough, or pushing hard enough even when asked to.

What does mostly by my own omission mean? I'm wondering here if you're not comfortable talking to them or something? That's a lot of therapists to have gone through - can you describe a bit more explicitly how things fail? I'm really wondering why any therapist would say you were fine if you were telling them you were having suicidal thoughts!

Have you addressed your anxiety issues? Being overanxious, I imagine, must be extremely fatiguing.
posted by canine epigram at 11:17 AM on July 19, 2007

A friend of mine was having fatigue issues around the time she started cutting meat out of her life. Turns out she was seriously anemic. Iron pills are helping.
posted by ThePinkSuperhero at 11:21 AM on July 19, 2007 [1 favorite has favorites]

Have you been tested for Hypoglycemia? If not, I recommend you get tested for it as soon as possible.
posted by milarepa at 11:21 AM on July 19, 2007

Have you had a blood test to determine your thyroid levels lately? A low amount of thyroid hormone in your blood causes constant fatigue and (for me at least) anxiety and depression up to and including the point of feeling suicidal in the past.

A lot more people have been at this point than you realize. Call your doctor up and insist on a T4 AND a TSH test. It's just a thought.
posted by princesspathos at 11:24 AM on July 19, 2007

I'll second canine epigram's questions; what is your daily routine like? I was horribly depressed and lethargic for a period of years. I wasn't sleeping well, wasn't getting exercise, and I was eating too much. I changed as many unhealthy habits as I could and I've come pretty well out of my depression and exhaustion.

If your doctors are writing you off as normal, they may be quacks or they may be right. You can try seeing another doctor or you can try seeing a nutritionist or physical therapist (maybe even a personal trainer?) on your health plan.
posted by lekvar at 11:29 AM on July 19, 2007

Here's the thing: this could be anything. It could be a low thyroid, it could be Addison's disease, it could be anemia, it could be depression, it could be an allergy, it could be lack of sleep, it could be sleep apnea...really, there are a hundred things it could be.

If I were you I'd go to a doctor and I'd say exactly what you've said here, and then I'd go from there. Don't get sidetracked, don't allow them to interrupt you until you're done describing the problem in the detail you have here. That should only take about a minute, as I read it in that amount of time. Then let them ask you questions.

If you can bring it up in AskMe, you can bring it up with someone who will be able to at least run some tests.

(You might also have a list of things to suggest to the doc, a list of things you've heard might be indicated by these symptoms, but anything you read in this thread is going to be useless in terms of diagnosis.)
posted by OmieWise at 11:40 AM on July 19, 2007

I had a very similar problem. I got a sleep test, and I had sleep apnea. Getting this treated with CPAP therapy improved my life enormously.
posted by agropyron at 11:41 AM on July 19, 2007

I had these symptoms (as a skinny person, even!) and it was a combination of sleep apnea and thyroid issues. And OmieWise is right, it could be these things or a host of many other things.

The problem with the US' specialist-focused health care system is that each specialist will view your problem through the lens of their own specialty. Which makes it very difficult to trust a diagnosis or get a "whole body" point of view. Is there a teaching hospital close by? Or a medical practice which specializes in sleep disorders? Even though you may not have sleep apnea, some sleep disorder specialists will be more willing to go that extra mile to help identify causes of fatigue.

I feel your pain. Good luck.
posted by jeanmari at 11:47 AM on July 19, 2007

I'm sorry to hear you are going through this. I can relate to most of it (although I have never had weight issues).

A few thoughts- possible thyroid issues? iron/zinc deficiency (which you've got to watch as a vegetarian)?

I wonder if there may be trauma in your past as well. That stuff saps your energy.

Best of luck.
posted by solongxenon at 11:48 AM on July 19, 2007

It really could be anything. Have your drs done a full blood work up? Mine ruled out frigging everything from lyme disease to lupus to anemia to hypothyroid to a vitamin B deficiency. And no dice. But if you haven't had everything like that ruled out, you should be very persistent with your doctor until they have.

I am the poster child for depression & lethargy & chronic exhaustion. I found a psychiatrist who realized that I was very much seriously exhausted and found it impossible to work on anything else when I could barely function. He thus made it his top priority to help me feel more well rested.

