Tired

Tired. Being tired. Feeling tired.

This is still the hardest thing of all for me to deal with. Especially so because I can’t really see that much of an end to it coming up with any haste.

Being or feeling tired, is pretty much the physical equal of being or feeling depressed, mentally. In fact I think they are different ends of the same condition. I’m sure that every depressed person feels tired; I’m not sure if every tired person, who is tired from some other cause that is ongoing and continuous, feels depressed but I’m guessing the percentage that do feel depressed is pretty high.

Most of the stereotypes are exactly the same.

You know, all the old favourites: “you don’t look tired”, “you don’t seem tired”, “I bet if you pushed yourself you would find that you’re not that tired”, “if you just tried a bit harder I’m sure you’d be fine”, “exercise is good for people when they’re feeling tired”, “if you were really tired you’d be sleeping instead of just laying around”, “are you eating properly because if you were I’m sure you’d find you weren’t so tired”, “are you sure you’re not just being lazy”, “are you sure you wouldn’t feel better if you did something for the day instead of sitting/lying there”, “are you sure quitting is good for you? If you pushed yourself I think you could keep going”, “everyone gets tired, you just have to push through it”.

Yawn! Surely it can't be time to get up! bed

Yawn! Surely it can’t be time to get up!

Really?! So let me get this straight. It’s not bad enough that I’m suffering with tiredness, but now you get to judge me for the affliction which I would never have wished for, and condemn me for however I somehow manage my way through it. Hmmm. Yep that sounds reasonable.

Rant over; that’s not what this is about. But I will make a side point here before we move one. Every single time that you want to ask someone a question that subtly suggests they are being useless and not helping themselves, think about this.

If that person had cancer and was suffering from whatever-it-is, in this case let’s say tiredness since that’s the topic, would you still ask the question? Would you still hint that they could do better and be better?

If that fails, try, and I mean REALLY try, to empathise with the subject, in this case, let’s say me. How about, as a mental exrcise, you imagine you were me? You may be a friend who knows a little about me, family who knows a bit more about me, or a stranger unmet that knows only what’s written here…but try. And if you can’t imagine it, or have insufficient information to really get into my shoes, then maybe it would be appropriate for you to consider that you also have no right to comment.

And please don’t take this as a rudeness or a get-out-of-here sentence! It’s meant only as a demonstration because I’m certain that most people commenting on health and mental health these days are not the people who have an inside and intimate view of the various conditions that exist.

So; being tired.

Here is the 50 million dollar question: is it physical or mental?

Here is the 25 million dollar: does it matter?

And here’s the question that I want answered that I’m not sure there is even an answer to: what the ……. am I supposed to do about it??? Fill in the blank yourself.

I have no idea what to do about it. No clue.

Everyone else has a lot of ideas.

Who has the answer that is best for me?

So here’s my systematic approach.

Why am I tired?

First cab off the ranks: I have depression, bipolar depression that comes with lack of motivation, lack of energy, lack of stamina, lack of feeling. So there’s that.

Second idea: medications including quetiapine (Seroquel) which literally puts me to sleep at night and possible hangs over a bit the next day; lithium which is known to slow you down a bit, so there’s a bit more.

Third thing: I have underactive thyroid which was caused by lithium and we’re still working on getting the thyroxine (Oroxine) dose right. I started on half a tablet, now I’m on a full tablet of the lowest strength and we’re waiting the 6 weeks before we can take a blood test to check if we need to bump it up again. Also I’ve had iron deficiency anaemia over the last year and while my iron levels are finally okay, my iron stores are still low so I’m still getting that sorted out with iron tablets and I’m also enrolled in a clinical trial to help with iron levels. None of that helps.

Fourth: the weight gain thing. The last time I ran around and got excited about jumping up and down, I was 30kg lighter! Thirty kilograms. It should surprise no one that a person carrying a bag of 30kg moves slower than they used to! It’s logical maths.

