ADHD and FATIGUE

[Anonymous]

Hello,

I wanted to know if there is any research that links ADHD and extreme fatigue. I am currently being assessed for ADHD but one thing that I noticed is that although I do display many symptoms of ADHD I also experience debilitating fatigue. Has anyone who has been diagnosed with ADHD had problems with fatigue. The fatigue I’m talking about is mostly mental but is also physical and this happens out of the blue and is intermittent. I would get these crazy urges to take a nap and if I don’t I get very irritable, foggy-minded, confused and ADHD symptoms are aggrevated.

If one of the doctors could drop their two cents that would be great.

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[BuxomDiva]

What you’ve described sounds to me like the fatigue that comes with depression. Lots of us who spent our “formative years” being told we weren’t living up to our potential are depressed; no big surprise actually.

Hope you get an accurate diagnosis and find a medication regimen that works for you.

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[Anonymous]

I have a hard time with the depression thing. From what I understand depression involves sadness and unhappiness but there are many times that this incredible fatigue comes out of the blue and doesn’t have much emotion behind it just a total mental and physical “shut-down.”

I have done a lot of CBT, cognitive behavioral therapy not the other CBT (Google it with the adult filters off to see what I’m talking about), and I have a hard time identifying negative thoughts. I believe it’s due more to low dopamine. Don’t get me wrong there are times when I feel really depressed about the situation but I can use the CBT techniques to move beyond that but other times the fatigue is just simply debilitating.

I want to know if it is common among people with ADHD to suffer from a lot of fatigue.

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[Anonymous]

Mental fatiguability is high. Probably related to filters taking in too much and mentally drained trying to deal with the noise.

CBT deals with the accumulated negative noise.

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[ADDled]

How does one reduce the impact of mental fatigue? Could exercise or meditation help? Or trying to avoid high stimulus/stress situations?

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[ADDled]

How does one reduce the impact of mental fatigue? Could exercise or meditation help? Or trying to avoid constant exposure to high stimulus/stress situations?

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[ADDled]

Sorry for the repeating my post……pressed the wrong key….D’oh…..

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[Saffron]

Fernando, I’ve been thinking about your post all week, but haven’t had an opportunity to respond until now. I wanted to let you know that the kind of intermittent, debilitating fatigue you describe has been a huge problem for me as long as I can remember. I could never understand why I couldn’t seem to get hold of my energies, or why other people didn’t seem to have this issue.

In other words, I believe I know, viscerally, what you’re referring to. I also want you to know that the meds I take for my ADHD (first Wellbutrin and then Concerta) have helped *enormously* with this problem, and that I now know what it’s like to have a fairly constant and predictable energy level throughout the day. There is HOPE, my friend. Things are going to get easier for you, okay?

Tell me, do you also find it nearly impossible to carry out “time-managed” tasks and activities that you planned out ahead of time (because when that time slot arrives, it’s always your energy level that decides whether or not you can follow through)? Does this happen even when what was planned was an activity that is normally pleasurable or that you thought you were looking forward to?

That’s been my story. Then I started noticing the same problem in my little boy, who has just been diagnosed with ADHD “in the clinically severe range.” The frequency and intensity of my son’s physical and emotional ups and downs, almost from day one, were stunning! At first I thought he was showing early signs of bipolar disorder, but other signs (like the length of his worst “downs”) just didn’t check out. He simply has a cup that runs dry way, way faster and sooner than that of other children.

I started to take note of the things that he does to stim, and the things that seem to work to “wake up” his brain and re-energize him physically (playing his favorite music and dancing with him, filling his self-esteem cup with praise and attention, making a game of the task, or asking outsiders like a neighbour he likes to join in).

I observed that he seemed to need more rest than the average kid. Although nutrition certainly didn’t account for the enormity of the problem, he apparently needs more protein to keep his body fuelled than the average kid too. He asks for snacks whenever he’s engaged in a cognitive task and craves carbs between meals to the point of tantruming if you can’t come up with one. (I caught on to this one early, because I myself had always functioned a bit better if I “grazed” all day. Big meals with big spaces in between were a recipe for particularly disastrous energy levels, and I kept quick pick-up sweets with me just to get through my school days and, later on, my work days.)

I noted that my son gets mentally and physically drained much, much faster when applying himself to a cognitive task. I can almost see his brain shut off. And generally, within moments of that shut-off point, he’s also lolling on the floor complaining that his legs and arms don’t work properly anymore. At the end of day, when he’s running dry overall, he’ll *only* put his pajamas on if he doesn’t have to climb the stairs to get to them—and is willing to take whatever consequences that noncompliance brings him! I walk with him upstairs now and tickle his back. So I’ve learned a lot from my son. Clearly he will need meds too.

When I’m not relying on my meds (usually because I’ve forgotten to take them before the “threshhold” time), I know now that there are certain things that will help me stim (e.g., listening to upbeat music sometimes helps, and for some reason making contact with other people who are lively and funny nearly always helps!) And when my brain wakes up and especially if I’ve had some little boost to my self-esteem, I get a jolt of physical energy. It’s the damndest thing. Might be short-lived, but hey, if it gets me to the next part of the day…

A last word about energy and dopamine levels (subject to Dr. J’s greater wisdom of course). I personally have to watch out for iron deficiency and vitamin D deficiency, both of which I understand make it harder to produce dopamine as well as serotonin. So do make sure you have those two areas covered. You might also want to have your TSH checked at your next physical exam (along with iron and vit D), to make sure everything that needs to work properly is doing so and you can get the best results if and when you try meds.

