Depression – a lack of energy

What is energy, as we experience it? It is a word with a positive force behind it, that glows and lives, and is the opposite of all that one usually experiences when depressed. Personally I find it quite difficult to recognise the feeling of low mood when I’m depressed, but reduced energy is actually more easy to identify, and probably more consistent. In an attempt to get a more positive spin on what I am experiencing at these times, I looked up the opposite of energy – sadly it was rather dispiriting. I found quite a lot of words, but nearly all had a rather negative feel to them – such as languor, lethargy, even laziness and cowardice. There was an implication that the person experiencing such states was lacking in some way, and bore fault for their situation.

I suppose it wasn’t much of a surprise, really, as I often feel that way when ill, and tend towards the self-critical. But it is interesting that so many of the words that describe these feelings are rather negative, unlike those that are synonyms of energy – stamina, vitality, ardour, perkiness.

I have always found it very hard to define the feelings of depression, however, and I think energy works better for me. I’ve occasionally tried to keep mood charts, to spot any blips either way, and I’ve never found that I can do it with any feeling of authenticity. It ends up being more what I think I thought I was feeling, if that makes any sense. On the other hand, I have forty steps up to my house, and if I have to stop for a breather less than half-way up, I’m either carrying too much shopping or I’m starting to get depressed. Being able to bound to the top isn’t exactly normal either, or not for me. I remember particular routes and walks that I followed when depressed, and just how tiring I found them. It was bone wearying, but at the time I thought I was just lazy and not trying enough. Walking them now, it is hard to believe just how difficult it was then.

I do wonder what links and similarities there may be to other conditions such as ME and long covid, but it’s impossible to know. Similar symptoms may have different aetiologies, or there may be more similarities than we currently understand. It is likely that immunological or inflammatory factors can play a part in all these conditions.

More practically, what should we do about it? For those of us diagnosed with mood disorders, medication can indeed help. I find mood stabilisers and antidepressants just about tolerable; when I have been more unwell I’ve taken antipsychotics, but I would find them pretty unbearable to take long-term. Interestingly, the reason for this is that they deplete my energy – I am lethargic and gain weight, perhaps I sleep better, but I don’t feel normal. Other people will have different experiences, I know, and different medications can suit different people.

But what do you advise someone whose energy has upped and gone, and who is exhausted at the prospect of going out to buy a pint of milk? Do you chastise them, and accuse them of laziness, so that they stumble off down the road under a cloud of guilt? Or do you tuck them into bed, advise against risking any exercise and dim the lights? I appreciate these are both rather extreme, but what do you do? A logical middle way is some sort of guided exercise, but I find myself wondering at times how reasonable this is. Do the thing that you can’t do, then you will be able to do it, and then you will feel better – or will you? I don’t know the answers – I think maybe it can work during the recovery phase, but I actually wonder if it has the potential to make things worse when more unwell. I’m not advocating the stay in bed plan, necessarily, but maybe rest can be beneficial. It may even be cruel or harmful to push people to do more than they can when experiencing the energy drain that is depression.

Forcing someone to stay still is unlikely to be of much benefit in mania or hypomania, either. While over-stimulation may be harmful, the increased energy of mania cannot be reversed very easily by will alone.

However my current interest in this is whether it could be used as a more accurate tool than mood to monitor actual changes in mood. Other factors will play a part, such as concurrent illness or experiences, but levels of energy might be a rather nice way of doing this. For those like me, with a predictable stair count, a quantitative value, taken at the same time each day, could be added to an app, giving an energy graph from day to day. Obviously this is not entirely objective, but I think it would be easier to do than allocating a number to one’s mood. This would then provide an opportunity for earlier intervention, perhaps before one had even realised one was becoming depressed.

I must emphasise that this is not an alternative to self-care and exercise, and I can’t underestimate their importance in keeping mentally and physically well. But I do think it’s equally crucial to recognise when all is not right, and to act accordingly. I am sure there are other ways of doing this, and that for some it might be, for example, that monitoring sleep or appetite would be more helpful.

Ultimately, when we talk about mood disorders, there is still a strong emphasis on the emotional aspects, but for many of us, these can be hard to recognise. I think a lot of the stigma that still exists about mental illness relates to the use of ordinary words in describing our emotions and our feelings. Sorrow is not depression, but apathy probably is. Unfortunately it’s not a very flattering term.