I'm not sad. I just can't. Do. Anything.

March 24, 2015 6:33 AM

I'm so frustrated. I've been depressed for years. Used to have all the classic signs, now I remain with just one big one: I've always complained about being chronically fatigued, and maybe there's some truth to that, but I'm almost never sleepy. I just can't bring myself to do anything that requires any effort whatsoever. The ONLY thing that helps get me over the hump of what really and truly feels like a paralysis is massive amounts of caffeine. What is this and how do I regain functionality before I end up stroking out at 30?

I've used chronic fatigue as a label for years, just because I assumed that what was keeping me from doing anything was my being tired. And I was tired, but never sleepy. In fact, I've recently realized that what was drawing me to my bed every 3 hours wasn't the fatigue itself- it's me crashing from whatever I happen to have coursing through my veins. Usually coffee or energy drinks, sometimes nootropics, never Rx stimulants. I realize now that I need to get off this shitty merry-go-round at some point, but unless I'm "on something", everything just feels like SO. SO. so. much work, to the point where it's paralyzing. It's not fear of rejection. It's something else.

I can't write emails, can't apply to jobs, can't answer facebook messages, can't go out. I just...sit there, in a weird twilight, and obsess over how hard everything is, over and over. Lately even coffee doesn't help, except to keep me sitting until I get tired enough to nap. It feels awful and it's crushing any hope I have of living a normal life. I can't think. I have to pull teeth to get words out or to do things like take a shower and get dressed.

This SOUNDS like garden-variety MDD or anxiety, I know. But I've tried almost every SSRI, therapeutic modality, sleep study and supplement out there. I've taken klonopin and meditated and done hypnosis. Nothing gets me moving, or it does, but I still feel like I need that extra push. I can't take stimulants or SNRIs because of my blood pressure, nor do I really want to.

I've posted on here about how I've not gone anywhere with my life lately. Truth is, I have so many opportunities staring me in the face- opportunities to at least start somewhere. Why can't I follow through? What's happening? Have you felt this same paralysis? What did you do about it?
Throwaway email: [e-mail]

posted by anonymous to Health & Fitness (20 answers total)

Dude, first off, start weaning.

Second, can you use your wired periods to get outside and walk around? If you can, maybe run; if you can't just walk.

I know I sound like your mother but get your blood moving.
posted by notsnot at 6:37 AM on March 24, 2015 [5 favorites]

I can't take stimulants or SNRIs because of my blood pressure, nor do I really want to.

Rethink this rethink this rethink this.

I completely understand, I do. Stimulants are scary. They can be addictive. They shouldn't be taken lightly.

My doctor recently put me on one for combo of depression and weight problems. I have high blood pressure that's controlled via medication. I bought a blood pressure wrist cuff. I should have been monitoring it with HBP anyways, but my doctor refused to try the stimulant until I had a cuff and promised him to monitor my pressure at home.

The stimulant has been a life changer. It's not the same sort of boost that caffeine gives you. This is more like "Hey, I'm awake.. and since I'm already in the kitchen I could take a couple of extra minutes and do the dishes. Oh hey, I should mop too while I'm at it." I was so sore after that first day on the medicine because I'd done more physical activity in four hours then I had in MONTHS. That's tapered off a little, but the energy is still there.

My blood pressure has been fine. Yours might not be if you go on a stimulant, but your doctor should be able to modify or put you on a HBP medicine.

And if the stimulant isn't working for you, you can stop taking it.

Also, this reads to me like depression. My depression has never been about saddness, it's been about lack of energy.
posted by royalsong at 6:47 AM on March 24, 2015 [6 favorites]

This is sometimes how my mostly-inattentive ADD manifests. I take Inderal with Adderall to manage the blood pressure thing, but there's non-stimulant medication in a pinch for that if you turn out not to tolerate it. But just taking stimulants often isn't enough--this is a bit better than the OTC stimulant cocktails I tried previously but not worlds so--you need to work with someone to improve habits and focus that energy the right direction. Otherwise you can just get really effective at playing video games for hours at a time instead of getting important things done. More energy, more dopamine--they're great things but the best thing to do to make them effective is work with a therapist. Yeah, trite, but true.
posted by Sequence at 7:00 AM on March 24, 2015 [3 favorites]

What is this and how do I regain functionality before I end up stroking out at 30?

