Bipolar depression is typically associated with symptoms like feelings of hopelessness and guilt along with loss of interest and isolating behavior. Another major symptom of depression is fatigue. Fatigue is not the same thing as sleepiness. It feels closer to exhaustion, and not the exhilarated exhaustion that comes with a good workout. It is a complete lack of energy. In bipolar disorder, fatigue is a major factor that determines factor how well a person is able to function on a day-to-day basis.
People who experience atypical depression are especially at risk for periods of fatigue. In typical depression, patients often have trouble sleeping, whereas patients with atypical depression often sleep more than 10 hours a day. Atypical depression is most common with bipolar II and carries additional symptoms of fatigue.
There are two types of fatigue, physical and psychological. Both are present in fatigue associated with bipolar disorder.
Physical symptoms of fatigue include:
- Digestive distress (nausea, vomiting, diarrhea)
- Chest pain
- Muscle aches or weakness
- Slowed reflexes
- Impaired coordination
- Leaden paralysis (most common in bipolar II)
Psychological symptoms of fatigue include:
- Lack of motivation
- Difficulty concentrating
- Increased or long term sleepiness
- Poor cognitive functioning
Many of these symptoms may be attributed to other factors such as medication side effects or an unrelated illness, so it’s important to keep track of when symptoms appear and any other coinciding symptoms or behaviors.
Most of the time, identifying fatigue as a symptom is not terribly difficult. Having to fight to get out of bed and shower are pretty clear signs. Countering fatigue during a depressive phase is the hard part.
There is no immediate fix for severe fatigue with depression, but there are several steps patients can take to improve symptoms of fatigue:
- Plan your day around when you think you function best. If you work better in the morning, don’t put it off and risk being too tired later.
- Limit caffeine. It can provide short-term energy, but comes with the risk of a worse crash later. Caffeine consumption can also interfere with sleep cycles.
- Regulate your sleep. Too much sleep and too little sleep can affect mood episodes.
- Eat right. A poor diet can exacerbate symptoms of bipolar disorder by affecting brain and body chemistry.
- Drink more water. Dehydration can cause fatigue and affect mood.
- Exercise. Finding the motivation to do anything when dealing with fatigue and depression is challenging, but doing aerobics increases oxygen in the blood, which can help treat both symptoms.
- Try to limit stress. It causes fatigue and can trigger mood episodes.
- Talk to your doctor. There are medications prescribed specifically to fight fatigue associated with depression. However, the fatigue you’re experiencing may not be the result of bipolar disorder itself. It could be caused by medication or another underlying issue, so it’s important to sort that out first.
Unfortunately, severe fatigue is a part of bipolar depression as both a precursor to an episode and a symptom of the episode itself. Other symptoms of bipolar disorder like restless energy, racing thoughts and insomnia can worsen fatigue, which can worsen other symptoms. It seems an endless cycle, but it is possible to manage it with the right combination of medication and behavioral changes.
Image credit: Jem Yoshioka