It's like the engine inside me has died

April 10, 2015 1:32 PM

Since quitting caffeine a few weeks ago, I've lost all motivation to do anything except lie in bed doing nothing all day.

I quit drinking caffeine because even one cup of coffee can trigger a hypomanic episode in which I can't sleep for 48+ hours, talk a mile a minute, act impulsively, aggressively argue with everyone, and annoy the shit out of my husband. Given that such a small amount has such a big effect on me, I don't think I was ever consuming enough for this to be simple caffeine withdrawal.

I'm already on Celexa, Wellbutrin, and Adderall for depression and ADD. The antidepressants seem to be working because I currently have none of the other symptoms of depression besides this lack of motivation. Meanwhile, although Adderall is stimulant for most people, for me it's just an anti-task-switching drug -- I can easily fall asleep and stay asleep while on it. I do, however, notice a definite "crash" when it wears off at the end of the day.

I've had blood tests for all the usual suspects: thyroid, iron, vitamin D, vitamin B12, diabetes, hepatitis, lupus, various forms of arthritis, Lyme disease, Epstein-Barr, etc. The only things I tested positive for was Epstein-Barr (but apparently almost every adult tests positive for that) and some sort of unspecified inflammation. I used to be vitamin D deficient a year ago but have been taking prescription supplements since then and my latest blood tests (a month ago) found no deficiency.

I typically have a couple of drinks and take Benadryl to help me sleep through my husband's snoring at night but eliminating both of those has had no effect on my energy or motivation either -- even when I can't sleep, I still just lie in bed doing nothing.

This is different than depressive episodes in which I don't get out of bed in that even then I least used to spend my waking hours on the internet or watching TV shows. Now, just opening the laptop feels like too much work, and if I do manage to get it open to start reading/watching something I'll quickly lose interest and just space out for hours instead.

The complete lack of motivation I'm experiencing these days feels very similar to a bad post-Adderall crash, during which my brain tells me body to move and my body simply doesn't obey. There are lots of fun and interesting things I *want* to do (and a bunch of other less fun and less interesting things I really *should* be doing) but I just can't get started or if I do manage to get started, then I grind to a halt pretty quickly and just sit or lie down wherever I happen to be and either fall asleep or stare into space for hours. I now spend more time thinking "I want to play my video game" than actually playing the game, even though playing video games is really fun and requires almost no energy.

On good days, I'm able to accomplish one small task -- e.g., take a shower, do a load of laundry, make a phone call -- before my motivation to be productive is completely spent. Writing this post is probably the only thing I'm going to do today.

It's like my brain has simply stopped making dopamine, and I don't know how to make it start up again.

Any ideas? I'm willing to try reintroducing *very* small amounts of caffeine via chocolate (seems easier to standardize the "dose" with that than with something that has to be steeped like tea or coffee) but given my bad reactions to the stuff I'd prefer to find a non-caffeine solution if possible.

posted by Jacqueline to Health & Fitness (29 answers total)

Have you been evaluated for bipolar disorder?
posted by rabbitrabbit at 1:36 PM on April 10, 2015

Response by poster: rabbitrabbit: They initially thought I had bipolar back when I was a teenager but I was consuming ridiculous amounts of caffeine then (my friends and I sat around drinking coffee literally all day). I never responded to mood stabilizers and seemed to age out of it (i.e., got a job and thus stopped spending all day and night at Denny's) so in my early 20s they rescinded that diagnosis.

I eventually figured out that every single manic episode had been preceded by excess caffeine consumption and thus I cut way, way back on the caffeine. However, as I've aged, I've gotten more and more sensitive to even small amounts of caffeine. The "final straw" that made me decide to quit it completely was when I drank some of my husband's Dr. Pepper (it's not my soda of choice and thus I didn't know it was caffeinated) and couldn't sleep for three days.
posted by Jacqueline at 1:48 PM on April 10, 2015

Since you talk about your Adderall wearing off at the end of the day, it sounds like you're taking an extended-release formulation. Have you ever taken the immediate-release type, and if so are you able to sleep through that?

If not, and it has the usual stimulant effects that amphetamines have, maybe you could ask your prescriber about taking an immediate-release dose in the morning when you'd previously had coffee. I took both for a while and ended up stopping the extended-release completely. Taking the immediate-release alone, in the morning, also improved my sleep in my case.
posted by XMLicious at 2:01 PM on April 10, 2015

Seconding seesom.

and couldn't sleep for three days.

The maximum amount of time caffeine stays in your system is about 14 hours. Even if your metabolism is wonky from your other medications, it wasn't caffeine that kept you up. There's something else going on here.

