Lack of motivation - or is it fatigue? - getting worse with age

[namechange4achange]

I'm 41 but feel older. I have always had issues with motivation and been a bit up and down - working very hard for a few weeks and then crashing. Over the years the "up" times are getting shorter and they take it out of me more. The "down" times are rapidly becoming the norm.

I am childless, single, self-employed and very un-materialistic, cheap rent etc. hence I can get away with doing very little. I am currently working about 10-20 hours per week. I don't have much social life. I do political activism when I am in an "up" phase but in between I do almost nothing. I spend a lot of time lying in bed, watching videos, scrolling through social media and eating.

This is not because it's what I want to do though! Inside, I am not a lazy person. The work I do is for good causes and I want to do it well, I don't want to keep putting clients off with excuses. I want to be there for my friends and family and participate in life. I don't think it's pointless or that I can't be bothered - I think there are fine reasons to do all the things on my to-do list, but when I think about doing any of them I just can't face actually doing it.

One thing that is worrying me is the last few months I've found it increasingly difficult to sit up straight or hold my back straight for very long. If I sit up in a chair at my desk for half an hour I feel an overwhelming urge to lay down on the sofa, which means I have to work on my laptop propped up with a curved back, and I'm starting to get a sore back all the time from this.

I do still have the up times, don't get me wrong. Recently I spent a couple of weeks doing something which expended a lot of energy. So I would expect a bit of recovery time, but I need so much more recovery time than anyone else, and am so much more incapacitated by it. I can't even imagine how anyone can do a 9-5 job or look after children.

I get tired earlier and earlier at night. I can happily go to bed at 6pm. I can't sleep at that time but I just want to lie flat and read or watch something. In the morning I wake up thinking "Oh God how am I going to motivate myself to do anything" and "What comfort food do I have for breakfast so I can lose myself in that and stop worrying" (because all this is very worrying to me)

I am letting everyone down every day and letting myself down, but it doesn't feel like my fault. I just don't have the energy!

I know you will probably say go to the GP but I live in a deprived area in the North and the GPs are all overworked. I just don't think they'd take it seriously. Previously in my life I have seen the doctor about depression because I've felt utterly miserable and had unbearable psychological pain. That's not how I feel now, I feel OK, just fucking exhausted.

I'm open to being persuaded to go the doctor but I am also interested in hearing if anyone else has felt like this and if they got over it and how...

I have a diagnosis of bipolar type 2 and my lows are similar to how you describe (occasionally they crash into full blown depression but not usually). I also have anxiety (like you describe with the worry) and I think this can really drain energy!

I would suggest seeing a mental health professional if you can. Maybe self-refer to talking therapies to begin with? They have an IAPT service in most areas.

I would also suggest setting yourself small and achievable tasks each day and committing to doing them, this helps me. I also find getting out of my house (even just to meet a friend for coffee) and exercise help somewhat with the fatigue and lack of motivation.

I hope you feel much better soon

How is your diet? And do you get any exercise?
I’d say lots of veg and cut out wheat for a few weeks see if you feel brighter (some people find it an inflammatory and can make you tired and ache)

Just a thought - there is the possibility that your problems have a real physical cause and therefore I'd suggest seeing a GP. They can do blood tests etc to check for anything obvious (thyroid, deficiencies, hormones etc) and might have other ideas. I do know it's no fun to live this way and so I'd suggest you make an appointment with GP first and then if you are given the all okay physically try talking therapies (or private therapy if you have the means).

OP I often feel extremely similar to you. Everything you have described is very very familiar to me. I suffer from chronic depression. Have doen for years. You put it so well when you say that inside you are not lazy. Lazy people are satisfied with doing little. They are glad when they managed to get away with less, whereas I alwasy feel sad and dissatisfied, as though I've let myself and others down. But the motivation is zero and the energy is so so low.