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[Anonymous]

Your insights are fantastic Saffron.

To summarize: basic things always need to be considered: nutrition, sleep, stress and exercise. Anything that makes the brain work better- that is a motherhood issue. After that, yes, getting the dopamine and noradrenaline systems to work better, great. Beyond that, trying to reduce the amount of clutter inside your head.

Always speak to your doctor before making any changes to medications. Dr. Jain provides advice generically and not for any one person. Advice does not constitute a therapeutic relationship or promise of care. Please consult the privacy policy for more information

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[Anonymous]

Thank you all very much for your responses. This is a difficult time for me and a confusing time as well and this forum is great for giving me an objective point of view. I will keep you all posted with any fatigue related progress.

@ADDled I believe that trying the medications should provide a steady energy level like Saffron said. I have tried meditating and have found it helpful sometimes but most of the time my mind is racing and jumping from one thing to another that I just can’t slow it down no matter how hard I try. I think Dr. J is great for promoting the idea that medication should be used to facilitate behavior change and my plan is to hopefully have the medication provide me with energy to start exercising, not miss work, establishing goals and clearing out the clutter in my head, put it on paper and get working on things.

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[ADDled]

Hi, Fernando!

You’re absolutely right about meds helping to facilitate change. I think of it as “providing a leg up” on the situation. But that’s only a start, then it’s all about learning new skills to work with, and within, ADD.

Meditation is a skill that sometimes takes a while work. Based on what I have read, when long-time practitioners such as Buddhist monks, are monitored for brain activity during meditation they have been shown to have lower brain activity. This is a linked I just quickly googled, but there is a lot of similar websites:

http://www.shambhalasun.com/index.php?option=content&task=view&id=1611

I guess it’s typical of the Western approach to things that we require immediate feedback for everything. I’ve use meditation techniques for a while and am starting to feel the benefits.

Meanwhile, the meds has allowed me to make those changes in my life to lessen the impact of ADD, Now that I know it’s neurological and not because of a character defect or lack of willpower, I can use that information to use work-arounds for my brainstyle. Before the diagnosis and the meds, it was all that negative crap I’ve been hearing all my life when there was a setback: your lazy, try harder, it’s easy, everyone else can do it. Blah, blah, blah.

It sounds like you have a few things in mind that you want to change. The only thing I can tell you is to be patient. The will be setbacks along the way, but do not be discouraged. Just carry on from where you fell, keep moving ahead.

If you can, find an ADD coach, or therapist (your local family services agency is a good start), they can help you along the way.

This is a time when the hyperfocus can be an asset, if used for good purposes! But now we tell when that happens, right?

Just keep your eyes on the prize and let us know how you’re doing. We love success stories here.

Hope this helps…and good luck

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[Anonymous]

@Saffron I have found it difficult to deal with the “time-managed” activities you mentioned. I do find myself often passing on socializing. I would agree to do something with friends/family and then wind up cancelling at the last minute due to fatigue and lack of motivation.

I found the following article pretty interesting on Wikipedia that talks about how fatigue, lack of motivation and other symptoms that have been classified as SCT (Sluggish Cognitive Tempo) were part of the DSM-III diagnosis of ADD and are considered to be a sub-group of the current ADHD-PI diagnosis. I identify most with these symptoms on a daily basis and are the ones that are causing the most impairment for me at the moment. Here is the link if you guys are interested:

http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo

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[Anonymous]

Great post. Thanks for all the info.

I have the same problem. I always have felt tired and foggy, starting when I wake up. In the evening, I would shut down completely.

Medication makes a huge difference for me for this particular issue.

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[Saffron]

Fernando, the info & link you posted on our apparent subtype of ADHD were really validating—thanks. I’ve also found a very good article (blog post) by Gina Pera about this issue:

http://adhdrollercoaster.org/adult-adhd-diagnosis-issues/a-new-type-of-adhd-for-next-dsm-revision/#more-1423

Its passage about students with this problem who found it “necessary to re-read passages multiple times in order to comprehend” hits straight home for me. I loved the learning aspects of university, still collect piles of books on my favorite topics, and can spend hours researching on the Web. My career is completely based on my literacy skills. But ironically, reading has always been a very hard slog for me in terms of speed, and school was all about late and unfinished assignments despite top marks for the work I did accomplish.

Since discovering that Concerta helps me take in material up to four times faster, I’ve become much more proficient at work. And I’ve had to wrestle with so much regret over how different my academic path would have been had I been able to work at a normal speed. I would absolutely have aimed for medical school had I known about my ADHD and been given medication in my teens and 20’s. (As an aside, now that my children’s father is refusing to allow meds for my son—whose favorite book is anatomy of the human body for kids—I’m reliving this regret. *sigh*)

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[Anonymous]

I like the article you posted too. Really good information. Dr. J it would be great if you could offer some insight and weigh in on the whole SCT (sluggish cognitive tempo) issue.

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[Author]

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