No, the term is not accurate. But fatigue is a possible symptom of episodes of depression or mania in bipolar disorder.
Bipolar disorder can impact your sleep cycle, energy levels, and motivation. So, if you live with the condition and often feel exhausted, it’s not just your imagination.
Fatigue is a common symptom of bipolar disorder, but it can be managed.
Yes, fatigue or reduced energy is a formal symptom of bipolar disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Fatigue is listed as part of the criteria for diagnosing an episode of depression. It’s one of eight possible symptoms you could experience over a period of 2 weeks when you live with bipolar disorder.
“Fatigue is actually a criteria we look for and expect,” explains Dr. Beth Gabriel, a psychiatric mental health nurse practitioner in Jacksonville, Florida. “This can be related to the imbalance of the neurotransmitters serotonin and dopamine in the brain.”
Fatigue can also be caused by sleep disturbances, another hallmark symptom of an episode of depression.
Perhaps you’re spending more hours in bed, but your sleep is interrupted. You may also not be getting enough “restful” sleep, which could leave you feeling tired in the morning.
“If someone doesn’t get enough sleep, over time, they wear down and can become very fatigued, down, and unmotivated,” says Gabriel.
Brain fog vs. fatigue in bipolar disorder
Though they often go hand-in-hand, brain fog is different from fatigue.
Fatigue may feel like a combination of being tired and a lack of motivation to pursue your usual activities, like household chores, paying bills, or getting work done.
- difficulty processing information
- decreased focus
- lapses in your memory
Both fatigue and brain fog are possible in bipolar disorder.
It’s not as common, though still possible, that you experience fatigue during an episode of mania.
Mania often causes insomnia, which can drain some of your energy the next day.
With that said, it’s far more likely that you’ll experience fatigue once the manic episode is over, says Sonia Martin, a licensed clinical social worker in Brooklyn, New York.
“During the manic state, despite not sleeping as much, you may have a lot of adrenaline-fueled energy,” she explains. “When you crash, you may experience the impact of days, sometimes weeks, without sleep.”
It’s possible that some people have the same experience during an episode of hypomania.
Many of the medications used to treat bipolar disorder can cause fatigue-like symptoms, says Dr. Joseph Flaherty, president of the Western Atlantic University School of Medicine in Freeport, Grand Bahama.
“This was particularly true for first-generation antidepressants (tricyclics and heterocyclics), which are still prescribed today or added to a medication regime for bedtime to improve sleep,” he explains. “They stay in your system a long time and cause fatigue the next day until you get adjusted to them.”
Certain mood stabilizers may also cause daytime fatigue, including:
- lithium (Eskalith)
- divalproex sodium (Depakote)
- lamotrigine (Lamictal)
“Additionally, some people living with bipolar disorder will require an antipsychotic medication at some point in their course, and these also can cause strong fatigue,” adds Flaherty.
If you think your fatigue could be related to your medication or dose, consider having a conversation with your health team to explore your options.
It’s possible to manage and decrease fatigue if you live with bipolar disorder. These tips might help:
1. Try practicing sleep hygiene
A consistent sleep hygiene practice can help your body transition into “rest mode.”
Perhaps your routine could include:
- a calming activity, like meditation, reading, or gentle yoga
- avoiding caffeine, exercise, nicotine, or blue light (screens) before bed
- eliminating naps during the day
- going to sleep at the same time every night
- setting your alarm for the same time every morning
2. Consider structuring your day
If possible, try your best to keep a regular schedule. You may find it helpful to:
- begin your day with a set morning routine
- set a timer while you work
- save your most important tasks for the hours when you have the most energy
“I know this is easier said than done, but if you are able to push yourself to keep to a schedule, even if it involves very simple things around the house, you will likely feel better and eventually start to sleep better,” says Gabriel. “Remember, your brain may follow your actions. I know it’s hard, but you can do this.”
3. Balanced nutrition can help
If it’s accessible to you, you may want to try a diet rich in nutrient-dense, unprocessed foods. This can help provide stable energy levels throughout the day so there are fewer peaks and lows related to your blood sugar.
4. Try to get regular exercise
Physical activity may be the last thing on your mind when you feel fatigued. But, exercise can boost your energy levels and mood.
Even a walk around the block in the sun or some gentle movement may help.
Research shows that in people with bipolar disorder, regular exercise can reduce symptoms like fatigue in episodes of depression. This is because exercise increases feel-good neurotransmitters, like endorphins, in your brain.
5. Visiting your health team is a good idea
Making adjustments to your medication may alleviate some of your fatigue.
You might find it helpful to ask a health professional what options are most appropriate for your symptoms. Sometimes, it can be as simple as adjusting your dosage.
However, try not to do this on your own because if the fatigue isn’t medication-related, your other symptoms may worsen if you discontinue or lower your dosage.
6. Consider limiting alcohol intake
Some symptoms of bipolar disorder could become more intense as a result of substance use.
Support for substance use
If you are living with substance use disorder or alcohol use disorder, you are not alone, and support is available.
You may find it useful to locate treatment options near you through the Substance Abuse and Mental Health Services Administration (SAMHSA).
Fatigue is a common symptom of bipolar disorder, often making it difficult to function in everyday life.
While there’s no one-size-fits-all approach to reducing fatigue, there are several strategies that may help you cope.
You may wish to try a combination of lifestyle adjustments, like sleep hygiene, diet, and exercise, as well as a visit to a health professional to see if you can change your medications.