Depression Marathon Blog

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Diagnosed with depression 16 years ago, I lost the life I once knew, but in the process re-created a better me. I am alive and functional today because of my dog, my treatment team, my sobriety, and my willingness to re-create myself within the confines of this illness. I hate the illness, but I'm grateful for the person I've become and the opportunities I've seized because of it. I hope writing a depression blog will reduce stigma and improve the understanding and treatment of people with mental illness. All original content copyright to me: etta. Enjoy your visit!

Wednesday, September 10, 2008

The tired and sleepy dilemma

Writing here has been difficult lately, as I have been struggling with fatigue, or more definitively, somnolence. My doc and I have slowly figured out that one of the major causes of my slower-than-normal running pace is a significantly increased heart rate. Recently, we realized the culprit behind the increased heart rate was one of my most beneficial medications. It is a med I take primarily for fatigue. Fatigue became a crippling symptom of my depression about 2-3 years ago. This med, once I started it, changed my life. I was able to function again.

One significant piece of my functioning life is running and racing. I am a runner. It is part of my identity. I have been incredibly frustrated over the past couple years with my running, as no matter how well-trained I've been, I have not been able to come near my past running performances. Not only that, but running paces that would have been "too slow" just a couple years ago have been painful, breathless, slogs since.

Fortunately and unfortunately, we now realize this fatigue medication is the culprit. It's main side effect for me (and another female runner my doc treats) is an increased heart rate. For a runner, increasing the resting heart rate is tortuous! It's akin to being totally out of shape despite thousands of hours and hundreds of miles of training! I've been breathless and unable to move my body any faster at what used to be a mundane pace. It's been very frustrating.

Fortunately, figuring out that it is the medication causing the problem means the problem is easily fixable. Decrease the medication! And that's what we've been doing over the past 4-6 weeks. Decreasing the med didn't seem to cause an increase in fatigue initially. Unfortunately, it also did not decrease my heart rate nor facilitate improved running tolerance.

We decreased the medication again about 10-14 days ago. Low and behold, I just completed a breakthrough running week! I saw almost miraculous improvements in my running pace and tolerance! Unfortunately, I've also begun to re-experience some days, like yesterday, where I've not been able to wake-up nor stay awake. Days, like yesterday, where I've run and run well, but otherwise slept almost as many hours as I was awake. The med decrease improved my running life, as I wished. But what about the rest of my life?

What do I do? Do I increase the med, which will increase my heart rate and slow my running again leaving me frustrated and non-competitive? Do I stay on the decreased med, run fast, which improves my self-esteem and confidence, but otherwise struggle to function due to debilitating fatigue? I don't know. I don't know.

I'm worried. I don't want to have to make this decision, and maybe I won't have to after all. There are other possibilities for the present fatigue. I don't have to figure it all out today, right? I pray I don't have to figure it out at all. The dilemma feels impossible. Do I take more of the med and improve my life, or do I take less of the med and improve my life? I pray I don't have to decide.

What would you do?


deepblue said...

wow, that's a really tough one. Is there any other medication you could try that might have the same benefit but possibly less extreme side effects?

I'm not sure what I would do. I wish I had something somewhat helpful to say, but I really don't. I pray you'll find your answer soon.

Bradley said...

That is a tough one to call. It's easy for me to say that I'd rather reduce the fatigue and slow the running, but I'm not a runner.

I hope you find someway to balance both. I'll join deepblue in prayer you'll find an answer.

Pink Floyd said...

This is definitely a tough decision. Which do you think has the greatest affect on your quality of life? I would probably lean towards taking the meds but some people find natural therapy (such as running) as more important.

Marissa Miller said...

How ironic that the medicine that's supposed to help you with fatigue is also contributing to it as well.

etta said...

Hey, thanks for commiserating with me everyone! I've been feeling a bit less fatigued the last few days, and therefore a bit more hopeful that I can have the best of both worlds! Maybe it will just take some time for my body to adjust to the decreased dose. I hope so. I have a race tonight, so we'll see how that goes!

@ marissa--the med isn't causing the fatigue. the med TREATS the fatigue beautifully. it is the decrease of the med which seems to be bringing back the fatigue, which, unfortunately, makes sense.

Marissa Miller said...

Isn't the med increasing your heart rate which, I guess, leaves you feeling fatigued enough that you can't exercise at your peak level?

etta said...

aahhh, good question, marissa.
Yes, the med increases my heart rate, but that does not make me feel fatigued. It impacts my running because, at rest, I am already nearer my maximum heart rate, and therefore have less room (for lack of a better word) before I run out of maximum heart capacity. For example, if my max heart rate is 190 beats per minute, and I start at a heart rate of 90, I only have 100 bpm to "play" with before I've maxed out my heart.

We all have a max limit at which our heart can work. A trained athlete will be able to tolerate that maximum level longer than an untrained person, which accounts for some of the variation in people's abilities.

Here's what I mean. In my case, at a resting heart rate of 90 bpm, walking may increase it to 110, jogging slowly to 125-130, running to 150-170, and running fast to 190. However, if I start at a resting heart rate of 50 bpm, walking may increase it to 65-70, jogging to 85-100, running to 120-140, and running fast to 160, and I've still got room to go faster or sustain my pace longer. Does that make sense?

One of the benefits of training is a lower resting heart rate. When I was in my best shape, my heart rate often dipped into the 30's and rarely went above 50 bpm.

That's why athletes pay attention to their heart rates. It gives us a sense of the shape we are in, whether our training is effective, and how fast or how long we can perform at peak levels. Hope that helps.

Marissa Miller said...

It does. Thanks!