Today I forced myself to shower, wash my hair and turned the shower to cold to try and wake myself up from the winter sluggishness. I got dressed and went for a hill walk with my DC, helped DS2 with some forms he had to fill in, and then went food shopping locally. Later I'll cook tea with lots of fresh veg. But that's it for today. As much as I can manage. I've been in bed for three days with exhaustion from doing nothing. I have some paid work that's been outstanding for several days because I can't focus on it. I'm supposed to start a new project tomorrow and I can't get any enthusiasm for it.

Tbh, I do have loads of tricks up my sleeve for times like this - I make myself shower and dress, walk outsde in the fresh air, eat five a day, watch comedies etc to stop my mood from dipping. I've done all of those today and am proud of myself for not staying in PJs and sleeping all day long. But I wish I could take it further and actually work. I long to be more productive.

Thank you for the replies!

@brightside11 I have wondered about bipolar but when you hear about bipolar it is always about people going so manic they don't sleep for days. Are your "up" times fairly moderate too?

You are right that I should get tests for physical causes. To be honest I think I'm a bit scared of going to the GP because they might be dismissive of me. But it would be wonderful to find out that it was a vitamin deficiency or something that I could just fix! So yes I will absolutely do that. (I am actually not registered with a GP since I moved house - a year ago! - but I will get on with that)

@bionicnemonic My diet is not too bad. I eat fruit and veg in between the cake and chocolate ... It could be better but I am doing what I can given the difficulty of getting to the shops and the difficulty of motivating myself to eat well. I have recently started going swimming with a friend once a week which I love, but other than that I find it hard to face doing any exercise.

Thank you for the advice about wheat but I think I will wait to have physical tests before making big changes to my diet. Also I have this thing about not restricting my food as I believe that having any kind of rules around food (apart from positive ones like 5-a-day) can lead to binge eating, which I struggle with anyway so I don't want to encourage it!

@milliefiori yes you sound a lot like me ... Congrats on having a good day today - that's a lot of stuff you have done & all healthy things! How do you "make" yourself do things though? I have never been able to do that. If I have specifically committed to do something for or with someone else then I can usually manage it (although not always and I'm often late). But if it's just for myself I don't know how to. I read somewhere that when you are tired your willpower goes out the window and that is definitely true for me. Any advice would be appreciated!

Also I often try the approach of setting myself things to do everyday, small things like you say, 5-a-day, writing a few pages of journal, getting out of the house... I make little charts with boxes to tick. This usually goes well for a while but then I get to a point where I can't motivate myself to do them and it all stops. I do think it's a good approach though, and I will try to stick at it.

Hi
I find it hard to 'make' myself do things. The most successful way is to say very quickly and loudly in my head, 'You don't have to want to do this, you just have to do it.' That gets me out of bed. Then in the bathroom, again, 'You don;t have to want to, just do it,' Turn on the shower and stand under it.

Recently tbh I would have found it very hard to motivate myself to go for walks, but it;s half term and I care a lot about DCs health even f I find it hard to care abotu mine, so I drag them out to get them some sunshine and air and execise as they are teens who would happily stay glued to screens in their PJs all day unless prompted.

So, only basic tips: involve someone else (which you are already doing and it works, so that;s great. Keep up the weekly swim and maybe add a weekly walk with another friend. And just do it before you get a chance to think about not doing it. Just 'Doesn;t matter if you want to or not, you are now showering/dressing/leaving the house etc. I find this works for small stuff. It's harder to do - sometimes works, sometimes not, for bigger challenges like completing some work to a deadline or organisingnything complex.

But I did just now manage to review a piece of work and send it off to someone I'm meeting tomorrow in time for the meeting, which I might not have managed if I hadn't read your post and thought, argh, I'm just the same. It prompted me to act. So thank you.

@milliefiori thank you for getting back to me, and I'm very glad that I inadvertently helped you!

I have not yet managed to try your approach but am working up to it!

