I am 38 yrs old and am on SSDI. I have fought severe depression my whole life. I was always told that being tired was part of depression. I have been hospitalized 4 times and had extensive meds and therapy. I am now only on one med and doing okay. I want to get a job, get off SSDI and have a normal life. The problem I have is I am always unmotivated, always run down feeling. I have NO ability to concentrate. I have never finished a book. I can’t focus, I feel so lost because I want to be a productive member of society and I can’t. If my depression is so much better why am I still so tired and worn out? Some days I am so tired I can’t even lift my arms to take a shower and wash my hair. I want to get work but am still afraid I won’t be able to keep up. My doctor has tested my thyroid and stuff, it is all normal. What do I do?

A. I suggest that you return to the doctor for further medical testing. It may not be your thyroid. It could be another medical condition. Others to explore include chronic fatigue syndrome, Epstein-Barr virus and other disorders that attack a person’s autoimmune system.

I also wonder if your tiredness is related to a long period of inactivity. Sometimes when a person is inactive for a substantial amount of time they simply have no energy. You may have to retrain yourself to do basic tasks like taking a shower. A psychotherapist may be able to help you with these issues, or perhaps a physical or occupational therapist.

It does not seem that you are ready to return to work at this point in time, but you may be very soon. It is best to first explore these issues with both your physician (to explore a medical cause) and a mental health professional. A therapist could help you explore how much, if at all, your depression is contributing to your tiredness and whether you should be referred to a physical or occupational therapist. Your physician may also be able to determine if a physical or occupational therapist is necessary. Ideally, a physician and a mental health professional should work together to explore this issue. That way, you’d be receiving the most comprehensive care. Thanks for your question.