The last change he made to my meds made the most profound difference. He prescribed trazodone to me, which is an antidepressant with a trademark side effect of extreme sleepiness. Apparently it is often prescribed specifically as a sleep aid since it lacks the dependency risk that most sleep aids have. For the first time in years, I have finally felt like my sleep was deep and restful.

I'm still tired often, but it is so much better than it was. I feel like a human being again.
posted by tastybrains at 11:53 AM on July 19, 2007

xmutex: Validation that I am not just being complainy, and that there might really be an issue.

canine epigram: I usually get 7-8 hours, less on occasion when I have trouble falling asleep (1-2 times a month ill go a few days with almost no sleep), but overall average would be close to 8. I don't wake up at night, once im out I am usually out.

As for general activity -- I am extremely active despite not feeling like I should be. I tend to bike every day as a mode of transportation around my home town, but that is <5 miles, and not at all strenuous. average, twice a week i'll do something reasonably serious, bike 20-30 miles, goto the gym and run/weight train. i know what fatigued muscles feel like, and i enjoy knowing that they are tired, and it isn't just me (ie, sleepy tired vs achy stiff tired). i give myself plenty of recoup time. there have been busy times when i get home and for 4-6 days in a row really haven't gotten much exercise other than the normal day to day walking around, and i have felt much the same. i started this because i assumed alot of the problem was due to a weight/diet problem. i feel great physically, and it has done wonders for self image, but alas.. nothing, or possibly a negative impact general wellbeing and fatigue. i *really* don't think i overdo it. if my muscles are at all achy, i am patient and don't push anything. br>
I specifically asked for a thyroid test as a reason for the appointment, and he asked a bunch of questions validating depression (the typical rundown), wrote me a prescription for an antidepressant, and kicked me out. I have another appointment soon and I will poke him as a reminder that I think its serious and should be checked, and remind him he agreed.

As for 'mostly by my own omission', yes there are things I am not comfortable talking about. I tend to get very anxious, self conscious, and afraid of being upset in front of them. I'm not sure how to directly address them, or even what parts of them need addressing. The anxiety comes in the form of not being able to think at all.. or even come up with replies. The replies that I do come up with are watered down for sake of not wanting criticism. But even when I write things down, and try to be open, it doesn't seem to go anywhere.

Addressed anxiety - The last therapist (the first that really pointed out the issue) pretty much said meditation was the answer. Some things work for some people I suppose. I do my best to apply the things she talked about, and we practiced, but they are momental, and not long term. With school, the concerns got to the point of being dehabilitating and failing classes (multiple, as in 8).

ThePinkSuperhero: I give blood regularly, and have had comments in the past such as 'you have enough iron for two people'. As a precaution, I do take a multivitamin with iron. I have always had a tenancy to not ever bruise that I attribute to a healthy level of iron. This supersedes vegetarianism.

milarepa: Nope. That is related to a thyroid test yes?

princesspathos: Nope. Asked and ye shall be given anti-depressants. Last therapist suggested getting it checked, which I made the appointment with the auspices of having done, but it didn't.

lekvar: I don't mean to say they think I am normal at all, infact I think they were concerned. The last doctor ended because I didn't have insurance. The latest is only a little over a month old working with me, so maybe he will be better than the last. Time shall tell.

OmieWise: Indeed. As I said above, things that are related to emotionally how I feel usually get blocked out by anxiety in said situation. Perhaps this will act as a decent outline for the discussion. I did post anon however :).

agropyron: I have read some people talking about that. Thanks for the reply. I'll keep it as a list of things to prod the doctorman about.

jeanmari: No teaching hospitals near by unfortunately, or atleast within a reasonable distance (reasonable meaning able to work, and still visit one, and not go broke paying for gas .. closest would be ~1.5 hrs). There are some far away, but still commutable sleep disorder places I do believe (~hour from work).

solongxenon: Thyroid - yep.. asking about. Iron should be ok, not sure about zinc though. I'll bring both up. Trauma - definately.