This may or may not interest you or you might already know about it but for a long time I've been quite fascinated by Kent Berridge's research on the difference between wanting and liking. "Wanting" being the motivation to do something, vs "liking" being the actual pleasure gained. You can want something, and be driven to do/seek it, even if you don't actually like it. I know this is true because I was like that with smoking cigarettes for years - I would crave them and be driven to smoke them but most of the time I found them quite horrible. And the opposite can also be true - you can like something (a walk in the park, a healthy meal, a bath) but not "want" it. In a healthy person (or indeed rat), liking something should cause you to want it and not liking it should stop you wanting it. But these are two different systems in the brain. The wanting part is to do with dopamine and the liking part is a pleasure response (endorphins perhaps, I'm not sure). And sometimes they can come apart when one or the other system dysfunctions.

So your thing about "I don't have to want to I just have to do it" really reminded me of this. And for the first time I started thinking about this phenomenon in relation to depression. Perhaps there are different kinds of depression which relate to dysfunction of each different system. The standard thing we think of when we hear "depression" is unpleasant feelings & lack of pleasure, which perhaps relates more to the "liking" circuit. And if people are unmotivated and disinclined to move, it is intuitive to think "Oh they don't want to do anything because nothing gives them any pleasure". But in the kind of depression you and I have, that doesn't seem to fit so well. We like doing things but we have trouble with the "wanting" side.

Maybe there are two very different types of depression?

Most anti-depressants seem to focus on the liking side, e.g. SSRIs to increase seratonin to make people feel happier. (I must admit I don't know exactly how seratonin relates to all this, but I know that people often describe anti-depressants as mood enhancers, the purpose of them being to make you feel better). But maybe what we need is not something to make us feel happier but something to tap into that wanting system so that we are motivated to do all the things that we know will make us feel better naturally. I know for a fact that if I was eating well, exercising, getting out in the daylight, doing a good amount of work every day and seeing my friends and family I would not need any help with my mood! Those things would lift my mood by themselves.

It turns out there is one type of AD that works on the dopamine circuit specifically. It's called Buproprion and in the US it is widely prescribed for depression under the name Wellbutrin but in the UK it is not, however it is prescribed for smoking cessation, under the name Zyban.

I've been reading the experiences of people in the US on Wellbutrin and it is full of people saying "I took it expecting it to cure my crushing, suicidal misery and it didn't work" and other people saying "My problem was that I couldn't get off the sofa and do anything - but now I'm on this I can".

So if my GP doesn't find any physical cause for this I might see if she can help me experiment with this although it would be off-label.

@milliefiori thanks to your advice I just had my most motivated day for weeks, thank you!

@namechange4achange - really glad you had a better day. Thank you so much for your long post. That's all so fascinating. I am really interested in your notion of there being two different types of depression. I also had heard that the serotonin type ADs weren;t ideal for my problems. I took them for years and I did feel happier but still didn't do anything. I wonder if Zyban would work...

Here's a paper on it: www.ncbi.nlm.nih.gov/pmc/articles/PMC5831552/ See especially this part: www.ncbi.nlm.nih.gov/pmc/articles/PMC5831552/#S6title

They don't talk about two sorts of depression but they suggest that depression has been mischaracterised as a liking issue when it's really a wanting issue

Actually they do touch on there being two types (or two sets of symptoms) at the end of that section

I would ask for a blood test. I developed anemia which I just couldn’t get rid of. I would be fine sometimes but other time’s I was practically falling off chairs. I once just put my head on my knees and fell asleep at the dining table. I often find myself completely unable to move. I just sort of ball up and stare into space. It’s crippling. I also can’t think clearly and have very very poor memory. Yet my periods remain unchanged and I haven’t had the usual lightheaded ness (I had anemia as a teenager but I could tell because my periods changed completely and I was constantly fainting). Other deficiencies can had similar effects on energy levels.

Hi, have you considered fibromyalgia? A lot of what you say rings a bell regarding that illness.

@milliefiori also this www.ncbi.nlm.nih.gov/pmc/articles/PMC4356228, especially this part www.ncbi.nlm.nih.gov/pmc/articles/PMC4356228/#s2title

Thank you @Velveteenfruitbowl and @Iloveliberty. I intend to get myself registered with a doctor and have some tests including anemia. I eat meat and my periods are very light so I didn't consider that but I will suggest it.

Isn't fibromyalgia painful? I don't really have pain, the sore back is just from the uncomfortable position I end up in when trying to work on my laptop when I can't sit up.

