Most people are aware that antidepressants are often used to treat chronic fatigue syndrome, but what many don’t know is that there are cases by which they actually can cause temporary cases of “fatigue” that could technically be diagnosed as chronic fatigue syndrome. The fatigue often sets in after a person has been medicated with an antidepressant or antipsychotic for an extended period of time, and may be thought of as a long-term effect of the treatment.

In other cases, people notice that when they pursue antidepressant withdrawal, one of the symptoms is fatigue. In many cases, the withdrawal is so prolonged, lasting for months (as opposed to “days” like most doctors suggest), that people believe they have developed “chronic fatigue syndrome.” Based on the relatively vague diagnostic criteria for chronic fatigue syndrome, a doctor may end up throwing another medication onto your existing cocktail – which may end up impeding the recovery of your natural, homeostatic energy levels over the long-term.

Did you have chronic fatigue syndrome before taking an antidepressant?

The most obvious question to ask yourself is whether you struggled with chronic fatigue syndrome prior to taking an antidepressant. If you have always been fatigued, then there’s really no need to question whether it was caused by your medication. However, if you developed the extreme fatigue after treatment with an antidepressant (or array of psychotropic medications), your physiology will likely recover (assuming you don’t exacerbate the problem by throwing more medications at it).

Identifying when you developed chronic fatigue

It is important to clearly identify when you first developed symptoms of chronic fatigue so that you understand whether it was caused by your medication or whether you’ve always had it. Usually the severest cases of chronic fatigue are caused by toxins and/or a latent virus.

  • Pre-antidepressant: Those that were extremely fatigued to the point that it was “chronic” prior to taking their antidepressant know that it wasn’t caused by their medication. Therefore if you had it before you took the drug, it’s unlikely that the drug was the root cause. It could have amplified the fatigue at a later date, but it wasn’t the specific cause.
  • During treatment: If you developed the extreme fatigue during your treatment, it may be a side effect of the medication. Many people develop fatigue in the early stages of treatment, but it doesn’t end up becoming chronic; it eventually subsides. However, some people experience fatigue throughout their entire course of treatment; this is usually caused by neurotransmitter alterations. That said, if a medication made you feel energetic for a year or two, then you became chronically fatigued, it’s likely that antidepressant-induced physiological changes were the cause.
  • Withdrawal: Nearly every withdrawal from an SSRI is characterized by fatigue. For some, the fatigue lasts longer than others. During withdrawal, the physiology needs an extended period of time, low stress, and nourishment to reset itself to homeostatic functioning. If not given proper care, the fatigue can often persist until the physiology recovers and stress is reduced.

How Antidepressants Can Cause Chronic Fatigue Syndrome…

Below are some ways by which antidepressants may contribute to the development of chronic fatigue.  Understand that since each person is unique, an interplay of these potential causes (to varying degrees) is very likely.

  • Adrenal mining: Some people believe that certain antidepressants (e.g. Paxil) are capable of essentially “mining” the adrenal glands while taking them. This is one theory as to why the Paxil poops out (or stops working) because the adrenal glands become fatigued and no longer make adequate cortisol to maintain alertness. This can lead people to feel tired while still taking the medication and the fatigue can persist for a long period until the adrenals have been given sufficient time to recover.
  • Chemical imbalance: It is known that antidepressants alter levels of various neurotransmitters like serotonin, dopamine, and norepinephrine. They also indirectly alter the functioning of many others and the exact changes made in the brain aren’t really well-known. The fact that many antidepressants can cause a chemical imbalance and actually deplete various neurochemicals over time could lead to fatigue.
  • Gut microbiome: There is significant evidence suggesting that antidepressants significantly alter the gut flora and are capable of causing microbial dysfunction within your gut. When your gut bacteria becomes disturbed and significantly altered, this can lead to numerous physiological responses, one of which is fatigue.
  • Hormone alterations: It is thought that levels of various hormones become altered with psychotropic treatment. Some believe that antidepressants lower testosterone levels, change leptin production, as well as cortisol. Although there isn’t much evidence suggesting how antidepressants affect hormone levels over the long-term, it is likely that they could cause an imbalance.
  • Motivational deficit: Taking antidepressants can make people feel emotionally numb and decrease their motivation. This is often referred to as emotional blunting or “apathy” and is a common experience. It can turn you into an amotivational zombie because you don’t have any emotion to support the motivation.
  • Sedation: A very common effect of antidepressants is that they make people feel sedated and/or drowsy as a side effect. If you find yourself sleeping a bunch while taking the drug, it could be that the alteration of certain neurotransmitters is making you excessively fatigued. This is very common among drugs that affect serotonin as well as histamine.

My experience with antidepressant-induced chronic fatigue

Back when I was taking Paxil back in the early 2000s to cope with my social anxiety and depression, it worked great for awhile. However, I hit a point on the medication where my energy level began to noticeably drop. During this drop period, I had extreme difficulty getting out of bed and became excessively tired.