I think you start dealing with this by seeing a doctor. They can rule out potential physical causes (and there are a bunch of them). If there is a physical cause (pernicious anemia, thyroid issues, low Vit. D, autoimmune disorder... there are a lot of things with "fatigue" as a symptom), the doctor can help you treat or manage that condition.

If there isn't a diagnosable physical cause on the medical side, the doctor can refer you to a psychiatrist and/or therapist who can assess your mental health and help put together a plan. I know you've tried some of the things, but there may be other things out there to try, and you won't know until you try them.
posted by pie ninja at 7:00 AM on March 24, 2015 [9 favorites]

"I can't write emails, can't apply to jobs, can't answer facebook messages, can't go out. I just...sit there, in a weird twilight, and obsess over how hard everything is, over and over."

Seconding get your thyroid checked - this sounds exactly how I felt when I had an undiagnosed thyroid disorder.
posted by joseph conrad is fully awesome at 7:11 AM on March 24, 2015 [8 favorites]

Here's a quick but hopefully useful observation: you talk about consuming lots of different drinks and medication, but say nothing about food. How's your diet?
posted by ZipRibbons at 7:17 AM on March 24, 2015 [1 favorite]

Sorry you said, "what did you do about it": I wrote down my symptoms - made a big messy list, it took a week as I kept noticing new things; then I condensed it into a bullet-point list, and made an appointment with my general doctor. I took my partner for support, and as a witness and possible advocate. I presented my symptoms (along with rough timeline of when things started to get really noticeable) and had to push pretty hard to get started on a low-dose thyroid medication.

I also emphasized that it was affecting my "quality of life" (used that exact phrase) and this seemed to really grab the doctor's attention. (I was told on that visit, incidentally, that the doctor, too, had concentration problems and that this was normal; so you might find your symptoms minimized by the doctor. Keep advocating for yourself.)

Do you have someone that can push you to make the doctor's appointment, and/or attend with you?
posted by joseph conrad is fully awesome at 7:18 AM on March 24, 2015 [6 favorites]

I had this same problem and it was my thyroid. You gotta get your doctor to do blood tests! If it is a thryoid thing there is treatment and the change you will feel once you start is beyond glorious. Sending you support!
posted by Hermione Granger at 7:34 AM on March 24, 2015 [3 favorites]

Agree with joseph conrad is fully awesome and Hermione Granger. Get that thyroid checked, as well as other bloodwork (B12, iron, etc) I can identify with much of what what OP has written here. I'm feeling so much better and energetic about everything since I started on Synthroid a few years ago.

For what it's worth, I went to my doctor a few years ago and told him I was really dragged out, down in the dumps, and unable to be productive. After a two minute conversation, he put me on an SSRI. I dumped him for other reasons shortly after and got a new doctor, who immediately sent me for bloodwork and discovered the hypothyroidism. I went off the SSRI after that and never looked back. These days, I'm as energetic as I have ever been.

Definitely worth checking into.
posted by futureisunwritten at 7:46 AM on March 24, 2015 [1 favorite]

OP here: I'm too lazy to keep this anonymized.... I just had to chime in to say that my recent (as of 2 months ago) bloodwork came back completely fine, thyroid and vitamin levels included. My D3 was a little low, and I'm taking supplements to correct that, but otherwise nothing.
posted by marsbar77 at 8:02 AM on March 24, 2015 [2 favorites]

OK great. One last caveat: I was told my thyroid was "in normal range", however, my thyroid TSH had been changing for a few years prior. (The thyroid 'normal range' is set ludicrously wide, at least in the United States, IMHO.)
posted by joseph conrad is fully awesome at 8:11 AM on March 24, 2015 [2 favorites]

Re: thyroid blood work: It also depends on what they run. And on you... some people can be hyper or hypo at levels that would be fine for most people (and that fact may show up on TSH but not on your actual thyroid hormone level).

Also, standard bloodwork is unlikely to cover everything that could be causing fatigue. In my experience doctors tend to assume I'm better unless I actively follow up with them to say "Nope, still not better, and here is how this is specifically affecting my life. What's the next step to figure this problem out?"
posted by pie ninja at 8:17 AM on March 24, 2015 [5 favorites]

I also want to challenge your idea that you can't take stimulants because of your blood pressure. You are basically self medicating with stimulants by drinking caffeine and other energy drink stimulants. And with self medication, you are missing out on help from doctors. Not that I think you should go into the doctor and demand stimulants, but what good is acceptable blood pressure if you can't participate in life?