Yesterday and today I've been doing really well and now I feel a bit bad for posting on here and getting all this sympathy. But I also know that if I don't get it sorted I will be back in that state in a few weeks as that is how it always goes. It's easy to forget, when I'm in one phase, what the other phase is like.

OP have a read up on the effects of vitamin d deficiency - lots of symptoms tally up with what you're describing, including depression, bone and back pain, tiredness etc.

It could be a vicious circle - one of the ways you get vitamin D is from being out in sunlight and if you're not going out then you're not going to get vitamin D - which means you'll be feeling tired and achy and less inclined to go out which means you get even less exposure to the sun and thus less vitamin D and so the cycle goes on.

Apparently it's really common in the UK these days, particularly in winter when people spend less time outdoors on average.

DS has been diagnosed with it - he's been feeling tired and listless so I took him to the doctor. Turns out he was both anaemic and had vitamin D deficiency, so just about to start him on high dose vitamin d tablets for 6 weeks (the iron is on-going). But it might be worth checking out, seeing how many of the symptoms tally and use that as a reason to talk to your doctor (this is the time of year there are usually lots of articles in the paper about making sure we get enough vitamin D so you could say you were reading about it and it seemed to match what you were feeling).

From reading about people who take supplements (and initially for example ds is just having 2 high dose tablets a week for 6 weeks) a short run of high dose tablets can be enough to make people feel a difference and then to move down onto a maintenance dose or stay on a high dose for longer. But it might be easier for you to go in to the doctor to talk about a possible physical cause rather than talking about feeling exhausted and worrying that the doctor will dismiss you.

Thank you @wibdib I will definitely mention that. It would be great if it turned out to be something as simple as that. I hope your DS starts to feel better soon.

I'm coming out of that dip now and my concern is how to get into a good routine so that I stay out ... I have a lovely park nearby so maybe a daily walk is in order.

Hi OP I could have written parts of your post.

I've just been diagnosed with ADD inattentive type. Initially I managed with diet, exercise. These do help, now I have also got an ADHD coach (you do not need a diagnosis to have
coaching) and am exploring meds. These work on dopamine.

One of the tips my coach gave was to plan your day the night before. What did you do well today, what's outstanding, what needs doing tomorrow, whats coming up in next 2 weeks. Make a checklist, five things or so. Spend ten mins. Give yourself a quick win for the morning - something that will motivate you, put it on a post it somewhere obvious, laptop.

@namechange4achange - just wanted to thank you for raising this. I've been thinking and thinking abotu what you've pointed out, about the difference between 'wanting' depression (literally, it depresses, pushes down the 'want' motivation versus 'liking; depression. It makes so much sense to me now I can;t stop thinking about it. I could never work out how I was such a happy depressive - how much I loved life and enjoyed so many things but felt pinned back from doing them by depression. This is why. I need to find out how to access the right ADs to kick start the want. This really is a revelation. Thank you so much.

@milliefiori that's great, I'm really glad to have given you some food for thought.

I've found it has helped me a lot over the last week or so just saying to myself "If I had a functioning wanting circuit what would it want me to do?" and thinking about what I like doing or would really like the results of doing, rather than waiting to be motivated. Which is just what you were saying really, about making yourself do things, but having thought it through in a scientific way kind of makes it feel more persuasive! Anyway I hope you do find something to help you, whether it's medication or a change in how you think. Nice to "meet" you x

Nice to meet you too @namechange4achange. I have spent many years researching how to overcome depression and the causes behind it. I had never come across this distinction before. It is so useful. New line of enquiry. I am going to beat the beast.

Are you finding you are getting more done?

Hi OP, I’m like this too - diagnosed with ADHD and bipolar type 2 (no manic highs in this type, just periods of being more Up then periods of sheer exhaustion & inability to function which occasionally spiral to months of depression without the meds) Medication makes it much much more manageable, though my daily routine needs very careful management to ensure adequate nutrition, rest, exercise, wellbeing, supplements etc... Private psychiatrist got me the treatment I needed after many years of struggling