I would sleep for 12 to 14 hours per day and my family would do their best to get my (seemingly) lazy ass out of bed. Although I wanted to have enough energy to get out of bed, I was excessively fatigued – to the point that most of my day was spent either sitting on a chair or the couch. Long story short I went through “antidepressant roulette” and no medication helped my energy – in fact Cymbalta made the fatigue even worse.

My energy remained low and it was highly frustrating – I could barely function. At the time I didn’t really know what to do and wasn’t getting any good advice. I truly believed that in addition to depression, I had simultaneously developed chronic fatigue syndrome – and my parents agreed. However, since I had many difficulties with all antidepressants and psychotropics (including worsening of depression), I stopped using them.

In the meantime, I had experienced at least 8 to 10 months dealing with (or at least attempting to deal with) chronic fatigue.  Even when I started to notice my energy levels returning approximately 1 year after I had discontinued all psychotropics, I still wasn’t at 100%.  When I finally started listening to my therapist and practicing guided meditation, self-hypnosis, etc. and relaxing each day to minimize anxiety, I noticed that my energy continued to improve.

I chalk this improvement up to the fact that stress was decreased.  When stress is high, it acts as a barrier for physiological healing.  By reducing stress, the adrenals become less taxed, neurotransmitter activity starts to stabilize, and hormone production changes.  In addition to stress reduction, I threw some light exercise into the mix; each day of going for a simple bike-ride

I also focused on eating relatively healthy and supplemented by diet with fish oil per recommendation of my therapist.  Whether it actually helped, I’m not sure, but I’m not going to dismiss the possibility.  It took nearly 1 year and 6 months for my energy level to fully return to what it was pre-medication.  This may seem like a long freaking time (and that’s because it is).  Even though it took a long time, I feel lucky to have escaped from the depths of chronic fatigue.

Looking back, I couldn’t believe that I had gone from a person thinking that I was eternally doomed with chronic fatigue to a person that had a full tank of energy. My experience goes to show that full recovery (in terms of energy level) is possible with enough time and the proper approach.

What may have caused my specific case of chronic fatigue syndrome?

If I wanted, I could’ve easily been diagnosed with chronic fatigue syndrome, but knew that most of the medications used to treat the condition, I had already tried (e.g. antidepressants). I didn’t see a point in having another diagnostic label tacked on what was already: major depression, severe anxiety, and premorbid schizophrenia (yikes). Below are some hindsight speculations as to what may have contributed to my antidepressant-induced chronic fatigue.

  • Adrenals: I believe that my adrenals were extremely taxed from being on an array of different medications. This lead to underproduction of certain hormones necessary for maintaining alertness and optimal cognitive function. If I had to place the bulk of the blame on one medication, it would’ve been Paxil.
  • Depression: My depression had actually increased for most of the time that I took medications. This increase in depression likely contributed to an increase in fatigue… this may have elevated slow, theta waves in certain parts of the brain in which they create dysfunction and tiredness.
  • Excessive sleep: Getting plenty of sleep is good to let the body heal, but when excessive sleep becomes a habit, it’s a problem. I got into a routine of oversleeping as well as being lazy around the house in order to cope with the fatigue. Although it’s difficult to force yourself to get up instead of sleep for 14 hours, it’s usually necessary for recovery.
  • Neurotransmission: The newly created neurotransmitter imbalances as a result of taking antidepressants for an extended period may have also lead to fatigue. Since most antidepressants that I took targeted serotonin, I’m guessing that they provoked problems within the serotonin system that caused fatigue.
  • Stress: I already had a significant amount of stress resulting from social anxiety as well as depression. Since I was in school, socializing, trying to fit-in, and getting homework done all increased my stress – which made me more fatigued. When your adrenals are already fried from the medications, and you’re stressed, it becomes nearly impossible for them to recover.
  • Withdrawal: Withdrawing from many antidepressants “cold turkey” may have served as a shock to my nervous system, leading to fatigue and a slower overall recovery. (Read: Quitting Paxil Cold Turkey). There are many elements of withdrawal that also increased my stress, which likely amplified, or at the very least, fostered my existing fatigue.

Why a Chronic Fatigue Syndrome Diagnosis Stemming from Antidepressants can be Problematic

Assuming the antidepressant(s) you were taking was the root cause of your chronic fatigue, there are some problems with getting formally diagnosed. In most cases a formal diagnosis is viewed as requiring “lifelong” treatment; medical professionals will always view you as suffering from a “chronic” condition on top of your depression.

The professionals often fail to realize that the antidepressant medications were the root cause of the newly developed fatigue, but instead they assume it’s just another new development. Though the fatigue is real, we know it stemmed from the antidepressant. It’s almost comparable to getting misdiagnosed with Bipolar 2 disorder after going through an array of psychotropics – it’s a temporary phase resulting from using medications.