My heart goes out to you and your situation. I have also have had luck with doctor's who didn't need to be convinced that my energy levels were important to investigate. So we do broader blood work yearly. I often have issues with B12, iron and folate as well as winter vitamin D and depression. When I am really tired I just remind myself that it won't last forever, as long as I'm working with my doctor to fix it.
posted by Gor-ella at 8:27 AM on March 24, 2015 [1 favorite]

I understand that SNRIs may not be, but what about things like Adderall or Vyvanse?
posted by marsbar77 at 8:49 AM on March 24, 2015 [1 favorite]

"SO. SO. so. much work"
I want to put this on a T-shirt. Then I would wear the T-shirt and then it would end up in a pile on the floor where it would remain for six weeks with me walking on it on the rare occasions I got out of bed. Here's something that worked for me yesterday, although it's not working for me today because I'm not doing it because I'm screwing around instead of doing anything.

Get a swank notebook and a pencil and start making daily lists that go across the page laterally, not down the page. Who can do things when the list goes down the page? Impossible.

You write a date, maybe today's, whatever, you draw a line under the date, and you write a list of three tiny things to do and then you write "walk." I mean tiny. Like "Put away the clean forks." You do the three tiny things and then you take a walk--a small one. You make check marks next to the things as you do them. You make a check mark next to "walk." Then you write three more things and the word "walk" on the next line down. Repeat until bored, then do whatever you do when you do nothing. It's not nothing. It's clearly typing. That's what *I* do when I do nothing, so it's probably what you do, too, because that's why we're both here. To drip more letters into the grand sea of them that is the internet.

(Or sometimes I do sudoku puzzles while listening to the Judge John Hodgman show.)

I think we'd better get off caffeine, because I think the emotional component of our (IMO definitely primarily physical) problem is more anxiety than lassitude or depression and I think caffeine makes it worse. (Plus getting completely off of it feels kind of blissy, and then if you go back to it, you have a memorably great few-days' coffee reunion honeymoon.)

As for speed, prepare for disappointment. It works for a lot of people, but not everybody. In any case, it's worth trying to withdraw from everything and see if it helps anything before you go getting on Adderal or something that's going to cost $$$ and be one more damn thing. I so wish I knew what this was. Some days I do all kinds of stuff, and then some days it feels like I have Parkinson's. If I'm standing up, I'm standing essentially still except for barely measurable half-starts in various unplanned directions. No follow through on any project, other than nap project.
posted by Don Pepino at 9:10 AM on March 24, 2015 [3 favorites]

I felt like this an i went to the doctor and I am the picture perfect balance of all measurable health measurements in my body. I'm like textbook perfect everything. But i still felt run down, so here's what I determined it was and here's what I did (and do) and here's how it is now:

1. I figured it was a psychological thing that was affecting me physically. I.e. I was MASSIVELY STRESSED OUT and this cause anxiety in everything which caused paralyzing times of zoning out whenever i was not at work. Caffine makes me quick, but jittery and anxious and eventually (like 3-4 coffees eventually) pukey and shitty, so I avoid.

2. Psychologically - Stop caring about things noone else cares about and just let it go (this for me was issues and problems with systems at work, but nobody cared to fix them and save money so I just stoped bringing up issues when I came across them. noone cares. I don't bother myself with it anymore).
Allow yourself to not do things you don't want to do and don't have to do. You don't have to respond to facebook messages. Or go out. you at some point need to clean / do laundry, but you do not need to like fold clean clothes. its ok to let it go till you feel like doing it.

3. Physically - exercise. cliche but it really works. I thought I got enough cause I walk alot every day, but really what i need is heart beat elevated exercise. I stuck post its to walls that say "Exercise makes me feel good" because it does and I need to remind myself. I have an android app for the 7 minute workout and its great. 7 minutes seems short enough. I can see my post it, hit my living room for 7 damn minutes, and get a boost. I don't even do this every day, but it does really help.

4. Trust in yourself. IS the world going to shit around you? ME too, but I'll figure it out, because I've sat and zoned out (meditated?) on the fact that I'm a capable smart individual and I'm not just going to roll over and die because i need to find a new job / move / change a relationship / whatever.