I typically have a couple of drinks and take Benadryl

Has your doctor okayed this in combo with all your medications?
posted by Specklet at 2:08 PM on April 10, 2015 [10 favorites]

How long have you been taking Celexa, how recently were you evaluated for thyroid, and are you taking any other non-psychiatric medications? Sorry I've got more questions than answers, but (a) being on an SSRI for me is an overall plus but definitely sucks on the motivational front; (b) thyroid status can shift fairly quickly (maybe not a matter of weeks but certainly over a matter of months); (c) I noticed myself dragging ass/worsening depression a few months ago, and eventually put two and two together and realized that it was at least partially related to a non-psychiatric medication that I'd started taking in December.
posted by drlith at 2:13 PM on April 10, 2015

Best answer: Specklet's words ring true-- Caffeine for an average user hangs around for about 4-5 hours (hence people reaching for the coffee pot again in the early afternoon) and for those with a particular sensitivity it can be double that.

If we guess you drunk 1/3 of the can, then that's about 10mg of caffeine. I'm not a doctor, but you're talking about the amount of caffeine in two Peanut Butter cups, that it could cause you to stay awake for three solid days seems too amazing to be the true cause.

Aside from obviously talking to your doctor about the mixture of drugs you are taking, can I suggest you work towards getting a good nights sleep? You're drinking and misusing Benadryl to make yourself drowsy-- that surely can't help the next day. Can you or your husband sleep in another room for a week or two to get a series of good nights sleep to see if it helps?
posted by Static Vagabond at 2:24 PM on April 10, 2015

The OP is specifically saying that having caffeine triggers a hypomanic episode, not that the caffeine itself is keeping her awake.
posted by XMLicious at 2:25 PM on April 10, 2015 [5 favorites]

Response by poster: Answering everyone's questions thus far:

seesom: I'm almost certain that this isn't just a breakthrough depressive episode because all my other depressive episodes included persistent feelings of shame/guilt/worthlessness/grief. I would also lose interest in doing anything because everything seemed pointless. This time, I feel fine emotionally and I'm still very *interested* in doing things in that I spend a lot of time thinking about how much I want to be doing them, I just lack the motivation to actually get up and *do* them. My brain says "go" and my body says "no." Or not even "no" -- it feels more like my body just never receives the signal to move at all. Like a connection has come loose in there somewhere.

The only alcohol I've consumed in the past few weeks is two beers on Sunday and three beers last night, both times at restaurants. My typical consumption level prior to this was a couple of drinks every night before bed but my current total lack of motivation to do anything includes bothering to go to the store to buy the kind of beer I like. I doubt that I'm an alcoholic because there's still plenty of alcohol in the house, but it's not the kind I like or it requires mixers we don't have to make it palatable so I don't drink it. I enjoy the relaxing effect alcohol has on me but not enough to drink something that tastes nasty.

XMLicious: I'm actually on the immediate release version. I say "wear off" because I have alarms set to time my doses at 8am, 12pm, and 4pm, and I try to take them on a full stomach so that they metabolize more slowly. The crash I sometimes experience comes around 9 or 10pm. These days, when my alarm goes off to take my dose I wake up just long enough to take it and then fall back asleep. I suspect that the anti-task-switching effect might even be helping keep me asleep. Adderall alone really doesn't seem to have any stimulating effect on me at all -- the only times I've ever felt like or come across as being on speed is when I combined caffeine with my Adderall.

Specklet: I agree that caffeine is merely the trigger and not the cause of my inability to sleep for days -- I think it kicks off some sort of feedback loop in my brain that is then further reinforced by the lack of sleep.

I've always answered my doctors' questions about my alcohol and OTC medication consumption honestly. None of them had any concern about the Benadryl and the only thing anyone ever said about the alcohol was that "technically" you're not supposed to drink while on these medications because they make the medications less effective. I did notice that if I drink at the same time as I take my Wellbutrin dose that I feel really crummy the next day, so now I just make sure that several hours have elapsed between when I take my Wellbutrin and when I drink and that seems to have eliminated that problem.

drlith: I've been taking Celexa and the other psych meds for over a year. I was also on this same combination for a couple years a few years ago, with about a one year break in 2013 due to lack of insurance. Celexa has never made me less motivated before -- the only side effect I ever noticed was excessive yawning and increased sleepiness when I first started taking it, but both of those wore off within a couple weeks.

My thyroid was retested just last month.

I've been taking the anti-inflammatory etodolac and prescription-strength vitamin D for over a year as well. I haven't started taking any new OTC medications. Really, the only things that changed have been stopping caffeine and drinking less.