  • Eugeroics: You may be given a drug like NuVigil to help you maintain alertness. While it may work to offset the fatigue, it may be a hindrance to recovery of your physiology. If you have adrenal problems resulting from antidepressants, this drug not only may be patching the problem, it may magnify it over the long-term.
  • Helplessness: Another diagnosis sure makes people feel good… not. Anytime you get diagnosed with another condition, you feel even more hopeless and become confused about your own mental health. This leads to helplessness and feelings of being “trapped,” unable to improve because you’re always battling something new.
  • Long-term prognosis: Assuming you are treated with medication like a eugeroic or psychostimulant, they will work, but may not be favorable over the long-term. They can mask the fatigue by activating the CNS, but you may need the exact opposite in order to heal and for your body to restore its energy levels.
  • Psychostimulants: Taking these drugs over the long-term can lead to a host of problems such as dependence, addiction, abuse, and exacerbation of fatigue. Not only can these medications be taxing on your adrenals, they can activate the fight-or-flight response of the sympathetic nervous system, alter hormones, and deplete dopamine.

How I Decreased Fatigue and Restored My Energy Levels after Antidepressants

At the time, I didn’t have a specific plan of action in place to recover from the antidepressant-induced fatigue that I experienced. In fact, I didn’t even fathom the possibility that I would ever overcome it; I assumed that I was fated to become a lifelong “sloth.” My energy was so low that I was convinced I had a brain tumor; an MRI eventually ruled this out. In hindsight, there are some specific things I could’ve done that helped me overcome my fatigue.

  • Acceptance: It was important to accept my current situation as well as how I was feeling. I needed to accept that I was tired, and needed to honor that feeling rather than ruminate over it. Constant brooding over the fatigue and contemplation as to why I felt fatigued only stressed me out more, which I now know can increase the fatigue.
  • Avoiding stimulants: Assuming my adrenals were already taxed and/or overexerted, I made a conscious effort to avoid stimulants. By stimulants I mean caffeine, energy drinks, etc. – I wasn’t taking psychostimulant medications, but if I was, it would’ve been beneficial to avoid those as well. Ironically these can be great for treating actual cases of chronic fatigue, but may exacerbate the fatigue in the long-term if it was caused by antidepressant usage.
  • Diet: Cleaning up the diet and eating foods that jive well with your physiology is key. I’m not going to make specific recommendations because I’m not a dietician, but I will say that getting plenty of vegetables, some fruits, and high-quality protein is beneficial.
  • Exercise: There’s no need to run a marathon, in fact excessive running probably won’t be much help in recovery. Simple exercise like walking and/or light jogging for short periods of time can help the body heal. High intensity stuff may impede recovery.
  • Letting time pass: While your body is attempting to heal itself, it is important to understand that time needs to pass before you will fully recover. Many people want to rush the process and stress themselves out because they aren’t patient enough to put up with their fatigue. Accepting the fatigue and understanding that time needs to pass to recover is crucial.
  • Relaxation techniques: Engaging in relaxation techniques that shut down the sympathetic nervous system promotes healing. The quicker you can reduce activation of your fight-or-flight response, the quicker you will recover. In fact, most people notice that when they are able to tone down the fight-or-flight, their energy level substantially increases.
  • Sleep: Getting plenty of sleep is still good when you are fatigued because the body may need the sleep to heal itself. That said, make sure you aren’t sleeping excessive amounts – set limits. You may want to play around with the amount you get and also track the quality.  Adjusting sleep is one of many ways you can use biohacking to improve mental health.
  • Supplementation: Really the only supplementation that I took was fish oil. Whether this actually helped my brain recover or not is debatable. However, even if it didn’t really do anything, it may have had a placebo effect on me at the time, leading to a slight reduction in anxiety and improvement in mood.
  • Therapy: To mentally cope with the fatigue, I sought out help from a trained psychotherapist. Although she may not have realized the extent to which I was struggling, she often gave me really good advice about how to cope with my anxiety and depression while being off of medication.

Bottom line: Energy Levels will Return in Time…

Assuming you have stopped taking your antidepressant and aren’t under the influence of any substances, your physiology should fully recover to its pre-medication state of functioning. If you are still on a medication, there’s no guarantee that your physiology will be able to heal itself and that you’ll be able to overcome the fatigue. Furthermore, if you are highly stressed and aren’t able to find a way to minimize your stress, the fatigue will likely persist until you find a way to manage it.

In my experience dealing with fatigue, it can seem impossible to overcome. As long as you are giving the body what it needs to recover (e.g. nourishment) and are avoiding things that trigger stress and tax the adrenals, you should eventually regain your energy. It can be highly frustrating to feel fatigued, unproductive, and mentally foggy all the time, but based on my experience, any form of antidepressant-induced fatigue can be overcome with time and proper effort.