5. Do something you want to do and revel in that you are doing it. You want to watch tv, watch it and think, this is great, i get to relax and watch tv. Allow yourself to be as you want to be in a moment and if you dont want to be as you are, shift the gear (see #3 - exercise briskly, quickly)

Now I am more relaxed adn laid back, I'm never going to be one of those always on people, but that's ok, I get things done, support myself, and enjoy my free time.
posted by WeekendJen at 9:29 AM on March 24, 2015 [8 favorites]

Yes, I have lived with this inertia/paralysis. It's demoralizing and frustrating to know that you are a capable human being who just seems to be stuck in quicksand. I have gotten better, though. It's been a long process.
Two books that helped (I'm pretty sure I saw them recommended here first):
Get it Done When You're Depressed - among other things, addresses how physical a disease depression can be, and what you can do to get around those physical symptoms (lethargy, hopelessness)
The Mindful Path to Self-Compassion - helped so much, learning to quiet that voice of relentless criticism and negativity, learning to be forgiving

Concrete stuff that has helped:
Yes to exercise. My goal is 40 minutes of jogging, preferably outside in nature, as often as is practical. But, sometimes you have an appointment, sometimes you have shin splints, sometimes you can actually get the laundry done that day if you don't break your stride, and that's okay. I'm prone to "all or nothing" thinking, and I have to keep it in mind that it is OKAY to not make perfect patterns in life all the time. (And I did Couch to 5k to begin with - no way I was doing 40 minutes at once out of the gate!)
Wellbutrin. It has a mild stimulant, and it may not be an option for you - the high blood pressure, the name brand is expensive (and the generics have been ineffective for me) - but it has helped me, considering that not doing things causes me situational depression on top of chronic depression.
List-making, calendars, reviewing and organizing the list. Even for things as mundane as "breakfast" and "shower." Dang right I feel good checking that off my list! And on those days when I don't get things done, there is another day right behind it.

I've gotten more productive since I accepted that I have some limitations that I have to work within. I do much more with my days, and am a much happier and nicer person, than I was when I was punishing myself and gritting my teeth to get through the days. You can get better, and you will!
posted by hiker U. at 1:53 PM on March 24, 2015 [2 favorites]

Request a sleep study.

My husband has anxiety... And mild sleep apnea. We have a baby, and a couple nights of poor sleep and I can feel myself spiralling into despair. It's scary. Sleep is serious business, and probably not checked often enough.
posted by jrobin276 at 2:04 PM on March 24, 2015 [4 favorites]

I was sure I had thyroid problems when I found myself sleeping 11 hours a day and being hardly able to do anything when I was awake. It turned out that my Vitamin D levels were really low. I couldn't get over how I went through a year of suffering like that and all along the cure was just a $6 bottle of Vitamin D from the vitamin isle. And it worked. So many things can cause chronic fatigue that it's worth getting a doctor's appt. Then at least you can eliminate many possible causes.
posted by rancher at 7:14 PM on March 24, 2015

Tired and unable to do anything can be as much depression as sadness. You don't have to feel sad - you can just feel nothing a black hole where you should feel something. Talk to your doctor - a family relative had to go through several years and trials to find a med mix that worked for their depression but it was worth it because the seventh time worked.

You could try hiring a personal trainer to turn up and make you exercise for a month, because the first month is the worst when you're not fit to start with. I started exercising a few months ago and the first month when I was so unfit was just horrible, but by the third month it was starting to be positive as I wasn't exhausted and in pain. All those fit people saying "oh go for a run, you'll love it", have no idea when it's exhausting just to get dressed. I was 'lucky' in that I was crazy sad and angry, so being in pain from exercising helped, but I think a tough and encouraging trainer could help you get through the first month or two.

I also cut my coffee from six minimum to one cup a day mostly. I could not function without coffee. I had to quit for medical reasons, and it was harsh. What helped was upping protein in meals, and making a big ritual out of the one or two coffees I do get. I used to get them at a cafe with a magazine, and it was the big treat of the day. Now, I make it at home (grind beans, froth milk, whole ritual) and while I have my coffee, I am totally ignoring the world so I get maximum bliss from that one cup. It's possible to cut back, and you can get a smoother all day buzz from tea if you want to switch to drinking tea for a way to wean your way down. I catnap more often though and I sleep earlier. On coffee, I could function well on six hours of sleep and now I need eight. You may just need way more sleep than most people.
posted by dorothyisunderwood at 7:31 PM on March 24, 2015