Does Depression Make You Tired? Depression Fatigue Explained

People who are depressed typically report changes in cognitive, emotional, and physical activity, but some still wonder “does depression make you tired?”. According to research, fatigue is one of the most common residual symptoms of clinical depression [1], but the reason why this happens is not clearly understood.

Furthermore, clinicians may not always recognize low energy levels, fatigue, or the reduced ability to concentrate as symptoms of depression because these issues are also associated with other psychiatric and medical disorders.

Gaining a better understanding of the link between depression and fatigue can help facilitate an accurate diagnosis and direct the treatment plan. This article discusses depression fatigue and beneficial management approaches that target this issue.

What’s the Link Between Depression and Fatigue?

Clinical research shows that over 90% of people who are suffering from major depressive disorder (MDD) experience fatigue [2]. Extreme fatigue is frequently experienced during a depressive episode and as a residual symptom, making it a particularly debilitating issue. Individuals suffering from depression often complain of sustained lethargy in the absence of physical exertion and indicate that minor tasks require more energy than usual (example: brushing your teeth). They may also be less efficient at completing tasks and frequently report that it takes a lot longer to perform daily living activities [1]. Despite these observations, the accurate identification of fatigue in depression is complicated by other conditions that are linked to fatigue such as sleep disorders, anemia, fibromyalgia, heart failure, and chronic stress [1].

Based on clinical observations, signs that may indicate fatigue associated with depression include [3]:

• Loss of energy
• Memory problems
• Poor concentration
• Heavy limbs (leaden paralysis)
• Sleepiness, irritability, or weariness
• Asthenia (abnormal physical weakness)
• Mental dulling (burnout, feeling overwhelmed)
• Persistent exhaustion (extreme tiredness following activity)
• Psychomotor retardation (e.g., impaired cognitive function, slowed speech, decreased movement)

These signs of depression fatigue appear to be caused by a dysfunction of certain regions in the brain and the abnormal activity of neurotransmitters (chemical messengers) such as serotonin, norepinephrine, and dopamine [1], [4]. Reduced prefrontal cortical activity as well as abnormal cerebellum and striatum function mediate fatigue in people with depression [2], [4]. Changes in norepinephrine, dopamine, and serotonin activity also contribute to depression fatigue [4]. These key neurotransmitters regulate energy levels, pleasure sensations, motivation, appetite, and sleep patterns [5]. Low levels of norepinephrine and dopamine are associated with sustained fatigue and a serotonin imbalance may worsen symptoms (e.g., loss of energy, lethargy) by reducing dopamine and norepinephrine levels [1], [4]. However, depression exhaustion may cause fatigue indirectly due to other reasons such as stress, dietary changes, sleep disturbances, or side effects of medication.

Stress

Stress can alter dopamine and serotonin production, making it harder to regulate mood and energy levels [6]. Inflammation also rises in response to persistent stress. Increased inflammation can lead to nerve cell and tissue damage in the brain that may cause fatigue and hypersomnia (the inability to stay awake) [7]. According to research, these types of stress-related complications can increase the risk of developing clinical depression [6], [7].

Diet

Diet affects many aspects of health, including cognition. A 2017 review showed that inflammatory foods such as processed meats, red meat, products with high dairy fat, refined grains, foods with artificial sugar, and other highly processed foods increase the risk of depressive symptoms for some people [8]. This finding appears to be linked to the damage chronic inflammation may cause in the brain [7].

A similar review explained that eating a high-quality diet that consists of food with a low dietary inflammatory index (e.g., prudent, vegetarian, and Mediterranean diet) helps lower the incidence of depressive symptoms [9]. It is believed that a nutrient-rich diet helps protect nerve cells and brain tissue from damage due to inflammation [8]. Therefore, a healthy diet can help some people combat depression.