So actually, when I see it all written out on paper in detail…I realise maybe I could be giving myself a break.

Hmm. That’s actually quite a lot of reasons to be going slow…maybe I need to go back to psychology basics and re-frame my life these days. Maybe what is desperately needed here is some of that self compassion that I blab about but forget to apply, and a new perspective.

The perspective that says, Danika, whatever you can get done today is excellent. Congratulate yourself for getting up out of bed, for having breakfast, for getting out of the house, for getting through a shift of work, for whatever activity you do.

Forget about wondering why you can’t this and that, why you used to be able to do this and can’t now, why it’s hard to get through what you want to get through.

Try being excited and satisfied and happy about whatever you can get done. Give yourself a break. Don’t just say it, give it! It’s not a theory, it needs to be a practice. Give yourself a break!

And remember that you have hope of improving in the future: the plan to eventually wean you off sleepy quetiapine, your intention to slow weight slowly but steadily, your commitment to your medication that should correct your thyroid function and anaemia.

RIght now, it doesn’t matter what the tiredness is; could be anything off the list. Just take each day as it comes, and try not to have excessive expectations of yourself in your current state. You aren’t last year, you aren’t later this year; you’re right now, so just handle what you can handle, and leave the rest to another day.

And seriously: take your own advice! Don’t just right these easy lines for someone else’s benefit; read them and believe them and check in on them again each day. Every day. I don’t want you getting into a state about this tiredness thing anymore; give yourself a break!

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Last night I had a dream…

Anxiety, depression, antidepressants.

Condition, condition, treatment.

Cause of dreams, cause of nightmares, cause of crazy, surreal, nonsensical, weird-as concoctions of ideas and sequence.

Either way, not a great night’s sleep!! And a poor night’s sleep leads to waking up tired and already sick of the day, and that’s no way to feel better about life!

In December last year I got started on a second and more sedating antidepressant to help with my anxiety, and depression. I was initially scared of being on two antidepressants simultaneously. The pharmacist in me was screaming “serotonin sydrome, serotonin syndrome!” [see author’s note]. But then I took it, as directed, at 9pm at night. Within in half an hour a warm fuzzy feeling was spreading all over me and I was feeling sleepy. So I went to bed. I fell asleep straight away, no tossing and turning and trying to force myself to sleep. No fretting, anxiety, stress, fears for tomorrow. Just pure sleep. Bliss!

I fell asleep, and stayed asleep. All night! In fact I couldn’t get up the next day! The doctor had warned me about this so I had started the medication on Christmas Day. I dragged myself out of bed about 9.30am, tried to keep my eyes open over breakfast and finally gave up after a shower and went back to bed about 11am. I slept solidly for two hours and woke up feeling a bit better, but still sleepy – luckily it was a small family lunch for Christmas so it didn’t matter too much. The next day was better, the next even better and within four or five days I could wake up bright and early as soon as my alarm went off and head off to work. And I was getting a full night’s sleep every night!! I was no longer waking up feeling like someone had “punched me in the face” as my doctor describes it, pretty accurately!

Oh mirtazepine! I still have a soft place in my heart for this wonder drug that put me to sleep, kept me asleep and then allowed me to wake up and get on with my life.

I’ve changed medications a lot since then. I had to get rid of mirtazepine because the doctors wanted to start quetiapine instead, an antipsychotic/mood stabiliser to stop me swinging from one end of  the spectrum to the other. It is also sedating. It does a pretty good job with my sleep: it certainly puts to sleep, and keeps me asleep, but I’m having this annoying phenomenon of waking up every morning at 4am or 5am bright as a button!

