The chicken and the egg: Fatigue and mental ill health

I’m full of the cold (again!), hubby has a chest infection and the little person isn’t well either. I’m so, so tired. Yesterday I had a nap and guess what- I’m still tired. I’m taking some pretty sedating medication but come on, I feel like I’m 62 not 32. I’ve lost count of the number of times I’ve put my kid to bed and woken up beside her several hours later still fully dressed, make-up smeared on my face and contact lenses still in. I’ve had enough.

 

According to the Royal College of Psychiatrists, at any given time, 20% (1 in 5) of us feel unusually tired. Think of how many people you know, that’s a LOT of tiredness.

 

Tiredness (or fatigue) is a common symptom of depression however there are multiple other causes of tiredness including physical problems such as anaemia, coeliac disease and thyroid disorders. You can find more information about physical causes of tiredness here. Around two-thirds of people who see a GP for tiredness have an underlying physical or mental health disorder which may be contributing to their symptoms.

 

It’s impossible to break the cycle of constant tiredness without reflecting about how and when the tiredness started. When I try to pinpoint what came first, the depression or the tiredness it seems like a chicken and egg situation: my depression makes me tired and being constantly tired makes me feel depressed.  My tiredness (and that of many others) is likely due to several factors: work, stress, sedating medication, looking after small children and underlying depression.

 

Something that resonated with me was the concept of an activity roller-coaster. Going from intense, full on activity during the week to low activity at the weekend causes increased fatigue because you’ve put all your eggs in one basket then have nothing left at the end of the week leading to burnout. Whilst it’s only natural to want to push yourself and do more, trying to self-insure against the bad day that might come tomorrow by cramming in as much activity today creates unhealthy patterns. When the bad day inevitably comes, we blame our illness and start a cycle of negativity by thinking of all the things we aren’t doing today but should be (see, there’s that should word again).

 

So what is the answer? Are we doomed to live in a cycle of energy abundance followed by crashing lows of energy depletion? I sure hope not.  Careful planning of what activities to do on what day (seeing free time as time to be free, not time to do more housework), tweaking my medication regime (I’m slowly weaning off the sedating drugs**) and appreciating the need for rest even if I feel fine are my strategies to tackle the tiredness. That and the occasional bar of chocolate!

 

Got any tips for fighting tiredness? Please feel free to comment below.

 

** remember, adjusting your meds should only be done as part of an agreement between  you and the clinicians treating you.

The Unwanted Christmas Gift

No, it’s not socks, you’re going to have to read on.

Here I was, sitting in a small consultation room whilst the psych took notes. It had taken 4 months just to get this “emergency” appointment and like many much-anticipated events there was relief that finally it was happening.

The psych eyed me from her chair, a petite woman who spoke calmly and quietly. She seemed nice. Still, I was terrified of her. I hadn’t actually met her before today’s appointment which added to my awkwardness. Thankfully, she “had already read all the notes” sparing me some of the gory details.

I only had two questions: what is wrong with me? how are we going to fix it?

“You have bipolar disorder.” It wasn’t unexpected but I still burst into tears. It had taken a year to get this diagnosis, lots of watching and waiting for me to become ill again so the psych team could see my symptoms first hand and decide what the hell was wrong with me.

It was a chain of out of character behaviours and events that led to bipolar first being mentioned. I’d felt like I was “flying”, over my depression and making up for lost time. Yeah I got over excited at times but thought of it as a good spell away from the crushing lows of a major depressive episode.

My husband would say I was “on one” when the early exercise sessions, overcommitting myself at work, not eating and sleeping for only a couple of hours at night happened. I’d spend more than usual (including buying a box of Emma Bridgewater mugs in what may be the most middle-class hypo manic episode ever), be louder, drink more and flirt more than usual (my normal social anxiety would be replaced with a ride or die party girl). Hypomanic me was fun. More confident, more creative, more productive than ordinary me.

Of course, there was a flip side. I’d burn myself out to the point of exhaustion then end up in bed for a week after pushing myself to the limit mentally and physically. The first hypomanic week felt great but as it rolled on I’d get anxious, paranoid and demanding, afraid of my excess energy and that I would end up doing something stupid like buying the Mercedes I’d been eyeing up for ages. For the most part, I was able to curb my behaviour at times, surrendering my credit cards to my long-suffering hubby and taking the pills the GP prescribed to make sure I got a few hours of rest at night. During the times I couldn’t curb my behaviour, the feelings of shame and guilt about my actions and behaviours added to the inevitable low after the fall, fuelling a negative cycle of hate and depression.

What a shitty Christmas gift I thought. Although we knew what it was, it wasn’t so easy to decide what we were going to do about it. The goal (apparently), is to avoid hypomania for as long as possible. The more episodes of hypomania, the worse the prognosis that things could progress to a full blown manic episode. Right now, I think bipolar could be the gift that keeps on giving and not necessarily in a good way.

Christmas a.k.a how to relapse in 24 hours

What are your plans for Boxing Day? Roll out of bed to eat leftover Quality Street whilst watching a boxed set? Hitting the sales for some bargains that maybe you don’t really need?

I’ve decided to blog today because I need to talk about how one day of excess can trigger a serious mental health relapse. Every year I think “It’s just one day, I’ve got this, I don’t need to stick to the rules.”

So instead of sticking to a routine, eating well, moderating my alcohol intake and doing some exercise, the day tends to unfold like this:

Get up at ungodly hour with excited child and slight headache after having too many gin and tonics the night before.

Skip breakfast, crack open a bottle of something bubbly around lunch time.  Extra points for drinking in ridiculously hot kitchen prepping lunch so dehydrate quicker.

Eat huge Christmas dinner, washed down with more fizz and some wine too. Screw sleep pattern by having  ridiculously long nap in the middle of the bloody day.

Get up in the early evening, not hungry but squeeze in some Quality Street/leftover roast potatoes/cheese and biscuits. Put a film on, crack open some gin, get tipsy and chattier than usual and reward self with another few drinks, go to bed at ridiculously small hours of the morning, sleep badly because you have heartburn and slept too long during the day.

Bonus points for: making a mental list of ways you’ve messed up previous Christmases/missing relatives who are no longer with is/looking at social media and berating self because everyone else seems to have their shit together.

So although I thoroughly enjoyed spending time with my family, eating gorgeous food and sampling some of the amazing gins I was gifted, today I need to be a little more responsible and manage myself better. That means eating regularly, not drinking today, going for a gentle walk and remembering that one day doesn’t have to start a downward trajectory.

Can someone remind me of this post on December 24th next year?!