Irregular Sleep Patterns

Sleep is vital for tissue repair, cell regeneration, and energy restoration. People with depression typically suffer from sleep disturbances that increase their risk of experiencing certain symptoms or make their health problems worse [10]. Furthermore, about 80% of people who are diagnosed with depression experience insomnia, while up to 35% also deal with hypersomnia [10], [11]. This fluctuating sleep pattern can cause extreme fatigue and poor energy levels.

Researchers have noted that poor sleep quality is associated with neurotransmitter changes in the brain that may lead to depression, but depressive symptoms may also cause sleep disturbances [12]. This issue creates an unhealthy cycle for people whose depressive symptoms are not effectively treated. Fortunately, treating depression and addressing sleep problems can help improve depressive symptoms.

Medication Side Effects

Antidepressants are commonly prescribed for clinical depression due to their ability to target neurotransmitters that help regulate mood, but certain medications are linked to significant fatigue. One particular antidepressant that may cause extreme tiredness is called a selective serotonin reuptake inhibitor (SSRI) [1].

SSRIs help regulate mood by heightening serotonin levels in the brain, but increased serotonin levels disrupt norepinephrine and dopamine activity by decreasing the production of these two neurotransmitters [1]. As dopamine and norepinephrine have a strong influence on energy levels, taking SSRIs causes residual symptoms such as fatigue for some people with depression. It is important to speak with a health care provider who can recommend a different type of medication if extreme fatigue develops.

How to Cope with Depression Fatigue 

If you’ve been wondering “why does depression make you tired” another thought that may come to mind is “can I learn how to fight depression fatigue?” The answer is yes, with proper management (e.g., therapy, medication) and behavioral changes, you can effectively cope with symptoms of depression, including fatigue.

Therapy

Psychotherapy, also known as talk therapy, is typically one of the first treatment approaches recommended along with pharmacological interventions (e.g., antidepressants) for people who are diagnosed with clinical depression [13]. This includes:

• Cognitive therapy
• Behavioral therapy
• Cognitive-behavioral therapy
• Psychodynamic (psychoanalytic) therapy

These approaches focus on helping people identify the underlying cause of their depressive thoughts and improve their coping skills.

Medication

There are several types of antidepressants that may be prescribed to treat depression including [1]:

• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-noradrenaline reuptake inhibitors (SNRIs)
• Serotonin antagonists and reuptake inhibitors (SARIs)
• Noradrenaline and specific serotonergic antidepressants (NASSAs)

Some people may not respond well to a certain antidepressant medication or may experience serious side effects. In such cases, switching to a different antidepressant may lead to better outcomes. Switching to a non-medication depression treatment (Transcranial Magnetic Stimulation) is another option as well.

Behavioral Changes and Self-Care

In addition to talk therapy, medication, or the combination of these interventions, behavioral changes such as establishing a healthier diet and exercise routine can help combat symptoms of depression [8]. Strategies that also help improve self-care include the following mindfulness-based interventions include [14] [15]:

• Mindfulness-based group meetings
• Day- or week-long mindfulness retreats
• Mindfulness meditation (e.g., tai chi, yoga)
• Daily audio-guided mindfulness practice at home     
• Stress adaptation through daily mindful practices
• Mindfulness home exercises (e.g., mantras, deep breathing, internal body scans)

Mindfulness interventions are typically recommended for people who have milder cases of depression or in combination with other forms of treatment. A mental health professional can help guide the decision-making process when trying to determine which approach may be best.

How Dr. TMS Therapy Griffith Psychiatry Can Help You with Your Depression Symptoms

Dr. TMS Therapy Griffith Psychiatry offers transcranial magnetic stimulation (TMS) treatment, which is a noninvasive, FDA-approved procedure that delivers magnetic pulses to areas in the brain that regulate mood and depressive symptoms, including persistent fatigue [16]. 

In addition to TMS therapy, our clinic provides medication management services and counseling that is based on a holistic approach to depression treatment, whether it is a primary or comorbid disorder.

To learn more about the services we offer and how TMS therapy can help fight depression fatigue contact our clinic today!