Thanks everyone for your input so far. On some level I am looking for validation, and hope of some kind, and also asking for input on things I might be missing, or things I should do. This has been awesome.
posted by sirliberal at 12:21 PM on July 19, 2007

no caffeine

Why? There are plenty of reasons that caffeine is not good for your body, but its primary purpose is to help wake you up, and zillions of people drink it without keeling over.

I am sure there's some underlying cause here, and others have given you solid advice, but if you need to just get through the day, caffeine is your friend.
posted by desjardins at 12:24 PM on July 19, 2007

I was also going to pretty much just let this slide (as I have on and off with depression over the last 6 years). I think its probably common to assume a role of dispair and hopelessness, and that nothing will change. What started this post was talking to a friend who is at the hospital right now getting a blood transfusion for anemia. She was a good close friend, and we hung out alot. She went to work before I did, but every evening I would be pretty much falling asleep and lethargic, while she would be cleaning up her place, or playing with her cat, or suggesting we go for a walk.

At the hospital she was saying how she has been extremely tired lately, and not as active as normal. It was entertaining to think that someone with bad enough anemia to have 4 units of blood had more energy than I did, and was more active than I was during the past month or so we've been good friends.
posted by sirliberal at 12:25 PM on July 19, 2007

desjardins: I think you may have misunderstood slightly. Given that a good caffeine addiction (which I would say I had pretty good a few years ago) can cause fatigue, and a dependency on it, I gave it a go without for a period of time. These were all exercises in self help, to which no benefit was seen. I occasionally have coffee, or an afternoon soda, but in college I would rely on caffeine to make it through studying/cramming. Gone are the days of drinking a liter of soda.

I eat normally with the exception of no meat. I don't follow any special diet, and eat fairly normally.
posted by sirliberal at 12:29 PM on July 19, 2007

Hm, you keep mentioning anxiety, so perhaps that's the reason for no caffeine (if tastybrains is the poster child for depression, then I'm the poster child for anxiety).

there are things I am not comfortable talking about. I tend to get very anxious, self conscious, and afraid of being upset in front of them... The anxiety comes in the form of not being able to think at all.. or even come up with replies. The replies that I do come up with are watered down for sake of not wanting criticism. But even when I write things down, and try to be open, it doesn't seem to go anywhere.

I'd tell your new therapist that you're afraid of criticism and have a difficult time expressing yourself and see where that goes. Figuring that out will free you to be more honest. If you can't be honest with your therapist, you are wasting your time there. I guarantee that whatever you have to say, he/she has heard worse and will not judge you.

As someone who has spent much of her life being terrified of what others might think, I can tell you that it's exhausting in and of itself. Being free and unfraid to be...whatever one wants... is energizing.
posted by desjardins at 12:31 PM on July 19, 2007

When you go see a doctor, take a few minutes before your appointment to write everything down - routine, symptoms, medications, timeline, etc. That way you won't forget anything during the appointment.
posted by radioamy at 1:19 PM on July 19, 2007

tastybrains suggested a vitamin B deficiency. Let me scoot a couple of letters to the right and offer the possibility of a vitamin D deficiency. This is an area I've been researching online lately because I might have this rather than fibromyalgia/chronic fatigue.

As a place to start (in addition to Googling "vitamin D"), here's the Vitamin D Council, where you can read lots of good info. Doctors are now talking openly about folks in the Western world having vitamin D deficiency (partly because of sunscreen use) and how the little we get from milk and multivitamins isn't enough by far. The symptoms of this deficiency include pain and depression.

May not be, of course, but it's another thing to check. Best of luck.
posted by bryon at 1:40 PM on July 19, 2007

Excess Iron in a man is not a good thing, http://www.drweil.com/drw/u/id/QAA74999
posted by kanemano at 1:49 PM on July 19, 2007

This may sound nutty, and maybe it won't work for you, but have you tried full-spectrum light bulbs?

I've been struggling with sleepiness and mild depression for a long time, and exercise, flaxseed oil, vegetarianness, 8-plus hours of sleep per night may have made life manageable, but they didn't make it go away.

