(no subject)

[johnpalmer]

PSA and thoughts to be thunk about...

Some of you know that I say I have depression and ADHD. Okay, but...

I think my real problem is and always has been fatigue. What's the difference?

I'm not entirely sure. But it does harken back to a thought I once had. I was reading up on cognitive therapy, where it encourages people to challenge nasty thoughts that pop up in their head. If you find yourself thinking "damn it, I messed up! I *always* mess up!" that's all-or-nothing thinking, and it's probably not just "untrue" but ridiculously untrue. You probably know it's not true, but if you let yourself keep thinking that, it seems that your brain stops realizing you know it's true. So cognitive therapy teaches you to catch those thoughts, challenge those thoughts, and, for a lot of people, have the depression get better.

It was a fascinating idea - prior to this, a lot of counselors didn't like to do this because they didn't want to question a person's personal experiences. Okay, but *feeling* worthless is valid as a feeling - "I feel worthless" is true, and shouldn't be challenged. Trouble is, "I am worthless" isn't valid, and should be challenged.

Cool idea; chase out the false, negative, thoughts, and let one's mind heal from the damage done by them, and get better.

But that kind of bothered me. See, I wasn't having false thoughts. I wasn't thinking "I'm *always* messing up" or "no one loves me!" or meditating only on the bad parts of my life. No, I was *tired*. I was always tired at that time. And I wasn't thinking, like "oh, hell, I'm tired today, life is *awful*" without recognizing that I just need to get through the day and get a good night's sleep.

No, I was rationally projecting that I was tired that day, I'll be tired the next day, and the day after that, whether I sleep well or not. I wasn't thinking false thoughts to be challenged; I was thinking true thoughts.

I might also have been depressed, of course. And I might also have been suffering from ADHD, of course. But this should have been a hint for me.

I was lucky, in a sense. I undertook a fitness program that allowed me to slowly recognize that exercise would significantly worsen my symptoms, and think about that from a lot of different perspectives, and finally recognize that what I had wasn't depression sapping my energy; what I had was too little energy, so I was always draining my reserves, just to get through the day.

And now I wonder what I could have told a 25-year-old John that would have helped him get this.

I'm not sure. In part because, well, hey, I'm tired.

But it seems there ought to be a way to make up some differential diagnostic criteria to determine a few differences.

Comments

[elainegrey.livejournal.com]

When i finally started addressing my allergies and asthma, i became pretty angry. Could a substantial part of my depression have been seeded from being unhealthy yet being taught you ignore your body's messages of complaint? The anger has passed, but - i agree- there's plenty to sort out beyond one single diagnosis.

[johnpalmer.livejournal.com]

Nod. The bit about being taught to ignore a body's complaint - that's been bugging me. It took me a long time to realize that exercise triggered the fatigue because I was so used to feeling awful all the time.

I sometimes dream of starting a website "what is normal?" where we could collect data about things. Collect enough stories that say "I'm 43, and I started training for a marathon, and it took me a year but I did it," and you can get people who say "wait! I'm only 38, and I've been unable to run a marathon after training for *two* years!"

Or you find that most people who are lactose intolerant have symptoms for 6 hours (made up number - I have no idea how many hours is normal!), and someone else might say "but I get symptoms for at least a day!" so there must be something else going on.

[ljgeoff.livejournal.com]

This makes great sense to me. I, too, have wondered at how much of my mood imbalance is happening because of migraines and cluster headaches. We are a fascinating, complex organism; I will be very interested in hearing how this all plays out for you.

[johnpalmer.livejournal.com]

Heh. I'll be interested in seeing how this plays out, too. I wish I could peek at the end of the book.

No, technically, I wish I could just know what would help. I don't want to look forward and find out that nothing did.

[acelightning.livejournal.com]

You could have told 25-year-old John, "Get your hormone levels and general metabolic performance checked - this is a physical, not psychological, problem." But that's not really completely correct either. The more research there is, the more it becomes evident that mind and body are, as the Buddhists say, Not Two. Mood disorders, and other "mental" problems, turn out to be imbalances in body chemistry, and antidepressants help with chronic physical pain. A psychiatry resident doing the requisite ER rotation diagnosed my mother-in-law as having depression, when what she actually had was a fulminating case of pneumonia (on top of long-standing emphysema); lack of oxygen in her body was depleting her energy. And sometimes I even have to ask myself, "Am I depressed, or depleted?"

The sooner they figure out what's up with you, whether physical, mental, or both, the sooner they can start fixing it!

[johnpalmer.livejournal.com]

What I'm really talking about above is, is there some way of figuring out that "it's not depression as primary; it's fatigue." Because there are probably millions of people with fatigue (1% = 3 million) and some will get put on one antidepressant after another, because they're close enough to normal otherwise. I saw one sad commentary on the state of medicine in a discussion group: "if you're not removed from 95% of the population, an endocrinologist (can't? won't? I don't remember) help you".

It's true, though perhaps a bit unfair - you don't necessarily need to be removed from 95%, a doctor can say "You're in the outer 15% *and* you have symptoms consistent with a shortage". That's frowned upon, and it should be, precisely enough to discourage wild experimentation, while still allowing patient treatment.

(Heh. And now I'm wondering about the history of estrogen replacement therapy. And that's yet another thing I don't have the energy to dig into.)

[acelightning.livejournal.com]

Endocrinology as a field of medical practice is somewhat behind the cutting edge of endocrinological research. Unless you're being treated in one of the top teaching hospitals in the US, you're likely to get a formulaic, one-size-fits-all approach to treatment. (This is true in other fields of medicine as well, of course - doctors, just like other people, tend to fall into a routine and become very reluctant to change it.) So the average endocrinologist probably won't get aggressive about diagnosis and treatment unless you have a very unusual condition.

This website might give you leads to more information. Among other things, it mentions genetic anomalies that relate to men's health, which you might want to look into.

And it happens that I know a fair bit about estrogen replacement, since I've had both endometrial (uterine) and breast cancers. For a very long time, menopausal women who asked the doctor for help with their hot flashes, mood swings, and decreasing sex drive were told that it was "all in their head", and maybe given some tranquilizers. But menopause also has demonstrably physical effects, including osteoporosis. When women were given estrogen to make up for what their bodies no longer produced, it helped reverse, or at least stop, bone deterioration. But it also improved their skin tone, cardiac health, and other physical factors. And it prevented hot flashes and mood swings, and increased their sex drive. Suddenly women were demanding that their doctors give them estrogen to keep them "forever young". After a while, though, it was discovered that estrogen alone could lead to breast and endometrial cancers, and other negative effects. Adding some progesterone to the mix did a lot to mitigate these dangers. (The combination is very similar to that of birth control pills.) However, the progesterone introduced other risk factors, and now a lot of women are dubious about hormone therapy. (I declined the offer, despite having some pretty gruesome symptoms, which turned out to be a very good idea; both of the kinds of cancer I had would have been much worse, possibly even inoperable.)