Tired of being tired
November 26, 2018 10:52 AM   Subscribe

I'm *what the medical community chalks up to being* depressed and anxious. I am nearly 29 years old and have tried everything: therapy, hypnosis, supplements, blood and imaging studies, exercise, every antidepressant, ketamine infusions, self-help books, motivational videos and speakers, travel, every anti-procrastination technique imaginable ( Pomodoros, lists, cbt-style tricks) etc etc etc etc. Nothing works.

I was always depressed but never like this. I'm on Adderall, Prozac and Klonopin when, given my medical and family history ( high blood pressure, heart disease and diabetes). I am a milimeter from throwing away what is, for me, the opportunity of a lifetime: the opportunity to collaborate with a leading researcher in neuroscience on published papers and presentations. He has been endlessly patient with me. I have sent him basically nothing of what he's asked for since June. His patience is wearing thin. He won't say it, but has already suggested that I be offloaded until I feel better, and to alter my responsibilities, in as kind and gentle words as anyone could muster.

Yes, this is a volunteer (unpaid) opportunity but it has the potential to change my life after 10 years post college without a job, living at home. I have cerebral palsy and a terrible stutter. I NEED this. I can't do anything, though. I live life between bursts of aimless artificial energy that's coming at a dangerous cost, and naps that do nothing. I feel like lead all the god-damn time. I can't leave my house without a week's worth of coaxing myself. I don't respond to emails or messages from friends. I go to a cafe or the drugstore a mile from my house on a good day.

What is going on? What can I do?
posted by marsbar77 to Health & Fitness (25 answers total) 12 users marked this as a favorite
Edit: Am on these medications, when given my medical history, I should not be on Adderall or Klonopin*
posted by marsbar77 at 10:53 AM on November 26, 2018

Not threadsitting, just forgot to add: Any sleep studies I've done have been negative for OSA. My sleep schedule does seem to be inverted, but even at night, I get nothing of substance done, even with slightly less sleep pressure. Also tried exercise. Nothing. Nothing works. Even admitting to needing a break doesn't work if I don't know what the fix is.
posted by marsbar77 at 10:58 AM on November 26, 2018 [1 favorite]

If you are taking medications that are not indicated due to your medical history, please go to your prescribing doctor and come up with another medication plan immediately! I wonder if simply changing your medication could go a long way to helping with a lot of this.

Other than that, can you think of anything you have done in the past that has helped, even a little? Maybe revisit it. And keep in mind just because you have tried something in the past and it hasn't helped, it doesn't mean it will never work for you.

Or think of things you haven't tried -- your list of things you've done seems to be very focused on *you* doing all the heavy lifting to solve this problem. Is getting someone to help you organize your daily goals each morning something you would consider / be able to afford? TaskRabbit has services like this, I'm sure there are others. Check-ins throughout the day with someone who acts as an accountability buddy?

Best of luck. I've been there before and it's very frustrating.
posted by ananci at 11:10 AM on November 26, 2018 [1 favorite]

Just for more information: how long has this been going on, and have there been intervals during that time when you have had more energy?
posted by trig at 11:11 AM on November 26, 2018

What different types of therapy have you tried? I dislike CBT personally and I’m currently in a day program doing Acceptance and Commitment Therapy (ACT). It’s less about “stop thinking negative thoughts” and more about “well you will probably think them, so let’s accept it when it happens.” Probably a bad description, but there are new modalities being developed.