Static Vagabond: I'll have to try that, assuming he'll cooperate. Even when he keeps me up at night I've been able to get plenty of sleep during the day when he's gone, but I suppose that my daytime sleep is punctuated by taking my Adderall doses and probably less restful due to my back-of-the-mind "I ought to be awake and doing stuff right now" anxiety.
posted by Jacqueline at 2:37 PM on April 10, 2015

I'm already on Celexa, Wellbutrin, and Adderall

Your caffeine consumption is very likely not the culprit. Toxicologist here, and that's quite a cocktail. Some of those drugs themselves are associated with some of the feelings you're experiencing, and it's troubling that your physician(s) haven't brought that up with you. You would be well served to bring up the possibility of interactions between your medications with your healthcare providers. If you need a starting point for this kind of conversation, here's the output from a basic online drug interaction detection engine.
posted by late afternoon dreaming hotel at 2:40 PM on April 10, 2015 [10 favorites]

I assume you are sharing your experiences online not for theories from unqualified strangers, but for similar experiences.

Caffeine in the dosages you are taking it in is not supposed to trigger multi-day hypomania. I think this would be a good time to go in for a rediagnosis and take a look at the Celexa, Adderall and Wellbutrin you are taking. Speaking from experience, self-diagnosis while taking that medication can be a little tough.
posted by phaedon at 2:45 PM on April 10, 2015

Are you overweight? Have you had a sleep study?
posted by Jahaza at 2:56 PM on April 10, 2015 [1 favorite]

Response by poster: Are you overweight? Have you had a sleep study?

I currently weigh ~160 pounds, which is ~30 pounds overweight for my height and frame. I'd been in my healthy weight range (~120-130 pounds) before I moved to the South 3.5 years ago, at which point I rapidly gained ~70 pounds. I finally lost ~40 pounds last spring/summer and have kept them off. (The dead cat grief diet is very effective!)

I have not had a sleep study yet. My PCP ordered one when I saw her last month but last I heard it was still bouncing around in insurance approval purgatory. Making the followup calls to find out the current status of the approval is one of the many things I've failed to do due to my complete lack of motivation to do anything at all.
posted by Jacqueline at 3:10 PM on April 10, 2015

Response by poster: Oh, one other thing that happened somewhat recently that may or may not be relevant: I had my gallbladder removed in late January.

I was sleeping excessively (but still motivated to do stuff in the few hours in which I was awake) for more weeks than expected after surgery and that's why I went to my PCP for new blood tests. The only thing she found was Epstein-Barr. I've since been told that almost every adult tests positive for that and so I didn't necessarily have mono in February?

The previous hypersomnia and current total lack of motivation might be related but they certainly feel distinctly different. Even when I was sleeping 20+ hours/day in the weeks after surgery, I was still enjoying myself playing my Dragon Age games and reading fanfics while I was awake.

Now I'm sleeping less but I'm spending the hours I'm awake just spacing out doing nothing even though I want to be doing things. Even little things. Like, it can take over an hour of thinking "roll over" at my body before the signal finally connects and my muscles respond.

I'm not sure if I'm explaining it adequately and maybe "lack of motivation" is the wrong term. It's definitely not regular depression or excess fatigue, both of which I'm very familiar with. Instead, it's like the process that turns thoughts into actions has broken. The only time I've ever experienced anything similar is during those occasional post-Adderall crashes, which is why I suspect there's something wrong with my dopamine.
posted by Jacqueline at 3:28 PM on April 10, 2015

Sorry to hear about your cat.

I have to agree with other people that maybe a comprehensive review of your medications is in order. Besides that I thought I might point out Wikipedia's list of herbal and fungal stimulants, in case there are non-caffeine ones legally available you'd like to try. (Which I suppose you'd do best to discuss with your prescriber too.)
posted by XMLicious at 3:29 PM on April 10, 2015

2 out of 3 times I have had mysterious relentless exhaustion it was due to issues with adhd meds, so I would look at medication stuff first. The other time it was from lady issues but I assume if you were having unusually monstrous periods (or were pregnant) you would have mentioned it in your post. How long have you been on these three meds together?
posted by poffin boffin at 3:55 PM on April 10, 2015 [1 favorite]

I know you said you took a bunch of blood tests, but have you talked to your psychiatrist? What does she/he suggest?
posted by discopolo at 5:14 PM on April 10, 2015 [1 favorite]

Also, have you tried to go outside, walk around for a bit? Do you have friends or people you can have coffee/tea with?

Being around people that aren't your husband can be a boost. You may have to force yourself to get up and out and suddenly find yourself feeling better.
posted by discopolo at 5:18 PM on April 10, 2015

Response by poster: How long have you been on these three meds together?

