bipolar_disorder_missed_depressionFor Ruth White, the fatigue that comes with depression can be overpowering. “I find it difficult to get out of bed and once out of bed, just walking can be exhausting. Texting or even watching TV can seem to take Herculean effort,” said White, Ph.D, MPH, MSW, a clinical associate professor in the School of Social Work at the University of Southern California.

Writer Therese Borchard finds it takes longer to do mundane tasks, such as washing dishes and folding laundry. Her work also has slowed. “It takes me about twice the amount of time to write a piece as it did before I had my breakdown 10 years ago.”

Fatigue is common in depression. In fact, according to clinical psychologist Shoshana Bennett, Ph.D, “it’s unusual for fatigue not to be one of the symptoms of depression.”

Her clients often say that they know what they need to do to get better, but they just can’t do it.

This is why fatigue is so destructive. As people become tired, they stop participating in social experiences and enjoyable activities, said Margaret Wehrenberg, PsyD, a clinical psychologist and author of several books on anxiety and depression, including The 10 Best-Ever Depression Management Techniques.

They don’t have the energy or endurance. But isolating and not moving their body makes them even more tired and depressed. In short, fatigue and depression have a circular relationship, Wehrenberg said.

Fatigue affects people emotionally, cognitively and physically, according to Bennett. “It slows down everything.” It batters self-esteem, which is already low in people with depression.

Many of Bennett’s clients call themselves stupid. They think, “I don’t even get the plot on that TV show; what’s wrong with me?”

Bennett, who struggled with postpartum depression, recalled the powerful deceleration of her motor skills. “It was very hard to get up off the couch. And my real self is active, task-oriented and productive.”

The best thing you can do to get better is to seek professional help. This typically includes working with a therapist and, for some people, taking medication as well. As this difficult illness abates, the extreme exhaustion and lack of energy will, too.

Below are additional tips for navigating depression’s overwhelming fatigue.

1. Eat nutrient-rich foods.

Depression often causes appetite loss, especially when anxiety is present, said Bennett, author of four books on depression, including Children of the Depressed. She suggested setting an alarm for every two to three hours. When it rings, eat protein and a complex carbohydrate and drink water to stabilize your mood.

“Making sure I eat high-fuel foods throughout the day is a way to fight the inclination to skip meals, which would then make me more fatigued,” said White, author of the book Preventing Bipolar Relapse.

White eats high-fuel foods such as eggs, yogurt and meat, along with lots of raw greens and nuts.

“My diet is extremely important,” said Borchard, founder of Project Beyond Blue, an online community for people with treatment-resistant depression and other chronic mood disorders and their loved ones.

She skips sugar altogether. Even though she gets an initial spike of energy, sugar makes her drag for days. Instead, she focuses on foods that level out her blood sugar.

2. Practice good sleep hygiene.

Borchard goes to sleep at the same time every night (usually 10 p.m.) and gets up at the same time every morning (around 6 a.m.). She also carves out quiet time in the morning to pray, meditate, read or do anything else that helps her mind rest.

3. Connect with others.

“Social engagement is powerful,” Wehrenberg said. Social media, however, isn’t the same, she said. When you’re already fatigued and you check Facebook and see all the exciting and wonderful things people are doing, you’ll probably feel worse, she said. “It’ll look like the world is having way more fun than you are.”

Instead, connect with friends in person. These don’t have to be major outings. Have a friend join you for coffee, she said.

White finds it helpful to connect with friends who support her “in taking baby steps until the clouds pass.”

4. Adjust your expectations.

“I have to continually — like four times a day — readjust my expectations,” said Borchard, who pens the blog “Sanity Break” and authored the book Beyond Blue: Surviving Depression & Anxiety and Making the Most of Bad Genes.

In fact, she calls her expectations the biggest threat. “If I can bring my expectations down, then I feel OK about myself. However, once I start comparing [myself] with other writers and people I respect, I’m in trouble.”

5. Practice compassionate self-talk.

Beating yourself up about being tired or calling yourself lazy only exacerbates the fatigue. It’s like being in the middle of a boxing ring pummeling yourself, adding insult to injury, Bennett said.

Pay attention to your negative self-talk. When you’re feeling bad about yourself, consider “What am I saying to myself right now?” Bennett said.

Then apologize and counter critical statements with the truth. Be specific, she said.

For instance, “I’m sorry. I didn’t deserve that. I’m doing the best I can. This isn’t laziness. I have a real illness. I’m taking good steps to help myself, such as attending therapy, drinking water and moving my body. I look forward to getting myself back.”

Also, consider what you’d say to a friend. And remember depression is a difficult illness. As Bennett said, “You can’t snap out of depression any more than you can snap out of the flu.” So be gentle with yourself.

Stay tuned for part 2 where experts share five more tips to navigate the extreme exhaustion of depression.