I’m So Tired – Bipolar Disorder and Fatigue
For me, fatigue is not just a symptom of an illness listed in a giant encyclopedia of diagnoses; for me, fatigue is practically a way of life. If I didn’t have a day where I was so tired I wanted to curl up in a ball with my cats, I’d be downright shocked.
Fatigue and Bipolar Depression
Of course, “loss of energy or fatigue” is specifically listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a symptom of bipolar (and unipolar) depression. In my view, it’s one of the more disabling, ongoing bipolar symptoms, but that’s just how it presents in me. Because whether I feel acutely depressed or not, the fatigue is almost omnipresent. It’s just one symptom that the medication doesn’t seem to squelch. I’m kind of famous for my naps.
Fatigue and Bipolar Medication
Of course, if you have bipolar disorder and you’re feeling fatigued and you’re also on medication, the fatigue you’re experiencing could be a side effect. Fatigue is a side effect of the following common bipolar medications:
- Lithium – fatigue, lethargy
- Divalproex (Depakote) – somnolence (tiredness), 27%
- Carbamazapine (Tegretol) – drowsiness, 32%
- Lamotrigine (Lamictal) – somnolence, 14%
And so on. You’ll find similar side effects noted for most, if not all, antipsychotics for bipolar as well.
How Do I Know if My Fatigue is Bipolar- or Medication-Related?
Determining if something is a side effect generally goes like this:
- Did the symptom start just after you started a specific medication? Then it’s likely a side effect.
- Was the symptom there before you started the medication? Then it’s likely a bipolar symptom.
- Did the symptom get worse when you started a medication? Then it’s likely both.
And if you really want to know whether something is a side effect you can always switch medication but there are oodles of downsides to doing that.
What to Do about Bipolar Fatigue
Of course, no matter why you’re feeling fatigued, really, all the matters is that it be treated. If it’s related to a medication side effect, then handling it usually involves decreasing or switching medications. If the fatigue is mood-related, though, what you really want to do is better treat all the mood symptoms. In other words, if you have significant fatigue often, you’re experiencing a bipolar depression symptom often, and we know that partial treatment of bipolar depression is less than ideal and tends to lead to less favorable outcomes. (People in complete remission with no lingering symptoms tend to have better long-term outcomes.)
Common strategies for dealing with fatigue include:
- Treating the bipolar with a more “activating” medication. For example, while almost all antipsychotics are associated with fatigue, some are more so than others. Aripiprazole, for example, is often considered a more “activating” medication and may have an energizing effect for some people.
- Treating the fatigue/bipolar depression with a stimulant. One stimulant that has some data behind it is modafinil (as an adjunct) for treating bipolar/unipolar depression, and fatigue specifically. (See: Modafinil Augmentation Therapy in Unipolar and Bipolar Depression: a Systematic Review and Meta-analysis of Randomized Controlled Trials)
- Exercise. I’m including this one because people swear they get more energy when they exercise. I don’t; I just get tired; but other people swear it’s the opposite.
So, the short story on bipolar and fatigue is this: you don’t have to live with it. Certainly, with the strategies I’ve employed, I’m a lot less fatigued than I was before. The solutions might not be perfect (When are they ever?) but they are available and something you should discuss with your doctor if fatigue is an issue for you.
Please note: no treatment is right for everyone and trying to beat fatigue with something stimulating could increase your risk of switching to hypomania/mania or a mixed mood which means that working with your doctor on something like this is extremely important.
Tracy, N. (2014, December 8). I’m So Tired – Bipolar Disorder and Fatigue, HealthyPlace. Retrieved on 2019, June 15 from https://www.healthyplace.com/blogs/breakingbipolar/2014/12/im-tired-bipolar-disorder-fatigue
Author: Natasha Tracy
I want to encourage everyone. I started treatment in the mid 70"s. At that time, it was still common to have professionals who blamed mothers for their children's schizophrenia. Depression was caused by anger turned inward and and we could all get well if we just wanted to bad enough. And, medication was considered a crutch unless you were absolutely unable to function and the professional didn't know what to do with you. When medication was used, it was much like the brillcream commercial - "A little dab will do it." And then you went through it all again..... At least they know we have neurological disorders that are thought of as life-long. Now there are psychiatrists who truly function in a medical mode.
Congratulations on coming so far and doing so well. You should be very proud of yourself.
It can be hard for other people to understand how hard treatment can be, no question about that. You're right, there is an impression that meds just fix everything. We, of course, know they are challenging, to say the least.
What I would say is that your dad needs some additional information about the illness. He can't know how hard it is for you unless you tell him. You are an individual and while learning about the illness, in general, will help your dad, nothing will help as much as the words coming from you.
If you don't feel like you can speak those words, maybe write a letter. Take your time and fully explain the situation as best you can. It sounds like your dad will listen if you just explain.
Also, suggest that your dad read more about the illness from others. Try memoirs or books/websites that speak to you, personally.
