Feels Fatiqued & Always Sleepy
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Q:  Feels Fatiqued & Always Sleepy

Forgive me if this type of question has already been answered in the  archives - I couldn't find one.
I began to self injure when I 13 and shortly thereafter was diagnosed with depression. My first medication was Paxil and as time passed, I was switched from one SSRI to another since none improved my condition. I'm 23 now and only recently (for about a year and a half) have I been diagnosed as being somewhere in between BP II and BPD. I take 1500mg Depakote ER , a mulitvitamin, and omg.3 everyday and 10mg Zyprexa as needed and I can definitely tell a difference in the stability of my moods. My biggest problem now is fatigue. For as far back as I can remember, I have always been sleepy (even as a child). I can usually manage to keep myself awake but if given the oppurtunity, I will fall asleep any time of the day and continue to sleep for at least 2 hours. I can even sleep for as long as 12 hours and feel tired an hour after I've woken up. Getting out of bed is nearly impossible and I even set my alarm for and hour and a half before I need to wake up (I've had to do this since middle schol). My doc prescribed Provigil to relieve the fatigue and at first it worked wonders and I finally knew what it felt like to be awake but now it only seems to fight off the very extreme fatigue. I don't have a history of drug abuse and my family doc has never mentioned the possibility of any kind of physical problem so what could be causing this? All those years of prozac & co. confusing my chemistry? My non existent exercise routine? I'm fairly thin so could it be my terrible diet (simple sugars - yum)? No one seems to be taking this problem as seriously as I am - any ideas?

Dear Erin -- 
Sounds really frustrating, to have the obvious symptoms gone but such a limiting one remaining.  So, first off, someone has probably talked with you about a "sleep study" to make sure you don't have some sleep disorder that causes all this daytime sleepiness?  Even thin people can have sleep apnea, for example.  Seems unlikely but that should probably be ruled out first. 

Then I imagine people have looked at your thyroid function many times as well.  There is some speculation, at least among people with the thyroid problems (less so the endocrinologists who treat them) that there are individuals who can have normal thyroid tests but still have "hypothyroidism".  If you were one of those people who's always cold when others are comfortable, this might be more likely; though usually such people are not thin.  However, it might be good to learn about thyroid and bipolar disorder; I've summarized most of what I've learned so far in that essay. 

Then there's your diet.  Insulin can affect mood and energy very powerfully.  Thin people generally have less trouble with this (there's a disorder called metabolic syndrome that is an insulin problem but those folks are almost all quite large around the belly, it's part of the syndrome). So that sounds like an easy one to try to vary on your own to see if it makes any difference -- e.g. turn yourself into one of those seriously healthy eaters for a month -- yoghurt, tofu, whole grains; or the Atkins approach even -- and see if it makes any difference.  

I definitely see people with low energy like this, but usually it's associated with low mood and motivation as well.  Yours sounds not so much like bipolar disorder as some sleep disorder that began way back there at puberty.  I've not heard of Prozac and company being accused of doing something like this.  

I hope you find something to address this problem.   Good luck with that. 

Dr. Phelps

Published June, 2004


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