I've been on the same Celexa/Wellbutrin/Adderall combo with the same dosages since 2010, with the exception of the one-year break in 2013 when I lacked insurance.

It's not so much exhaustion as it's a total lack of drive to do anything. I sit and think about all the things I want or need to do, steps I need to take to do them, etc. but then I just can't make myself get up and actually DO them.

To use a video game analogy, it's like my willpower stat has dropped to 0.
posted by Jacqueline at 5:27 PM on April 10, 2015

Best answer: Has your husband had a sleep study?

You mention your husband's snoring being bad enough that you sometimes/often need to medicate. Sleep deprivation and/or diminished sleep quality can wreak havoc with seemingly independent health issues. My partner's snoring was not taken into account by doctors consulted about my health, but turned out to be a key impediment to improvement.
posted by wonton endangerment at 5:28 PM on April 10, 2015 [5 favorites]

Response by poster: I can't even get my husband to go to the doctor when he has a sinus infection. He just self medicates with amoxicillin he gets from an aquarium supply company. :P
posted by Jacqueline at 5:37 PM on April 10, 2015

This could be a shifting of your depression symptoms and/or a shift in how your body reacts to your meds. I occasionally go through periods where even if I really want to do stuff my brain just goes, "HAHA, you thought you were feeling just dandy but we're not doing shit today." This is a newer symptom for me...started popping up occasionally the past year.
posted by fluffy battle kitten at 5:43 PM on April 10, 2015 [2 favorites]

I don't understand why you are even taking the Adderall if you are literally sleeping or laying in bed all day. It's not like the antidepressants that need to build up in your blood and be taken regularly to work properly. This is a short-acting drug that is used to help you focus or limit impulsive behaviors. It you aren't working or studying (and it sounds like you are not?) there is really no reason not to try going off it for a few weeks and seeing how your brain and body respond.

The real answer is that you should see a psychiatrist about this issue, rather than your PCP. I've been in a similar situation where it was easier to have my PCP refill all my scripts each month, but she really had no idea how to manage these medications in the same way a psych would. The level of listlessness you describe is concerning.
posted by Jemstar at 6:52 PM on April 10, 2015 [2 favorites]

Have you talked to a therapist about this? Maybe you're adjusting to where you are in life right now.

Not everything can be attributed to this of course, but I did notice it was something unmentioned in your post.
posted by oceanjesse at 7:31 PM on April 10, 2015

Oh Christ do not stop adderall cold turkey based on terrible Internet stranger advice
posted by kagredon at 7:31 PM on April 10, 2015 [8 favorites]

for one thing you won't shit for a week. for another you will sleep 2x as much as you are already.
posted by poffin boffin at 8:50 PM on April 10, 2015 [2 favorites]

Best answer: The fact that you are having to medicate yourself to sleep through your husband's snoring says to me that he must be snoring REALLY loudly. I imagine it's possible he's waking you up slightly again and again all night long even with your alcohol / Benadryl cocktail, and the drugs are keeping you just drowsy enough that you feel like you're sleeping all night when you're actually not.

A snoring partner can have a serious negative impact (NYT article) on your sleep patterns and your health in general. I know this from personal experience; I was actually diagnosed with an alteration in my own sleep cycle due to disrupted sleep from sleeping next to a heavy snorer.

Maybe the caffeine was helping you cope with disrupted sleep, and maybe the insomnia is also related to disrupted sleep. Have you tried having your husband sleep in a different room for a week, and seeing how you feel after that?

And has your husband been evaluated for sleep apnea?
posted by BlueJae at 6:15 AM on April 11, 2015 [4 favorites]

Best answer: My depression doesn't present as sadness or emotional angst. I just have zero motivation to do anything. I wouldn't assume that your depression would always manifest in the exact same way as it has before.

I also think you could be suffering from terrible sleep deprivation. I'd sleep apart from your husband while you sort this out.

Have you been seeing a real psychiatrist with a good reputation in pharmacology?
posted by barnone at 6:20 AM on April 11, 2015 [3 favorites]

Response by poster: The fact that you are having to medicate yourself to sleep through your husband's snoring says to me that he must be snoring REALLY loudly.

I measured it once and it peaks at 85 decibels.
posted by Jacqueline at 6:32 AM on April 11, 2015

Response by poster: It was sleep deprivation. It went away for a while when I was sleeping better but then the exact same symptoms/feelings came back after a few shitty nights' sleep.

We've settled on a combo of husband sleeping with his head at the foot of the bed, running a very loud fan right next to my head, and me wearing those soft wax earplugs (the other kind hurt my ears).
posted by Jacqueline at 6:47 PM on July 16, 2015