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I’m So Tired – Bipolar Disorder and Fatigue

December 8, 2014 Natasha Tracy

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:

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

People with bipolar disorder often experience fatigue. But is your fatigue medication- or bipolar-related and how do you treat 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.

You can find Natasha Tracy on Facebook or Google+ or @Natasha_Tracy on Twitter or at Bipolar Burble, her blog.

APA Reference
Tracy, N. (2014, December 8). I’m So Tired – Bipolar Disorder and Fatigue, HealthyPlace. Retrieved on 2024, May 18 from https://www.healthyplace.com/blogs/breakingbipolar/2014/12/im-tired-bipolar-disorder-fatigue



Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Find Natasha Tracy on her blog, Bipolar BurbleTwitter, InstagramFacebook, and YouTube.

Diane
August, 15 2018 at 9:51 am

I agree with Natasha. And don't give up on finding the right mix or right doctor. It took me 10 years and a relocation to find mine. Therapy also helps. I would also suggest bringing Dad with you to one of your doc or therapy appointments. There are also family support groups out there. Hang in there. You're on the right path. Try praying and going to church too. Just a thought.

Lynn Clark
April, 9 2019 at 1:12 am

I really like what Natasha and the others have given as suggestions, Elizabeth. Congratulations on your recovery day by day! That’s all any of us has, after all, isn’t it? One day , then one more... you will do great, Elizabeth! You have already reached out here and been proactive in your recovery in other ways. You’re not feeling sorry for you and you are willing to do whatever it takes to stay sober and clean. Simple. You will gain strength with each victory. Hold your head up, Elizabeth! You ARE making it, RIGHT NOW. Way to go, girl!

Di
June, 7 2018 at 10:58 pm

So pleased I read this. My hubby has bipolar type 2 and is on medication under care of a psychiatrist. He is constantly tired and I have really struggled to understand it and feel as though he is just "giving up" or "being lazy" when he spends so much time on the weekends sleeping. This article has just opened my eyes to the tiredness just being a part of the disorder and that it is so difficult to fight against for the sufferer. Thank you! I will try to be more patient and undertsanding.

Marie duck
September, 24 2018 at 4:58 am

Its a relief to learn that i am not the only one,,,,i am alwaysracing in my mind with all the stuff i am up against for the week,,,,i am bipolar,,,i get tired very easily and feel this is lead on because i tire my mind and soul with every task i think of,,,i have worked with myself by using a form of meditation,,,i try not to ket it take me over because i have a shortattention span and i get annoyed pretty easily...so i try to help myself to stay calm and try to focus on what im doing at that moment,, i mess up sometimes and i just hate myself for losing my cool,, i usually end up yelling and arguing ,i wish i could find other avenues sometimes,,i believe that people who have bipolarism, we are very sensitive,,with all our senses, and we want everything perfect,,,we are very smart people and we get let down very fast,, because we move in our minds and feel the ending on anything which depresses our" spirit or drive"so quite frankly we work harder than one who does not have bipolorism, i believe it tires your mind,,,,maybe the sleep is actually the best part for this.And the medication i was prescribed is too strong for me,,,does anyone have a recomendation for a med, that has the exact dosage to put one into a better mode and mood?? Ive just been analyzed for the first time and was told i am bipolar, my moods got so bad, i was admitted to a clinic,,with no choice because i wound up in a very irate and wild mood swing....im so embarrassed, but in my own mind i felt it to be justified for the way i was,,, i got lost, the med im on is zirprasidone, is there one thats more popular than the one im on , it needs to be one that will not put me in a stuper mood of wanting to sleep?

Michelle duCros
October, 16 2018 at 12:24 pm

I’m bipolar type 1 and on a injection of drug to keep taking it. As I have a habit of taking myself off the drug in order to have energy. They took me into hospital in February and forced me to take medication otherwise I wouldn’t be allow to return home. I’ve since had to give up exercise, walking the dog & brain is foggy all the time. Even struggle to put clothes on at times. I’ve got myself a part-time job only 12 hrs but even that feels too much. I’m constantly thinking I wish I could take an injection of medication to combat this and end it... I can sleep 12 hrs a night and still want to sleep.. please tell me this is not just me. It’s like I have memory loss was a competent individual able to over come most things now a waste of space, lazy, in-creative and boring. Any suggestions appreciated

