I experience massive fatigue with bipolar disorder. True, there are likely other components to my fatigue, but I know bipolar disorder is a driving factor. The fatigue is so bad that I think it’s one of the worst parts of bipolar disorder or any chronic illness. Fatigue affects my life on a daily basis like no other symptom of bipolar disorder and worse yet, there are pretty much no cognitive tools I can use to cope with it. Read on to learn about bipolar disorder and fatigue, why it’s so hard to best and the treatments for fatigue in bipolar.
What Is Fatigue?
Fatigue feels like extreme weariness. Fatigue feels like every cell has no energy, every cell is exhausted. Fatigue feels like a ball and chain is attached to your body every six inches and you’re being forced to drag that iron around every day and you don’t have the strength or stamina to do it.
According to one study (referenced at the end):
Patients describe fatigue as diminishing vitality, work and activities because of muscular weakness, and/or impairment in their cognitive functioning.
But fatigue is not the same as tiredness. I didn’t truly understand the difference for years, but now I do. Watch this video for more on how fatigue and tiredness aren’t the same thing.
What Is Fatigue in Bipolar Disorder?
Fatigue (or loss of energy) is a core diagnostic symptom of depression so it makes sense that people in a major depressive episode as part of bipolar disorder would be experiencing it. However, I have found that fatigue is considerably stickier than that. Fatigue seems to happen in bipolar disorder even when the depression is not as prominent. Research does bear this out. People with major depression experience fatigue even when successfully treated with antidepressants, even to what is considered remission.
There doesn’t seem to be the same kind of data on fatigue in bipolar disorder; however, I suspect we can generalize that if people with major depression experience fatigue even in remission, then those with bipolar disorder likely experience fatigue even when not in a depression.
The Problem with Fatigue in Bipolar Disorder
To someone who has not experienced fatigue, it might sound like just drinking extra coffee or sleeping more would fix the issue. After all, if you’re tired (not the same thing [see video above], but more widely understood), that can work. But fatigue just isn’t like that. Fatigue doesn’t respond to the same things that being tired does. Fatigue is constant. For those who experience it, fatigue is something we have to battle every second of every day. I wake up fatigued and I go to bed fatigued (although the mornings are better for me). For me, with bipolar disorder and fatigue, it feels like I’m exhausted all the time but I’m able to fight it — until I can’t. I fight, and fight, and fight and then I just seem to crumple into a ball, unable to move an inch. It’s then that I have to lie down, and lie down, and lie down. It feels like half of my days are spent desperately fighting the fatigue and the other half are spent lying down, giving into it. In other words, 100 percent of my days are spent being controlled by fatigue.
And I’m not the only one. Not only might people with bipolar experience fatigue but so might people with major depression, anemia, thyroid dysfunction, or cancer, among many other illnesses.
Treating Fatigue in Bipolar Disorder
Believe it or not, there may be things you can do to help fatigue in bipolar disorder or another disorder. While there isn’t a lot of empirical support for it, these antidepressants are thought to help with fatigue because of their specific mechanisms:
- Venlafaxine (Effexor)
- Bupropion (Welburtin)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
Of course, if you have bipolar disorder, antidepressants may not be an option for you as antidepressants can destabilize a person with bipolar disorder. That said, some people are able to take an antidepressant if it is prescribed alongside one or more mood-stabilizing drugs. Your doctor can tell you more about this risk.
Another option to fight fatigue is modafinil (Provigil). Modafinil is what is known as a “wakefulness-promoting agent” that is typically prescribed for those with narcolepsy (typically, excessive sleepiness during the day). Modafinil is also known to help with depressive symptoms — possibly because it improves fatigue and this helps with other depression symptoms. (I don’t know of any information about modafinil destabilizing a person with bipolar disorder, but your doctor should be able to evaluate your risk.)
Amphetamines (Adzenys, Adderall) and methylphenidate (Ritalin) (these drugs are often prescribed for attention-deficit/hyperactivity disorder [ADHD]), can also reduce fatigue although these drugs tend to work on fatigue more slowly and less frequently. (Again, your doctor should be able to evaluate the risk of adding this type of medication to your existing medication(s).)
Finally, new research suggests that ketamine can also reduce fatigue in bipolar disorder. One study using ketamine infusions in those with treatment-resistant bipolar disorder found that:
. . . ketamine significantly lowered fatigue scores compared to placebo from 40 minutes post-treatment to Day 14 with the exception of Day 7. The largest difference in anti-fatigue effects between placebo and ketamine was at day 2 . . . The effect remained significant after controlling for changes in non-fatigue depressive symptoms.
In other words, ketamine reduced fatigue in bipolar disorder even when other depression symptoms were not similarly improved, indicating that ketamine (which alters glutamate) may specifically target the symptom of fatigue for improvement. Unfortunately, ketamine can be difficult to obtain and is out-of-reach for many. (Note that this study was on ketamine IV infusions and not the more available intranasal form of ketamine.)
