Anxiety, problems sleeping and tiredness are seen as the symptomatic triad of depression. Even though depression is a psychological disorder, it can trigger somatic (physical) symptoms, loss of energy being one of them. Often, this sense of feeling tired all the time unleashes a vicious cycle that keeps some people depressed for years. Chronic tiredness, a physical disorder, is often confused with depression because the symptoms are so common. Each, however, can trigger the other so it’s possible to develop both.
Being depressed is tiresome
“My problems commenced when I had to leave University. I suffered from a flu-like condition, which led to panic attacks, depression and complete exhaustion for a couple of months,” wrote an anonymous user on a medical forum.
“I am taking mirtazapine which helps me get a full nights sleep now, but I still lack the energy that I need to do things. When I do feel well enough to get out and about and do something with my day or go out for the evening it exhausts me and results in me needing to recover for a few days,” wrote another user.
Reports such as these are abundant all over the internet. They’re not even surprising given 1 in 10 Americans are affected by depression at one point or another, and 80% of the clinically depressed are not receiving any kind of treatment.
“Some of my patients have been surprised and shocked when I’ve told them they were depressed,” says clinical psychologist Angel Adams. “They think it’s something else. If they have a lack of energy or fatigue, they might just think they’re doing too much. Sometimes they think, ‘It’s just this illness’ or ‘I had a break-up with somebody’, but really they’re experiencing depression as well as the illness or the grief reaction.”
Many of us simply don’t understand what depression looks like. “People don’t quite understand that you can still function and have depression,” says Adams. “A lot of people think if you have depression you’re going to quit your job and so on, but many people continue to work, continue to function but to a very different degree. You don’t have to be suicidal to be depressed. You can just be clinically depressed and think, ‘This is the way my life is.’”
Depression affects appetite and sleep — both vital to generating and replenishing energy. In most cases, patients report insomnia and getting less sleep, though sleeping more than you have to will also ruin your mood and energy levels.
Even when patients do get reasonable hours of sleep (six is considered the bare minimum), most report waking up “un-refreshed” and tired throughout the day. That may be due to the fact that depressed people don’t get the same kind of quality sleep as everybody else. Researchers who scanned the brains of the clinically depressed found:
- it takes much longer to get off to sleep
- the total sleep time is reduced
- there is little or no deep sleep
- REM sleep occurs earlier in the night
- there are more frequent wakenings during the night, which may last long enough for the person to be aware of them. The person wakes up earlier in the morning. The person wakes up earlier in the morning and can’t get back to sleep, even if feeling very tired.
Scientists assess sleep by measuring the brain activity that occurs in the brain. Depending on the frequencies of the measured electrical signals, sleep can be divided into different stages. A normal person will go from stage one to four when falling asleep, and in reverse when waking up. The fifth stage is called rapid eye movement sleep (REM) because the eyes move frantically — it is in this sleep stage that we dream.
Dream are very important to our psychological well being. Even when we have repetitive dreams of everyday occurrences, these sort of dreams help the mind ‘put things in order’. Here’s an enlightening account by sleep researcher Rosalind D. Cartwright, from the book The Twenty-four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives (public library):
“The more severe the depression, the earlier the first REM begins. Sometimes it starts as early as 45 minutes into sleep. That means these sleepers’ first cycle of NREM sleep amounts to about half the usual length of time. This early REM displaces the initial deep sleep, which is not fully recovered later in the night. This displacement of the first deep sleep is accompanied by an absence of the usual large outflow of growth hormone. The timing of the greatest release of human growth hormone (HGH) is in the first deep sleep cycle. The depressed have very little SWS [slow-wave sleep, Stages 3 and 4 of the sleep cycle] and no big pulse of HGH; and in addition to growth, HGH is related to physical repair. If we do not get enough deep sleep, our bodies take longer to heal and grow. The absence of the large spurt of HGH during the first deep sleep continues in many depressed patients even when they are no longer depressed (in remission).
The first REM sleep period not only begins too early in the night in people who are clinically depressed, it is also often abnormally long. Instead of the usual 10 minutes or so, this REM may last twice that. The eye movements too are abnormal — either too sparse or too dense. In fact, they are sometimes so frequent that they are called eye movement storms.”
There’s another pattern related to REM in the depressed: they don’t remember what they dreamed or have a tough time recalling fragments. Thus the mood-regulating function of dreaming may be disrupted in the depressed brain.
It may all be rooted in stress
It’s not clear what causes depression, but prolonged stress seems to play a major role. When we’re stressed, the brain is flooded with the stress hormone cortisol. If this state of stress remains heightened for a long time, there will be more cortisol and less dopamine and serotonine, the lack of which have been linked with depresion. So, stress can exhaust the brain and lead to depression, which always seems to trigger more vicious cycle problems: you’re depressed so you become more stressful; you have trouble sleeping so you feel tired; you feel tired so you don’t feel like doing anything meaningful anymore. It really is terrible, and once the circle is complete most people have a hard time breaking free.
This is why depression can be very cruel, and serious medical attention needs to be considered. Both depression and insomnia can be treated with anti-depressive drugs. The most common belong to the class called selective serotonin reuptake inhibitors, and insomniacs who start taking one of those drugs often find relief for their sleeping problems. Non-pharmaceutical methods of addressing insomnia can also help with depression. A few short tips that might help include:
- exercising during the day, but avoid doing so two hours before planing to go to bed.
- avoid caffeine (coffee, tea, energy drinks) and alcohol.
- use deep-breathing exercises to relieve anxiety.
Remember, feeling tired all the time isn’t solely confined to depression. In fact a slew of physical disorders can cause these lethargic sentiment. Before visiting a psychiatrist, the best course of action is to have some basic blood tests. The doctor will then be able to check for infection, anaemia, and thyroid problems, which could all be relevant.
Hopefully this article helps explain why depression makes you tired.