Biggin
December, 23 2019 at 5:43 pm

Hi Michelle,
I was in the hospital twice this year . They forced me to take the invega shot as well I’ve been dealing with many side effects from all of these new medications. My last manic episode was 3 years ago. I’m worried about my life... I had a business the I invested all of my money into and feel like this can not be manageable anymore. I’m hopeless all’s I do is lay in bed. I think this lithium has me feeling like a zombie

Jen
January, 19 2019 at 6:50 am

I just came across this page. I am on lamictal, lithium, prozac, an ADD medicine, Rexulti and valium for sleeping. I cannot add another medication to my list. For the past several days all I can do is sleep. I am taking two naps a day and going to bed very early and sleeping until morning. I cannot wait to take a nap as soon as I wake up. It's times like these I miss the mania. At least my house is clean, I am showered and am able to function. I just cannot do this anymore. I can't. There is no point to my comment other than to vent. It is depressing being depressed.

carol moger
February, 3 2019 at 3:06 pm

After 40 years of treatment, I'm the one who said,l "Hey. I think I am bipolar!" I have bipolar 2. My most serious complaint is fatigue, exhausting, depleting, fatigue. Last spring I became so weakened, I couldn't walk without assistance, my memory was shot with significant mental confusion. My arms were even weak. I was put into the hospital with the doctors thinking I had had some kind of stroke. After thousands of dollars of testing, nothing showed up. They took me off lamictal, but my psychiatrist doesn't believe it had anything to do with my symptoms. I've had these symptoms in the past (only very milder) and am in a fatigue state now where my hands & arms feel weak and all I want to do is go to bed. I need to push for a definitive dx for these symptoms. At the same time, I remember being 16 and having to push through a wall of fatigue to do what I wanted & needed to do.
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.

Marty
April, 10 2020 at 1:44 pm

Reading these comments I don't seem as bad as some being hospitalised but then again if people knew about my experiences I have sometimes then I may of been hospitalized. As I kinda keep quiet about thinking the world is going to end and thinking of ways to stop it and thinking spiders are going to kill me and other fantasy I have had. My problem really is being tired as that's the only thing that keeps me from a normal life anything else I can hide. I don't really get depressed if anything I'm tired and I have delusions that don't really affect my day to day life apart from arguments sometimes. My main problem isn't the delusions it's the debilitating tiredness. It's mad because I have a normal parsonality if you don't know me but completely different tired not that I'm unwell tired but being like that for a good amount of time people start to get suspicious like their is something up with him. I don't care so much what people think but I can't get anywhere in life just for the fact of the tiredness literally spend most of my life in bed or hardly doing much. It really shuts me down I can't think properly I even speak a bit slurred.
Trying to get a change of medication at present but getting an appointment is an nightmare, pre corona virus still no luck. I'm only on 5mg of olanzapine and I'm really tired, I did try olanzapine and sertraline which worked amazing and I mean amazing but then after so many months ended up with not much motivation and a real crap sex drive which totally wrecked a relationship I was in plus didn't feel like a man anymore. The most weird thing was I was just happy staying in bed for so many months like I never got fed up of it on the sertraline I was just happy to do that haha. I have a female friend who felt the same in the sexual department so atleast I know the medication does this. All the same I'd of stayed on the sertraline if I didn't get really lazy again just in a different sort of way but with the same outcome. The Dr said I may of just needed to up the dose. I just took myself off it which wasn't a problem as I was only still on the starting dose. I mean how long does it take to get a Dr's appointment anyways and if its not unsafe to do why not.. Maybe a consultation first may of been a good idea. I tried coming off olanzapine previous to this, never felt so horrible in my whole life! Only dropped half the dose! It's unbelievable that the tablet actually fixes so many problems for me it's just crap that I'm tired/ lethargic, too chilled out all the time. Granted I do get more energetic times but when I get tired I can't do much at all. Its weird because even though I was scared for my life and depressed morning to night, was visiting family all the time as I felt that I'd didn't want to die alone at home I'm still more concerned about being tired when I compare halfing my olanzapine dose to my usual life on 5mg of olanzapine. Maybe that's because I could easily solve the horrible anxiety by taking more of the olanzapine tablets where as this tiredness I can't solve as of yet. Though maybe so by taking sertraline! Though I did hear I went a bit off my nut taking sertraline though I could of just been having a bit of an episode anyways.. Tbh I got really over confident anyways as my memory was top notch, could speak to people normally, get up really early, concentrate really good. Everything just seemed really fluent.. I mean I managed to remember my 1 to 12 tables in about 5 days which I can still remember now and I could look at 13 didget numbers once and remember them quite easily. Everything I have wanted for such a long time and more .... Bang! It was kinda crap though as I had reached normality but still no job, no friends and living on my own, I was getting bored really really easy as I'm used to being tired and withdrawn. Which suites someone with no friends and nothing to do. I had started going to church to make friends but I don't know about anyone else but church people are really boring and are different to the rest of us they might aswell have mental health problems as far as I'm concerned because if their was a god and he was good why is everyone on this message bored suffering with these problems eh. I just pretended to believe in god and didn't particularly like the personality of the people who went to these groups to do with god anyways as some used it to manipulate their opinions to be right by using quotes from the Bible which infuriated me but never mind about that haha. Anyways just thought I would pop a message on here, like we are not alone:)