Then a few weeks ago I replaced all the light-bulbs in my house with these full-spectrum bulbs imported from Scandanavia, and I as feeling better within a couple of days. I've been sleeping 6-7 hours per night and feeling much better about my life and my job. The bulbs, which are incandescent, came from a specialty lighting store and cost around $7 each. They shine pinkish light, whereas I think of standard incandescents as being more yellow and CFLs as being blue.

I'm sure this won't work for everyone, and I'm sure my decision to cut back on the beer a bit is also a factor, but you might give it a try.
posted by croutonsupafreak at 1:57 PM on July 19, 2007

Way to go on all the positive changes you've made in your life...can't have been easy.

This question sounds a lot like what I've been struggling with - and I had the same issues with psychiatrists/therapists/doctors not helping. (Just telling me "that must be frustrating" or some such does NOT help!)

I finally went in for a physical, and got bloodwork to rule out anemia, thyroid issues, mono, etc. I felt better once I knew that none of these were the problem, but I was still exhausted all the time, for no reason that I could tell.

My psychiatrist just prescribed Provigil (modafinil) last week, and for me it has made a very noticable difference. I feel awake now during the day in a way that I haven't for many years. I am able to distinguish between exhaustion and lack of motivation, which has been very enlightening for me. I haven't had problems getting to sleep at night...in fact, it feels almost like my body is doing a better job at knowing when it's time to go to sleep and wake up (something I've had serious problems with). So maybe that's an option for you?

I'm not big on taking drugs as "quick fixes," but given the level of frustration I had reached (and that you have reached), it might be worth a try. The fact that there is little evidence on how it actually works is definitely anxiety-inducing, but I'm so tired of being tired that I've decided to use it anyway.

My next step is to check into a sleep study...the Provigil has been great for me thus far, but I really want to know WHY I need it to function in the first place.

My overall advice:

(1) Continue doing what you can to rule factors out - even if this doesn't uncover a root cause, there are that many less things to wonder about.

(2) I've found that people don't seem to understand just how fatigued and exhausted I feel when I tell them - but only you know exactly how you feel. Be insistent until you get help that is helpful for YOU.

Good luck...
posted by splendid animal at 2:15 PM on July 19, 2007

Desjardins: I told the last therapist that, but I think I naturally have this 'everythings fine, but ......' tone to how I talk. She didn't seem to pickup on things when I said them, even when they were hard for me to get out. I'd much rather not upset/worry someone if it isn't serious, and even then, as little as possible. I know its their job.

RadioAmy: I've been keeping a journal/blog of sorts that I update spuratically.. Though to be honest, I find this sort of interaction much more helpful. I don't think I would have made such a complete list if I didn't have the MeFi audience. There are some things I am ok with anonymously.. and are hard to do in the real life.

bryon: Added to the list!

kanemano: I'll ask for decent bloodwork w/ thyroid/iron/etc.

croutonsupafreak: Not nutty at all. I had migranes 2-3 times a week because of the junk lights at work. I have full spectrum bulbs at home and at work as a result. Much fewer since! (and back to the random once a month or so schedule, instead of almost every day). Btw-I rarely drink except socially, or when I haven't slept well. (Sleep directly effects how I feel, and sometimes I need to be a reasonable human at work. A bottle of wine puts me right to sleep - as bad as that probably is).

splendid animal: Thanks for the story of hope... and that persistence pays off.
posted by sirliberal at 2:26 PM on July 19, 2007

I used to feel very similar in college. Tired -- exhausted, really -- with no known cause. Demotivated. Groggy. Foggy memory, even! And hurt by people telling it me it was all in my head and I must just be lazy.

Finally, one summer, I was referred to a gastroenterologist for a check up, and whaddya know? The blood test for celiac disease -- gluten intolerance -- came back positive. I cut out all bread, pizza, flour, beer, cookies, pasta -- anything made of wheat -- and felt immensely better within a month. Also, some weird problems I'd been starting to develop and which I hadn't connected to my fatigue problems, like menstrual cycles that started lasting 45 days instead of 30/31 and weird cystic acne, cleared up. The messed up cycles were caused by the celiac damage starting to negatively affect my thyroid levels, which slowly normalized on their own after I cut out the wheat, and the cystic acne and blotchy skin that had seemed so resistant to dermatologists' treatment (including antibiotics) turned out to be chronic hives!

