Extreme Fatigue

[Stabbitha]

Hello everyone,

I'm at my wits end and feel very lost.

I'm in my 30's, I was diagnosed with adhd when I was 31 or 32. It's only been 2 years since I've been on ADHD meds.

I also have depression, anxiety, PCOS. I take escitalopram 20MG, Wellbutrin 300 MG, and Vyvanese 40 MG.

I use to work in a very busy job where I was on my feet all day, I was always exhausted and never slept well. Since then I've changed jobs (to an office job), have found out I have sleep apnea which I have a cpap machine for.

By all means I should be feeling okay. My iron levels always come back okay.

I am so tired that I could nap during the day and easily sleep 3-6 hours. It doesn't matter if I get 5/6 hours of sleep, or 12 hours of sleep. I am always exhausted. It is severely impacting my life and I don't have the will to do anything because I am so tired.

Another example: If I really need to clean my house I'll two of my vyvanese (don't worry I don't do this often) but if I didn't sleep well enough the previous night, I can easily go to bed for a nap and pass out.

I feel like Doctors & people just look at me and are like "hey you're fat. Just move" I have nooo energy to move. I am so exhausted, and I use to walk 20k steps a day and I was still exhausted.

It frusterates me so much because I spent my 20's working 6 days a week in retail, then I got a horse who I had to take the bus too and was it was normal for me to get 2 hours of sleep after closing the store, taking care of the horse, sleep 2 hours, then go open the store. Then I got into Management and was easily working 10-16 hours a day. The past 6 ish years I've just become so tired and I'm not use it to it.

Apologies, I hope this mostly made sense. Thank you for listening to my ramble.

[Redpanda5]

I recommend getting a full panel blood test done and make sure it includes testing for MTHFR. I had been exhausted for years and no doctor gave me any explanation other than ridiculous ones like, “you have children —- that’s making you tired,”…….and my favorite…..”you have tired blood.” Seriously?

I recently saw a nurse practitioner who got right down to business and my blood test came back that I have the MTHFR gene mutation. In other words, my body doesn’t absorb vitamin b12. That’s why I’ve been so tired for decades! She put me on liquid drops and it’s helping. Being zombie dead tired all the time is awful. I hope you can find some answers.

[Slmndrs]

It's possible you are just really tired from years of pushing yourself. I also feel like half the people I know are dealing with post-viral fatigue (not necessarily long covid) now, and you're body is either still fighting something off or recovering. There are other possibilities too. Two years ago I was tired for months and the docs never figured it out, retrospectively their best guess was mono. Eventually I did recover.

It's a great idea to get a full physical with tests for the usual suspects (vitamin D, B12, thyroid, etc etc), and also just listen to your body and rest.

[wtfadhd]

hey Stabbitha,

if 2 vyvance help ya get moving, then why not have your script increased?

i agree that a blood panel might be a good idea, but i assume that you get yearly physicals and if do then the medical provider probably already has checked your blood?

the mist common culprit of low energy is modern society is processed foods n sugar, “ low fat” food just replaces the fat with more sugar which does way more damage than full fat food. just avoid processed foods n all processed sugar all together if you struggle with weight. not a quick fix but the reality is that having a healthy body weight is first step in trying to figure out what is causing you to be so terribly low energy. after u can rule out being overweight, u have a better chance of going to next step like blood panels, n more expensive tests. with zero energy, its ridiculous to think a human can start losing weight by exercising. im sorry n sick that u have to hear that nonsense:(. but cutting out processed foods n all sugar takes no extra time or energy

good luck

[KoalaWalla]

It DOES take a lot of time and effort to cut out out processed foods. It takes a lot of time and energy to prepare meals and do basic self-care tasks when you work a stressful job for which you are likely not well-compensated and have to take a bus to visit a beloved animal that also requires tremendous care and upkeep. I think our culture that demands constant “productivity” is making many of us completely burn out and shut down.

[KentuckTD]

If you have not already done this, I would recommend getting a sleep study done. Where you go to a facility and they monitor you for one night of sleep. My mom just did this and found out that her sleep apnea was so severe that even with a CPAP, she still was not getting enough oxygen while sleeping and waking up many times during the night. So they just put her on a BIPAP machine to try out.

[Quincie]

Heya I am sorry to hear of your troubles. Fatigued all the time is horrible. You said you've been diagnosed with sleep apnoea? Have you been prescribed a c-pap machine? These help a lot with the fatigue from sleep apnoea. Persevere & try different masks until you find a mask that works for you.

Do you use caffeine and sugar to give you energy when fatigued? They only add to the burn out long term. Please look into your diet & experiment with changing it. Lots of processed carbs will not help you. Try eating a new way for a month and see how you feel. New ways can be low carb, keto or carnivore. One month will not harm you & you may be surprised. I cut out grains in my diet & my brain fog lifted. That was a surprise to me.

Are you on electronic screens at night? Too much blue light keeps your mind awake when your body is screaming for sleep. So you're tired but wired.

I agree that Drs telling you to exercise is useless. Until you feel less tired you're not going to be motivated to go for a walk. But changing your diet will probably help you have more energy. Best of luck.

[HCStymie]

A medication for sleep apnea would be modafinil or armodafinil which are wakefulness promoting drugs. Amphetamines like vyvanse are CNS stimulants, but aren't the ideal drug for sleep apnea and wakefulness issues. But therapist are often reluctant to prescribe more than 1 stimulant out of fear.

People mentioned a full blood panel which I also recommend. Also, did you have covid and could you maybe have "long covid"? Lyme disease is a common culprit that my present without the tell tale skin issues around the infection site. And often goes undiagnosed.

Have you checked your testosterone and estrogen levels? Amphetamines can affect those levels and one side effect is a lack of energy.

Another possibility is between Vyvanse which affects dopamine and norepinephrine and Wellbutrin that also affects dopamine and norepinephrine, you may have downregulated or damaged the dopamine and/or norepinephrine pathways and what you are feeling is that your medication is no longer strong enough to get back to a reasonable level of therapeutic effect at those dosages. And your tolerance puts you below your natural baseline to start with each day. You need to be off amphetamine overnight for receptors to upregulate after downregulating to counter the effects by your body. If you don't have that break you may accumulate downregulation of receptors. Wellbutrin I believe takes time to build up and therefore may retain elevated levels of NE and DA and reduce upregulation before the next dose. But, that is a theoretical guess. Either way, if that was the case, increasing dosage would just make the problem worse down the line.

I'd tell the doctor that the fatigue needs to be address as it is an unacceptable and unmanageable level and you are suffering from it. If they can't or won't help, you need to find a new therapist that will.