Cassidy
August, 7 2021 at 10:44 am

I just wish I could get help with meds over a online doctor just for a couple weeks to be able to get outta the bed long enough to make it back to a doctor's office. I have a child I haven't been able to do anything with almost 2 years now I lay and cry feeling so bad. I've begged for a place to help me get back on Prozac just long enough to get to a doctor but no psychiatrist think that no help apparently is better than some help. I'm sorry but I think a lil help is better none. Sometimes you have to take baby steps but if that's what it takes to get someone better than I feel like if it's in my chart I've already been on this medication and it has worked long enough to where it would help me at least get back into a doctor. I feel like happy that I just don't know what a lot of people pay three say therefore they cannot relate making it harder for them to even see where somebody's coming from a and b making it hard for a patient to ever really want to go see a doctor. There's a big difference in studying psychology for a degree and "living it"anything is I don't feel like too many people really should be able to argue with that considering half the time when you go to psychiatrist I put you on 15 different medicines before they find one that works because why it's all trial and error they don't actually know what medicine works with your body which is something they need as a patient might actually know so therefore sometimes I feel we're more qualified in psychology when it comes to our own bodies and these doctors are of course I try hard I'm not going to say that because God forbid. Nvm sorry I just want you to text me I still need to call you from years so I understand the textbook study and Doctor side but I also understand the patient side too. And I feel like putting someone being put back on a medication cuz they have a record of being on by itself that they're telling you help them just not in the long term should be ok. Because the other side of that is this is not a patient crying begging for help killing me they know that they would never make it to an appointment because I'm sorry that that happens when you get too bad off. To have someone say they won't help them on top of making out like they're stupid & crazy that's a recipe for disaster typically. But what do I know I've only delt with mental illnesses my whole life between me my mom, my 2 kids and grandmother. And took a few classes but as I was made to feel I'm just a moron. Anyways Thank you 4 having a comment place to just type this I apologize if it's somehow offended anyone.

August, 10 2021 at 8:11 am

Hi Cassidy,
I'm so sorry you're going through this right now. I know what it's like to not be able to get to a doctor's appointment. It's a catch-22. You can't do it when you need it the most.
I don't know if you've tried telemedicine, specifically, but it seems like they should be able to help you. Telemedicine has become much more prevalent since COVID. Try to work with a telemedicine doctor to either take over your treatment long-term or make a short-term plan.
Also, you might want to make an appointment with someone who will see you in person and then have a loved one "carry" you there. In other words, make a plan to get there any way you can and involve other people to help .
You can do this. I know what you're saying about how difficult doctors can be but you're strong and you can work the system to get what you need.
- Natasha Tracy

Kyle G
April, 13 2022 at 6:57 pm

I’m tired all the time & it gives me a scared feeling to feel so lethargic & uncomfortable…

April, 15 2022 at 9:59 am

Hi Kyle,
I'm sorry you're tired all the time. Obviously, I know just what that's like. I'm not sure why it's scaring you, though. I hope you're discussing it with a doctor. They may be able to help you.
- Natasha Tracy

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