And to all the helpful people who say “just get up” – thank you for your advice but I respectfully decline!! What kind of time to get up is 4am?? What am I meant to do at that hour of the day? How am I meant to occupy myself all day? It’s hard enough as it is! So I go to the toilet and get back in bed and start the fight with myself to get back to sleep. Unfortunately by the time I succeed it is time for my hubby to get up and a much more reasonable hour of the day to be awake, and I’m conked out! Completely out to it! So my actual getting up time is more like 8am, 8.30am, 9am, 9.30am. Which doesn’t work well with a plan to go back to work eventually on a 8am to 5pm shift…but hey, I really shouldn’t be getting ahead of myself!

I asked my psychiatrist about this early waking thing. At first I thought it was just going to be a temporary thing, but it’s going on and on. He doesn’t want to increase the quetiapine dose anymore; I’m already fat and have cholesterol problems which are in part due to this medication and neither of us want to worsen that! Besides I’ve been started on lithium since which he hopes will be my main medication and the idea is to eventually reduce and possibly cut out altogether my antidepressant and mood stabiliser. His opinion on the matter is that depression is the cause. Early waking can be a typical sign of depression in his view. Bummer!! I was hoping it was something medication-induced that was more easily fixed than depression! Ah well, at least I got most of a good night’s sleep. Mostly.

There’s still the odd crazy antidepressant dream. I’ve heard about other people on antidepressants having strange out of context or deranged dreams, so I guess it’s something that can be part and parcel of treatment. I’ve had a lot more in the past but since being on a mood stabiliser they’ve been a lot rarer.

However I had one last night that got me thinking about this again.

Here’s the reality as background. My sister is a chemistry and nutrition teacher and mostly we get on well. We had a phone conversation last week that was really nice, we had a good chat about different things and only stopped because we had to go out for a date.

Now here’s the dream. I get invited to go to a private girls school to give a lesson on nutrition but I can choose exactly what I want to give the talk on. I choose to talk about waist circumference and it’s link to heart disease. I go to give the talk but I get lost and I’m running late so I have to call ahead and tell them I’m going to be late; not impressive for a guest lecturer! I finally get to the classroom and there are 5 girls; a bit surprising for a guest lecture but okay. Somewhere in the dream the classroom becomes a car and the number of girls drops to two!! Anyway when we get to the car part my sister (the nutrition teacher) turns up and begins heckling me about my facts, saying that they are not evidence-based, the greatest insult in modern medicine! I respond but suddenly I can’t find the evidence that I had before and can’t fight back against the allegations. It turns into a bit of a shame fest for me as a lecturer and then I start getting criticised for my lecturing style, my notes and my slides and it descends into a big higgle-di-piggle-di and I wake up!! Ridiculous!!

Questions: I have no idea on what authority I’m giving this talk, why me? I don’t really have to guess why waist circumference; it’s clearly because mine is well over the line and I need to do something about it other than eating chocolate! Why am I running late – I don’t actually do that much anymore; I’ve really turned over a new leaf. How did we get into the car and why? Why a private school; I went to public schools and have no idea what private schools are like. Why is my sister even there, she lives in a different state? Why are my facts being questioned, especially by my sister who would absolutely support them in real life?

There is no reasoning why with these dreams, they just have to be brushed off as we go on with life. Sometimes they are harder to brush off but I’m sure that looking for meaning in them isn’t very productive. If you beg to differ, and can find a meaning, I’m listening.

So sleep, dreams, life. All wrapped up together and getting the perfect balance is an art. It’s not perfect now, but it’s a long way better than it used to be so I’d like not to fight it but to be glad for what I’ve got and make the most of it!

[Author’s note on serotonin syndrome: when prescribed a high dose of a medicine that increases serotonin like SSRI and SNRI antidepressants, or when prescribed a combination of two medications that increase serotonin there is potential for a patient to develop serotonin toxicity or serotonin syndrome. I have been prescribed both at different times and have never experienced any problems; that is not to say it doesn’t happen, but it is not common. If you believe you have been prescribed one of these you should discuss serotonin syndrome with your doctor/psychiatrist. I am not an authority on the matter and won’t be giving a list of symptoms to look out for. ]