Have you ever done a partial hospitalization or day program? I’ve basically struggled with depression and anxiety forever, then a breakdown landed me in a day program (different one) and it was a lifesaver. The structure and the group setting and different types of activities, plus a medication change, let me see that something might work and gave me a little strength to keep trying. Then I moved on to the ACT group which is less intensive but giving me time to figure out what’s going to keep me going on a day to day basis. But, admittedly I haven’t tried as many things as you.
posted by cabingirl at 11:13 AM on November 26, 2018 [2 favorites]

The procrastination and fog have been a ( worsening) issue for about 10 years now. You could say I've been depressed since I was about 11 or 12 but was never dysfunctional until about the halfway point of college/university. Different things, maybe especially lots and lots of sleep with forced offloading of deadlines, helps for a day or two, but never more than that, and never consistently.
posted by marsbar77 at 11:17 AM on November 26, 2018

Working alone, especially working solo at home, can be very difficult in this situation. Just as an experiment, you might consider ratcheting up the boost people get from working in a cafe by actually hiring someone to literally sit and work with you for a few hours a week, perhaps they might help you get going with your project work of the day and help you break it all down to get organized and then they would literally sit there, doing their own thing but being mindful of you at the same time while you start to get into a groove. Sometimes it's easier to do things in a way that is responsive to others and your way with words makes me think this could possibly be true for you.
A college or grad student in psych, education, etc could put it on their CV in some form. Yes, in a sense you'd be paying to do volunteer work, but in another sense you'd be making an investment in yourself that has no side effects.
Just an idea. Good luck to you.
posted by nantucket at 11:34 AM on November 26, 2018 [2 favorites]

I would suggest that you talk to your doctor about the ketogenic diet. It's been wonderful for inflammation, anxiety, depression and mood swings in my own experience (ymmv). It lowers the amount of inflammatory cytokines in the body which a cursory search reveals has a correlation with cerebral palsy.
posted by crunchy potato at 12:11 PM on November 26, 2018 [2 favorites]

I love the Pomodoro method, but 25 minutes is way too long sometimes. Some days, the only way I get anything done is to set a timer for 1 minute, 3 minutes, 5 minutes, or 10 minutes and force myself to spend those minutes working on a thing (or a category of things, i.e. "email" or "reading"). If I get really hyped up about it, I'll promise a treat to myself if I repeat the sequence x number of times. Or if I'm not hyped at all, and really dragging, at least I'll have gotten something done.

It is surprising how much you can do when you force yourself to do it fast in order to cram into a limited window of time. And it creates forward momentum.
posted by witchen at 12:39 PM on November 26, 2018 [1 favorite]

I have pretty chronic depression & anxiety. Can you find a coach? Life coach seems to be the term. Someone to call every day or so, check in, help you get in motion.
posted by theora55 at 12:43 PM on November 26, 2018

I have known a few people who had chronic depression and fatigue issues and it turned out to be bipolar disorder, or something other than regular depression. I would recommend exploring this with your doctor. At the very least, if your meds aren't working and they are contraindicated for your history, ask to try something else. Consider keeping a journal of when you manage to do things and take it in with you - sometimes for severe fatigue, it's hard to impress upon someone who doesn't experience it just how life-dominating it is.
posted by bile and syntax at 1:01 PM on November 26, 2018

Any sleep studies I've done have been negative for OSA.

Have you ever had a multiple sleep latency test (MSLT)? If not, I would look into getting an overnight study and then an MSLT the following day. Several symptoms you mention remind me of narcolepsy without cataplexy, and these tests can be helpful to explore that. Good luck!
posted by mayta at 1:17 PM on November 26, 2018 [2 favorites]

Seconding the MSLT.
posted by Stewriffic at 1:21 PM on November 26, 2018

Yeah, I don't have OSA but a CPAP still changed my life.

Also: meditation. I hated it when I started but it really did help.
posted by dpx.mfx at 1:31 PM on November 26, 2018

IANYD: If fatigue is your primary complaint, I would work with your doctor to taper down the Klonopin, perhaps with a goal of using it only at bedtime or even transitioning to using a shorter acting benzodiazepine only as needed. It's very easy for me to imagine that being on Klonopin all the time could make you feel listless and unmotivated. To be clear and on the off chance this is news to you, the Klonopin must be downtitrated in collaboration with your doctor -- do not stop cold turkey.

