Which Comes First: Depression or Fatigue?

Why are people suffering from depression almost always also very tired?

The relationship of depression to fatigue is very complicated, for the following reasons:

1. Fatigue may actually precede or predict the development of depression, through mechanisms involving chronic insomnia and sleep deprivation, poor nutrition, and a disturbance in gut bacteria which can affect energy levels and mental health, or chronic high levels of stress which create a breakdown in physiological and mental function.

2. Fatigue is a symptom of active depression. In most cases of major depression, individuals will experience fatigue as one of the symptoms of the disorder. In one recent study, over 90% of depressed individuals experienced severe fatigue as a symptom, despite the fact that they were actively being treated for the disorder.

3. Treatments for depression can create additional fatigue. Unfortunately, a majority of the medications used to treat depression list an increase in fatigue as a side effect.

It May Not Be “All In Your Head”

In spite of all that mental health professionals know about the fact that fatigue and depression seem to go together like peanut butter and jelly, it is actually unwise to dismiss a patient’s symptoms of fatigue as simply another of probably several mental health-related symptoms.

Other causes of fatigue should always be investigated and ruled out before assuming that the fatigue is simply a symptom of depression.

The advantages of doing a thorough investigation into the medical causes of fatigue cannot be underestimated. Here’s why:

Managing an episode of moderate to severe depression is no cakewalk. One of the cruel things about depression is that the disorder saps the sufferer of the very things needed to recover from the disorder: energy, motivation, the desire to get better.

Depressed people often know that they will feel better if they would just get out, exercise, be more social, prepare more nutritious meals for themselves. But they are exhausted and end up giving up prematurely, falling onto the couch or bed, and it simply takes longer to get better because it just takes too much effort to do the things that will help them to get better.

Thus, the more energy you have, the easier it will be to function on a daily basis and to make use of cognitive-behavioral therapy provided by your psychologist.

If it can be determined that any fraction of the patient’s fatigue can be eliminated (often quite easily with a supplement), it will leave the patient with increased energy necessary to make use of any other treatments or techniques that can be taught in therapy.

So, what kinds of things do we look for that can sap a person’s energy,
without them being aware of it? What do we want the depressed person’s physician to be looking to rule out with a variety of tests?

Major Hidden Causes of Fatigue

After looking at the quality of nutrition the patient is getting on a weekly basis, and whether or not they are getting enough sleep, here are the other things that need to be investigated and ruled out.

1. Sleep Apnea
When a person’s breathing starts and stops while they are sleeping, they may have a potentially dangerous condition which can cause chronic fatigue, heart problems, and diabetes.

2. Vitamin B12 Deficiency
Vitamin B12 helps to ensure neurons function properly and assist in the creation of red blood cells. A lack of this vitamin affects how much oxygen your blood can move throughout your body and to your brain cells. This deficiency should be ruled out, particularly if depression is accompanied with forgetfulness, restless legs, or feelings of numbness or tingling in the extremities.

3. Vitamin D Deficiency
A deficiency in Vitamin D comes with a host of major potential health hazards, but also an 8-14% increased chance of depression and an increased risk of suicide.

4. Iron Deficiency
Iron Deficiency leading to anemia is more likely to be seen in people with digestive diseases, thyroid problems, in women who have heavy periods, and those who are on hormone birth control pills.

5. Magnesium Deficiency
Fewer than 30% of Americans are getting the recommended daily intake of magnesium. In addition to fatigue, deficiency of magnesium can also cause muscle cramps, facial tics, poor sleep, and chronic pain.

6. Hormone imbalances
The hormones produced by the glands in the endocrine system all have the ability to influence and affect what is known as the “Big Five:” mood, energy, sleep, appetite, and sex drive. Unless your hormones are working well together, fatigue and depression may be some of the signs of an imbalance. Women going through major hormonal transitions at puberty, post-partum pregnancy, and peri-menopause or menopause are especially likely to experience some changes which may need to be addressed with their doctor. Thyroid hormone tests are especially important to consider when a patient presents with symptoms of fatigue and depression.

Remember that people are complex and approaching a complex disorder like depression from a mind-body standpoint just makes sense. Rule out physical causes of fatigue first.

Work with your physician to effectively treat any that are detected to increase your energy levels. Then you can know how much fatigue and/or depression you have left to address through other forms of treatment. If you do it this way, you’ll hopefully have increased energy to make better use of treatment for depression and start feeling better sooner.

Dr. Anita Sanz, PhD, Psychologist

For More Information:

Insomnia and Depression
Gut Bacteria May Exacerbate Depression
Stress and Fatigue – Safer Healthcare
Fatigue as a Residual Symptom of Depression: Page on nih.gov
CDC Study Shows Association Between Depression and Sleep Apnea
Vitamin D Deficiency and Low Vitamin D Symptoms & Treatment
How Does Anemia Affect Mental Health? – Article by Rheyanne …
Magnesium and the Brain: The Original Chill Pill
Depression, Thyroid Conditions, and Hormones