So. Get a blood test for celiac disease (gluten-intolerance) at your local gastroenterologist. It's not that expensive a test, and your insurance should definitely cover it. I do miss eating pizza, but I feel a zillion times better. I hope you will too!
posted by Asparagirl at 2:27 PM on July 19, 2007

Seconding the gluten thing. My sister has chronic fatigue and, while she tested negative for gluten allergy, making her diet as low in gluten as possible has really improved her energy levels. I've also read about gluten being implicated in other inflammatory problems (e.g. IBD) with fatigue as a side effect.

Definitely still follow everything up with your doctor and therapist as suggested (because they can diagnose you whereas we can't) and I totally support the idea of having written notes when you go in there, but reducing gluten is a reasonably easy, albeit annoying, diet change you could trial in the meantime.
posted by shelleycat at 2:44 PM on July 19, 2007

More generally, you might try an elimination diet. Celiac disease is the big one, but a lot of food allergies (or non-allergy food sensitivites, really) seem to manifest as general fatigue, depression, malaise.
posted by hattifattener at 3:47 PM on July 19, 2007

Omega 3 deficiency? Particularly if you're not eating any meat. I know that my mood and energy levels both improved dramatically once I started taking flax oil supplements on a regular basis. It's been like night and day, really.
posted by longdaysjourney at 6:14 PM on July 19, 2007

Nasal irrigation helped my husband with this problem tremendously. He was tired constantly. Inflamed nasal passages make it hard to sleep. You think you're getting a full night's sleep, but mini-awakenings during the night mean you never get fully rested, like with sleep apnea. Flonase helped, but it was the nasal irrigation that really did the trick. I know it sounds crazy but it's been studied and shown to work. The mayo clinic has a nice video showing how to do it.
posted by selfmedicating at 6:43 PM on July 19, 2007

Oh, I forgot to say - I couldn't help noticing you're posting this question at the height of allergy season. Irrigate those nasal passages! You have nothing to lose but your exhaustion!
posted by selfmedicating at 6:44 PM on July 19, 2007

Its a long post, but please make sure you see the part where I said I have at times tried different diets, restrictions, and this is a long standing problem, not ZOMG new. I haven't specifically trued to pick low GI foods though, or cut out wheat completely, though low carb kinda handles that.
posted by sirliberal at 7:04 PM on July 19, 2007

I did read your question, all of it, very carefully. But low carb does not mean low gluten, and cutting out wheat isn't enough. There's gluten in all kinds of places you might not expect (MSG, barley, anything malted, some beers, even gelato can have it apparently*) so you need to be really specific in cutting it out. If you've tried that then good, but it certainly doesn't say so in your question.

*I have a friend with celiac disease, she had a horrible reaction to gelato recently, something gluten-ish was probably added as a thickener
posted by shelleycat at 9:28 PM on July 19, 2007

I know a lot of people have already suggested checking thyroid levels, but I'm going to mention it again. I was extremely lethargic before I was diagnosed with hypothryroidism. At the time, I was an overweight college kid and had a diet similar to your college diet. Depression and fatigue are two of the major symptoms that I've struggled with. It might be worth checking out a list of symptoms to see if anything else sounds familiar.
posted by Mael Oui at 9:34 PM on July 19, 2007

If you have experienced trauma, then please read up on PTSD.
posted by solongxenon at 9:47 PM on July 19, 2007

It took a long time, and about 8 trained mental health professionals- counsellors, psychiatrists and psychologists - to get me to open up and be honest with my self and my therapist.

You mentioned you had trauma in your past- so have I. I'm 26 now and have only just started dealing with the crushing depression, rage, anxiety and confusion that I felt every day, all the time, since I was a child.

I tried to talk to my friends, many of whom said, "You think too much" and I tried to talk to a lot of different therapists, most of whom came back with the same answer worded differently.

When I think about the fact that almost 20 years have passed since I was 'scarred' I am shocked that neither I, nor my therapists, got to the bottom of my behaviour and my depression.

