Health And Wellness

The Relentless Fatigue Of Depression

Photo: Adrian Swancar | Unsplash
Fatigued man

If you look up the common symptoms of depression on a major health website, you’ll see words near the top of the lists such as “sad,” “hopeless,” and “irritable.” Those are all true, and they’re symptoms I’ve experienced myself. However, many of these sites mention another depression symptom further down the list — although it belongs near the top.

The Mayo Clinic calls it a “lack of energy” and WebMD says it’s “sleeping too much.” What they’re trying to say is, “Exhausted. Bloody exhausted.” I have had periods of depression over my life, but my most recent one has lasted the longest.

It started, interestingly, at the same time as we lost my older brother unexpectedly. That was compounded by the loss of some other wonderful people around the same time, and then the pandemic hit.

Up until 2018, I was coasting along pretty nicely. I was a relatively new dad and was enjoying my new(ish) life of working from home as a freelancer. The horizon was pretty sunny from where I was standing. In late 2018 when my brother passed away, I started going downhill — while my anxiety and depression trended upward. The pandemic came at a time when I was still processing the losses, and it added a whole new layer of despair.

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Depression treatment can deliver a knockout punch.

It was in 2019 when my doctor agreed antidepressants could help. Well, they did, at first. Maybe it was a placebo effect, but I felt like I had more spring in my step after a few weeks of treatment.

What I’ve noticed during the recent years that I’ve been on antidepressants is that I’m tired — like, extremely tired. I didn’t notice it much during the Covid outbreak, because napping was a way to kill time during government lockdowns. But even after the restrictions were lifted, I felt like I just wanted to be in bed — even when the sun was shining. I nap regularly now, almost every day. I even joke to my wife that if I make it through 12 hours without napping, it’s an “all-dayer.” As in, “I’m tired honey, I pulled an all-dayer.” She rolls her eyes quietly, having worked in her massage clinic all afternoon.

A short slumber during working hours helps me keep my mind sharper to focus on writing and other tasks. But there’s more to it than that. Yes, depression itself can be tiring, and can even cause physical aches. And if you’re someone who has chronic pain, you’ll know pain is a drain. However, there are other, quieter ways that depression might suck the life from you.

One of them is the medications themselves. Selective Serotonin Reuptake Inhibitors (SSRIs) like Prozac are commonly prescribed for symptoms of depression. However, “drowsiness” is a word often listed in the side effects.

In this article from the National Library of Medicine (NIH), I learned something interesting. The article explains that those with major depressive disorder (MDD) often get partial relief from medication, but not a “full response” — “One of the most common residual symptoms of a partially resolved depression is fatigue.”

If I’m reading this correctly, it’s saying that those of us who are being helped by medication but not “cured” are tired more often. It’s like we’re stuck in some kind of depression purgatory.

The physician cited in the article notes that up to one-third of people who are in remission (diminished/no symptoms) for major depression still experience bouts of fatigue, which can have other impacts. “We see apathy and considerable emotional disturbance occurring as a consequence of fatigue. We have also seen high rates of diminished focus, word-finding difficulties, and recall problems in fatigued patients with MDD," Dr. Maurizio Fava explains.

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The article notes that the associated fatigue comes in the form of “physical, cognitive, and emotional symptoms.” Some people do get relief from antidepressant medications. However, while around 60% of patients feel somewhat better after two months, according to The Guardian, many patients (like me) have lingering symptoms that can fluctuate by the day.

Being tired is one of them. One day I’ll pull an all-dayer, and the next I’ll want to go back to bed at 11 a.m. after being up for only a few hours. My bloodwork is fine, so it’s likely not a physical problem. I suspect that it’s either the depression itself worsening, or the medication needs to be adjusted (although I’m at the lowest end of the dosage scale). It could also be that I’m stuck somewhere between having symptoms and getting better (“partially resolved depression”) as explained by the NIH article earlier.

   

   

Fatigue: A forced time out from reality?

The other reason, I realized fairly recently, is that I’m using sleep as an escape. While an alcoholic turns to the bottle to escape their existence, I hit the pillow to escape mine. I suppose in that way you could call my napping a vice, although I’ll take it any day over blacking out drunk.

My main point is this: while sadness is usually at the top of the list for depression symptoms, I think it’s trumped by general fatigue — at least in my case. Not only does depression sap my physical energy, but my mental energy too. Fighting off negative feelings is exhausting, to the point where I need to take a brain break. Depression is a triple threat when it comes to being tired: the disorder can sap your energy, your medications can make you drowsier, and you might find yourself sleeping as a way to escape reality.

I don’t want anyone reading this to worry about me. I have been dealing with anxiety, depression, and a neurological condition since my teens, so I’m pretty resilient.

I can feel joy occasionally bubbling up inside me, pushing hard against my stoic outer layers. Sometimes it even breaks through, like the sun does after a week of rain.

But not for very long. I’ve given up on feeling “happy” as my baseline. At this point in my health journey, I’m looking for ways to let go of unnecessary stress, and trying to be more grateful. The latter practice can go a long way.

I’m also no longer berating myself for sleeping during the day when I could be making money. Having more cash is nice, of course, but it doesn’t convince my brain that things are good. It doesn’t lift the black cloud from above me.

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Depression often defies logic.

“Sadness” and “lack of interest” are often cited as the main markers of depression. But true “sadness” is often triggered by external events. Depression, on the other hand, often makes no sense when you look at a patient’s situation from the outside. It might make you think the person is imagining it, but we aren’t.

For example, I have a loving family, access to good food, and a decent house, which is more than many can claim. However, some days — like today — my depression kicks me right in the gut, and I can’t get up for hours.

Depression doesn’t rely on a specific thing to make you feel down. It can also be caused by past trauma, as some scientists have theorized. It shares some symptoms with post-traumatic stress disorder (PTSD), such as avoidance, and having trouble sleeping (when you’re supposed to be sleeping), says WebMD.

It’s not known exactly how depression medications work to alleviate symptoms. Some doctors think antidepressant medications do no more than a placebo. I’m beginning to think they’re right. But if there’s one thing I do know, it’s that depression in any form is tiring. And now I’m tired of writing about it. But not too tired to read your comments about your own experiences with depression, and to help if I can.

If you or somebody that you know is experiencing a mental health crisis, there is a way to get help. Call SAMHSA’s National Helpline at 1-800-662-HELP (4357) or text "HELLO" to 741741 to be connected with the Crisis Text Line.

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Jeff Hayward is a writer and photographer/visual artist based in Hamilton, Ontario. He’s had his work featured by The Good Men Project, Medium, The Hamilton Spectator, CBC Hamilton, and others. 

This article was originally published at Medium. Reprinted with permission from the author.