That said, the other treatment for treatment-resistant depression that I see missing from your list is ECT. It can be difficult to access but can be life changing.
posted by telegraph at 1:41 PM on November 26, 2018 [3 favorites]

I should clarify/mention: it's not exactly fatigue. I can't fall asleep whenever, necessarily. It's more akin to a psycho-physical, all day version of that half-hour to an hour of sleep inertia most normal people get after waking. It's equal parts cognitive and physical. I just feel heavy and muddy and my waking hours are really just me waiting to in fact get tired enough that I can fall asleep again.
posted by marsbar77 at 1:54 PM on November 26, 2018

I’d definitely look into diet factors. Can you see a registered dietician? Maybe you have some food intolerances that haven’t been noticed because they have subtle symptoms, but that if you could track down and eliminate would make a huge difference. Good luck! This sounds so frustrating.
posted by bananacabana at 2:07 PM on November 26, 2018 [1 favorite]

Have you been screened for autoimmune diseases? Vitamin deficiencies? The "fog" part of what you describe sounds like what a lot of people with active autoimmune diseases experience.

Other ideas: take your antidepressants at night before bed maybe? They make me somewhat sleepy so it helped me when I switched from taking it in the morning to the evening.

How's your diet? Do you eat much sugar? How often? Sugar can put me into a fog--less like a "crash" and more like a sedative sort of effect.
posted by purple_bird at 2:11 PM on November 26, 2018 [3 favorites]

A friend of mine was prescribed dexamphetamine sulphate 3 x 15mg to help with non-responsive depression and it has helped. I'm on it for ADHD and it helps me concentrate.
posted by b33j at 2:12 PM on November 26, 2018 [3 favorites]

Seconding screening for autoimmune issues.
Research low-dose Naltrexone, and discuss treatment options and possible medication conflicts with your doctors.
posted by Iris Gambol at 3:02 PM on November 26, 2018

Is it possible that you have Complex PTSD instead of depression and anxiety? With your medical history, you might have experienced some traumatic events as a child. Not saying this is the cause, just throwing it out there in case it rings true to you. PTSD treatments differ from therapies for mood disorders.
posted by crazycanuck at 5:37 PM on November 26, 2018 [1 favorite]

You mention your cerebral palsy in passing. Are your psych doctors knowledgeable about cp? Just wondering how much your problems might due to an interaction with either the cp or cp medication.
posted by metahawk at 6:41 PM on November 26, 2018

To me, this sounds very much like the exact issue a close friend struggled with for years. It ended up being Hashimoto's. He had Type 1 Diabetes and so when the initial bloodwork came back from the lab 'within range' for his thyroid, his doctors chose to focus on the Diabetes. Nothing worked to help with the fog. Turns out, you can have more than one autoimmune issue at a time.

Apparently is it extremely common for a lab to get a thyroid result on the low end but within range and for that to be seen as meaning everything is fine. In his case, it really wasn't. He ended up eventually going to an endocrinologist who was willing to discuss the possibility that perhaps something outside his (carefully controlled) Diabetes was going on. This doctor put him on (I think) levothyroxine and within weeks it was like he'd emerged from a deep hole. He was simply a different person - more energy, better memory, less procrastination. He said he felt he could think again.

Presumably you've had bloodwork for thyroid done, but if it is possible to get a referral to an endocrinologist and go over it again, it may be worth pursuing.
posted by DSime at 8:22 AM on November 27, 2018 [5 favorites]

Have you been evaluated for Chronic Fatigue Syndrome/ME? Or hyperadrenergic POTS? There are a number of disorders that many doctors chalk up to depression or anxiety that are, in fact, serious medical conditions that require treatment. POTS takes, on average, 5 years to diagnose, which is incredibly frustrating. Keep looking for a cause here -- don't give up!
posted by equipoise at 2:56 PM on November 27, 2018

Not that depression and anxiety aren't serious medical conditions that require treatment, btw. Just that there may be other causes worth investigating!
posted by equipoise at 3:00 PM on November 27, 2018

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