I had to stick with it though, and continue therapy, because whenever I stopped, I just ceased to function like an ordinary human being.

My point is, sometimes you have to try a lot of different therapists and therapy approaches before you have your breakthrough moment. I get counselling now by a woman who specialises in psychosynthesis, and it is the best combination of therapist and therapy so far.

Now I don't have to be afraid of sharing my 'deep dark secrets' because I know I can trust her, and that she has seen worse, and has helped. It's taken me six months of weekly meetings to get to that point of deep trust though. Time and money consuming, and not something you want to do over and over.

Nevertheless! Keep trying. It sounds as if you are doing most everything right, but keep getting put off by others and possibly by your own self-limiting / self-effacing when it comes to dealing with Root Causes.
posted by gerls at 10:17 PM on July 19, 2007

I feel for you and your frustration. I felt the same way as you for years, like six or seven years. I did everything I could on my own, exercised, took up yoga, changed diet and lifestyle, kept routines, took supplements etc, all to no avail.

Eventually I gave up all this and found a really good GP. She was honest and said that it could take me a long time to figure out the problem. Tiredness is very hard to pinpoint a cause. We did all the usual blood tests to rule out the obvious suspects: diabetes, thyroid, anaemia etc etc. Bloods came back fine so then we had to think of something else.

Depression was one of the suggestions by the way but for me it just didn't feel like the right diagnosis. I felt that was a result of my tiredness which was affecting my ability to think. (Like you I would blank out in the middle of a conversation and hate myself for it)

Turns out my problem is a combination of factors. Sleep apnoea, endo, and a susceptability to low mood in winter. This winter has been my best so far since I have received treatment.

For the sleep apnoea the doc might give you a list of questions like:

Do you have trouble staying awake in situations like at the movies.

Do you have trouble staying awake in the passengar seat of the car.

Are you likely to fall asleep while someone is talking to you.


If you answer yes to enough of these questions then they will send you to a sleep clinic to investigate further.

Stand strong. Definitely do not be put off by people who try to tell you there's nothing wrong with you. It's about your quality of life which is seriously diminished by the fact you're feeling so tired.

Hope you feel better soon.
posted by BAKERSFIELD! at 3:51 AM on July 20, 2007

Add me to the list of people who experienced the same symptoms due to a gluten allergy. Ten years of going to doctors, shrinks, and countless other professionals and I was never diagnosed properly. I figured it out myself, changed my diet, and felt better within days. Loads of energy, neuroses completely gone.

Google "elimination diet" to get information on how to identify a range of food allergies. It's a very significant variable to account for, albeit one dismissed by most doctors.

There are countless people who would rather diagnose themselves with a medical condition than do the work necessary to address their psychological condition. You don't sound like one of those people.

Someone who has the motivation to exercise and be disciplined with their diet despite terrible fatigue suggests someone with good mental health. How could your mind be responsible for your fatigue when you're clearly driven to feel better? A body that isn't working right would depress anyone. That determination will help you get to the bottom of what is causing this, try not to let dismissive professionals get in the way!
posted by yorick at 8:46 AM on July 20, 2007

I would like to thank everyone for their responses. At a follow-up appointment with my doctor today I explained pretty much what I wrote in the original post here. He ran a series of blood tests (thyroid, glucose, whatever is for anemia, some other random ones because I said I was vegetarian, and I think he checked off a few more for fun as well).

I especially appreciate anyone who brought their support and push to continue.
posted by sirliberal at 12:01 PM on July 25, 2007

Please follow up if you find out anything useful! There's nothing I like better then a mefi medical mystery solved.
posted by selfmedicating at 6:41 PM on July 25, 2007

Well the results came back, and the doctor says everything looked 100% normal (thyroid, not anemic, no other tests were abnormal).

