I have felt exhausted almost all the time for about as long as I can remember. I know that being autistic is a factor in this as I have talked about in other articles, not least because I have to spend much of my life living an “act”, trying to work out what a supposedly normal person would do in my circumstances. But I also know that my depression and anxiety play a huge role in my ongoing tiredness.
I believe that there are a number of reasons for this. As ever, I come to this subject from my personal experience, not as a medical professional, but I hope that the little I have come to understand about myself over many years may be of some use to others.
I should also say at the outset that I also have severe anxiety. I find it very difficult to separate the impacts of my depression and anxiety. I consider the two to be closely related as far I they effect my life, and I suspect that this is not uncommon.
So why am I so tired? As with so many of the things I would like to improve in my life, I think that there are a number of different reasons which combine to give the end result.
Firstly, I believe that the medication that I take for depression makes me tired. Fatigue is certainly listed as a possible side affect. But I would absolutely not be without it. After years of fighting my mental health, I spent an entire weekend in tears which drove me to get help and ultimately medication for depression. It has changed my life, and while I do not like having to take pills every day, I cannot contemplate trying to come off them any time soon. The odd time I have missed a day or two by mistake have been bad enough.
Secondly, depression and anxiety make almost every day a struggle. It is a fight just to do normal things like get up, get dressed and so on. That all takes energy and expends emotion. In my experience, emotion is the most tiring thing of all. If I exercise, my body feels tired but I soon bounce back. Emotion is utterly draining in every respect. When you are having to fight resistance from inside your own head to do even the simplest of things, the emotion and energy used to do so are enormous.
Thirdly, anxiety means worrying. Worrying about pretty much everything. I have heard all the rational explanations for why worrying makes no sense and achieves nothing, but the part of my brain that does the worrying is in no way logical and is not interested in these arguments. I cannot help myself from not only seeing the worst possible outcome of any situation, but the only way I can deal with it is to then plan how I will deal with it if the worst actually happens. In effect, and this is often how I actually think of it, I have to have plans B, C and D for every possible situation.
Again, all that thought and working through what are by definition stressful situations, even if they have not actually taken place yet, is exhausting. Thinking them through is almost as stressful and tiring as actually living through them, but if I do not plan like this I will worry even more that these things will happen and I will have no solution prepared. It is my coping strategy for my worries to work through what could happen and try to deal with it in advance. It may well sound ridiculous, but it works for me most of the time – apart from the fact that it is incredibly wearing!
Another reason for my tiredness is that my depression and anxiety have a huge impact on my sleep. I can find it very difficult to relax and fall asleep in the first place, however tired I am. I need to have some form of talk radio or podcast on to fall asleep to try and distract me from my thoughts. Yes, I effectively have be kept away from my own mind in order to get off to sleep. But then I will wake up several times a night and have more trouble getting back to sleep. My brain wakes up and fills with thoughts and questions that I cannot shut out for some time. I frequently end up googling some obscure fact in the early hours to try and stop myself from dredging my lousy memory for the answer to the random mental question of the night.
Then some of the time when I wake it is from intense and stressful dreams, usually full of bad things happening and while I am relieved to find it is not real, I am tired from living through the dream as if it were. It almost always involves trying to get somewhere or finish something, and repeatedly failing. I honestly feel like I sometimes get more rest when I am awake than when I am asleep.
So I am tired all the time for a whole range of reasons, and I imagine others with depression could tell similar tales, if different in detail. My wife will frequently remind me not to be cross with myself for being tired as there is really very little that I can do about it, but it is immensely frustrating. All I can do is to continue to take one day at a time, try and be kind to myself and find what works best for me. Please try and do the same for yourself.