I hope you find a better cocktail. Don't give up. It's out there.
- Natasha Tracy
I feel much the same way only I have bipolar 1 disorder. I'm taking anti seizure meds too. But medication is just one form of the many therapy options out there. I also have a counsellor now but I'm finding that it's not really helping me that much. I'm still tired and depressed most of the time.
Have you thought about seeking out a naturopathic doctor as an adjunctive form of therapy? I'm looking into a naturopath myself but first I wanna to try a light box. I'm off to get one today. My funds are pretty limited but anything is worth a try
I just wanted to write and say I get you. All of you. And your pain. I've been there. I'll be there tomorrow. This moment is a peaceful moment so I'll cherish it. I pray for more peace tomorrow. And I'll pray for you and your loved ones as well. May healing and wholeness be ours. Xo.
Just been to hospital for what I thought was heart as feeling tired and heart pounding. Now I am thinking its lithium as this came back very low on bloods. I reckon it's that. Anyone else had anxiety and health problems when lithium is to low. Feeling of exhaustion?
I'm joining in on the extreme lethargy discussion, to which I can relate. A load of laundry? Cook a meal? Maybe later or another day.
So it's now almost 3 & my big accomplishment is that I walked my dog for 1/2 hr & I managed to eat something fairly healthy. It's a gorgeous day & I'm feeling really low... and deeply lethargic. Trying to find help, support, & inspiration on YouTube videos and on psych sites.
I am right there with you. Had the same problem of needing a 2+ hour nap at work and I'm sure my boss started to wonder what was going on everyday. Certainly didn't help my career and I was lackluster at best.
I've been BP-2 for 20+ years and here's what I've found. Routine go is is KEY. You need to go to sleep and wake up the same times 7 days a week. Naps aren't horribly deteriorating if you keep them short (<45 min) and limit to once a day. Also - Jen - BEWARE off going off meds as a diagnosed bipolar 1!!! The sad but true fact of life is we will ALWAYS be dependent on a medical regimen for the rest of our lives. Just a hard fact I guess. I've been on the same three for 15 years and it's worked pretty well.
I did want to ask though - does anyone also suffer from ADD? I'm finding it very hard to concentrate (last 2-3 years) but my Dr says he won't put me on anything for the ADD out of fear that it launch a "major manic episode"???
So, in my case, the fatigue is purely due to the disease and not the medication.
Every thing that you wrote is EXACTLY what I go through everyday. If only God would help us and cure us so we can lead a normal life! I am SOOOOOOOOOOOOOOO TIRED TOO OF BEING SICK AND TIRED!
I'm sorry to hear that you are feeling so tired. I too go through periods where I quickly get my son ready for school each morning and then am so tired that I lie back down and take a nap for 3 more hours. I feel like depression is always present to a small extent on meds but hypomania is gone. I miss it because I felt so happy about life, so fulfilled, more awake and energetic 7 hrs of sleep was enough vs my usual 12. One thing I thought of for you is if your provider is following your labs at least every 3 months. Lithium will cause hypothyroidism and you will need to take throid replacement medicine. Hypothyroidism can cause fatigue and tiredness among other things. Well just in case, I thought this was worth mentioning.
I had this type of fatigue even before I was diagnosed as Bipolar II. I have tried to eat well, exercise and it's still there. The only time I can remember not having fatigue is during a hypomanic (and I've come close to full blown manic) phase. Otherwise, it's relentless. I take Lithium and Wellbutrin.
Yes, I do miss those hypomanic phases when I would be super productive, though the mass destruction that followed was not always great. I've lost friends and completely ruined my finances. Especially after my last episode of racking up 20K of debt in 3 months, which I'm still trying to pay off. And after racking up that debt getting fired from my job on a depressive run where I would sneak out during lunch and be gone for 2-3 hours because I had to nap. I didn't tell them I had to nap obviously, but my boss was always wondering where I was, so in part I blame my fatigue.
I find myself getting frustrated I feel this way when my friends don't have this problem and can keep a clean house, stick to social commitments, don't always feel tired, etc.
I kept thinking there was something wrong with me and it wasn't normal to feel tired all the time. I'm only a year into being diagnosed as bipolar. I now have a work from home job which offers me flexible hours. I find this perfect for my situation. Now if I need a nap, I take one and find I'm more productive when I get up. It's still not easy by any means and more of a work around to manage my life.
I don't want to accept or embrace the tiredness. I have hope to find a way out of it. If not, I'm going to continue to work around it the best I can. If anyone finds a magical solution, please share!
Hang in there! Take one day at a time! It is hard to head into the fall/ winter time now. I too have bipolar and it sucks! I take lithium and lamictal. I am always tired. Try not to think about what you can't do but rather what you can do. Take naps and don't feel bad about it. Don't compare yourself to others. And drink as much caffeine as you want, definitely helps me.