Somewhat disappointing, it would have been nice if it was a thyroid issue, or something plausible (in the sense that there was a light at the end of the tunnel).
posted by sirliberal at 5:20 AM on July 27, 2007

Thanks for the follow up! I would be very curious to see if the elimination diet suggested by several people above works. Let us know if you try that. Please do keep trying to figure it out. I just reread your question - being this tired when you are sleeping, exercising, and eating right just isn't normal.
posted by selfmedicating at 6:12 PM on July 30, 2007

I very much feel for those responding to this string. I have had chronic fatigue for several years now. Unfortunately, it is a diagnosis of omission (a diagnosis you receive when other, positive diagnoses are eliminated [such as thyroid disfunction, etc]).

I have to second the contributor who spoke of people not understanding how fatigue is distinct from lack of wakefulness, sleepyness or being tired.

As a self-catharsis, I want to give you some idea what chronic fatigue is like at its worst. I think because I am a professional and I believe many people perceive me as fairly intelligent and "normal", they find it even difficult to believe it when I even speak of some of the worse symptoms. For example, it may take a whole day to be able to work up the will to wash a single dish. I have *continously* slept many times for 35 or 40 hours only waking to use the bathroom. I have also read that there have been people that have commited suicide because they don't see any light at the end of the fatigue tunnel. I even recall being a bit jealous of a middle-aged neighbor who, despite her age and despite undergoing cancer treatment, had more energy than I did on my *better* days. On another ocassion, I heard a diabetic say they almost wish they had cancer instead. "At least they would either get treatment or it would all be over." It would not be an everyday thing for them. I have even thought to myself, "we'll heck, at least your condition varies within your day - mine is both chronic and unrelenting."

I want people to understand just how debilitating CFS can be. I started to have symptoms in 1990 when in college. When I kept going to the doctor with fatigue, they would perform some cursory bloodwork and find no abnormal results. My health insurance would even deny payment since "nothing was wrong with me". I have come close to loosing my job several times due to fatigue. Even many endocrinologists prefer to treat the more profitable infertility patient group and may even refuse to see patients with fatigue. I have even read about people go to street drugs to try and find some relief.

There *is* more and more cause for hope in terms of medically-approved treatment options for this condition. Hang in there! Chronic Fatigue is now a recognized medical diagnosis. The Federal Government is even paying attention now and is setting aside several million dollars to research it since it affects so many Americans. Even the CDC had a conference on the topic a couple of years back.


As a layperson (not an MD), I offer a few observations and suggestions. I have observed a relationship between my platelet count and fatigue. There have been clinical trials done showing positive results when treating Chronic Fatigue sufferers with blood-cell-boosting drugs approved for use by those undergoing chemotherapy. I have also found a very significant relationship between levels of progesterone [a hormone with depressive effects] and fatigue. If you are female, you may wish to speak to your internist or gynecologist about trying to treat fatigue with birth control, specifically that of the estrogen family. Ironically, the much lower-dosage current birth control options out there may have enough estrogen to control fertility, but not enough to combat fatigue. You may wish to enquire about dosage levels that were more common 10, 20 or even30 years ago and see if that is effective. Provigil is fairly new. The most current version of Provigil out there is improved over its earlier release a couple of years ago. You may wish to consider anti-depressants that have stimulant effects (such as Effexor). Check with your physican to see if you are a good candidate. If you have low blood pressure, there are treatments for that now. While not an absolute correlation with CFS, many people with Chronis Fatigue suffer from low blood pressure. [Like so many things about CFS, there are many correlaries, but no magic bullet.] You may also wish to try fairly aggressive dietary supplements, particularly if you are vegetarian. [I have been for over half my life now, going between veganism and vegetarianism.] Allergies can be very fatiguing. Many allergy sufferers have allergies continuously through out the year. Treating these allergies with drugs that do not have fatigue as a side affect may work for you. They may at least help.

Many things affecting auto-immune systems and brain function ultimately are not understood. Like the person submitting a previous post, that was far from enough to stop me from trying them. Heck, if someone told me holding my breath and dressing up in a clown suit might work, you better believe I'd try it. It is so impactful.

Best of luck to you. Nothing is a magic bullet. At this point in my life, I am delighted to have moments when I don't have fatigue. And I am delighted that I am able to keep my job (and health insurance). I attribute this ability to the pharmaceuticals I am taking. Let's see what else they can come up with to help us :-).
posted by iconography at 8:55 AM on October 10, 2007