Finally, while I haven’t seen it mentioned specifically, I suspect that exercise can help with fatigue as well. Of course, some people will be so fatigued that this simply isn’t an option for them. If this is you, I understand completely.
Bipolar Disorder and Fatigue
So that’s the story of fatigue and bipolar disorder. Unfortunately, I haven’t found anything that truly helps my fatigue dramatically (although I haven’t tried ketamine). That said, maybe one of the above will be more useful for you.
If you’ve found something that helps with fatigue, please let us know in the comments.
Reference
Saligan, L., N. et al, “An Assessment of the Anti-Fatigue Effects of Ketamine from a Double-Blind, Placebo-Controlled, Crossover Study in Bipolar Disorder.” Journal of Affective Disorders. April 2016.
Image by Shanghai killer whale / CC BY-SA.
I have chronic pain from a back and neck injury, as well as bipolar. As soon as I take any mood stabiliser, my mood drops into depression, where I stay for months and months at a time. The fatigue kills me. I’m due to have a ketamine infusion for my pain very soon. I’m so hoping I get some side benefits of reduced (remission? ?) depression and fatigue. Let the experiments begin.
I’m interested in learning more about how we can support those with Bipolar through their rights within the Americans with Disability Acts (ADA). These rights support accommodations that could address the issues through means other than medication. I recognize and respect that medication can be of some assistance to address the fatigue, however, as you indicated not all people can tolerate some of these medications or may not want to add more meds. I’d appreciate thoughts or resources on this topic. I am also aware that receiving appropriate levels of support of one’s rights can be a battle or include some discomfort in terms or labeling, bias, prejudice, etc. My hope is to help identify resources to help level the playing field for those who are protected by the ADA.
Hi Natasha and all here, thank you for writing this article and to my peers here, thank you for sharing comments. I was diagnosed with PMDD and Schizo-Affective Disorder, Bipolar Type. I think I used to experience more fatigue, but maybe it has improved. I take Perphenazine and Latuda, and have been in treatment for my PMDD. I used to take Lithum. I used to take Clonazapam, which may have made me sleepy, and added to fatigue. PMDD made me feel super depressed fatigued at times. Looking at my life recently,I have trouble relating a ton with the feeling of muscle heaviness and being attached to a heavy ball and chain, related to fatigue. I hope this improves for you, and that you will have support and discover tools and active strategies to work through and treat this form of fatigue. What works to help my fatigue is coping through through depressive phase: I might call a warm-line to talk to a counsellor or peer support provider, and today have been accessing mental health recovery resources online, through Google and from a warm-line crisis responder in my area. Sometimes releasing emotions via healthy self-expression and venting with my therapist may help. I try to schedule regular follow-ups with my care team. When I am depressed, I usually spend more time feeling down/negative in mood, I have trouble coping at times, and am unable to function as well, also. Stressors worsen this for me. Now, come to think of it, I personally tie my experience of fatigue to feeling less able to do tasks, and feeling down and tired. I might gravitate towards laying in my bed, and at that time, may feel like I cannot do much else. I want to develop coping skills to get through tiredness and lack of motivation due to bipolar depression. I want to be able to function well on a day to day basis, and learn the actions and tools that will get me there. I think I was more fatigued yesterday, after I began a new treatment for PMDD. I was “stuck” a lot in bed, stressed and depressed and worried, and rated my lethargy, tiredness, fatigue; low energy a 4 out of 6, 1 being “not at all” and 6 being “extreme.” The medication you had mentioned that may help with fatigue sounds kind of promising, but I am hoping not to take more meds, unless I know it will be good for me, and the whole thing on possible side effects is a tough one for me. If the med helps with fatigue, that increases our hope l though. Today, I worked out for the first time in a long time. Afterwards, I felt brighter, and did not feel as fatigued from a depressive phase. I felt more positive after the workout, and had to coach myself a bit to get to the point of starting the workout and getting through the “hump” somewhat inertia and stating a purpose in the workout for me, and, thus, to boost my motivation. Fatigue is tough, and I am glad we can openly talk about strategies to overcome it, here and our unique individual experiences with bipolar fatigue.
Thank you for this post! I find the battle between describing “being tired” and “fatigued” are so prevalent when trying to convey how i feel sometimes. Chronic fatigue is a battle i have been facing since I was initially diagnosed with depression at 19 but was more prevalent as I entered my 30s. So interesting how challenges change, fade, increase as we age!
Judy. I am on Provigil and have been for nearly fifteen years. I find that it helped right away with fatigue and some of the depression. It doesn’t jangle one’s nerves or interfere with my other meds. If anybody out there is fighting fatigue, I recommend trying it. Oh, yes-it took affect right away for me.
Thank you for the comprehensive information. I have bipolar disorder and I have been stable on my meds for quite some time. My symptoms are minimal except the fatigue. I find it a daily struggle and problematic if I am at a lengthy social event. At some point, I hit a wall and I can barely talk or move. I just sit stuck in a chair yawning.
Such a great article! This is my worst symptom now that I have a working mood leveler. Just constant!