Drained All the Time? The Psychological Causes of Exhaustion

by Andrea M. Darcy

Our modern lifestyles can mean sleep slips to the bottom of the list so often that ongoing tiredness can feel a normal part of life.

But don’t assume it’s just a lack of sleep leaving you drained. Tiredness is actually a sign of several psychological health conditions.

Why is fatigue related to our moods? And how can you tell if yours is a sign of a mental health issue?

Is it physical fatigue, or psychological fatigue?

Physical fatigue is when your body fails to perform in ways you are used to. You might find yourself exhausted by things that used to be easy, like walking up stairs or carrying groceries.

Psychological fatigue manifests as being unable to think as clearly as usual. Concentrating might be hard, you could feel like you have ‘muddy thinking’ or ‘brain fog’. Psychological fatigue can also manifest as feeling spacey, dizzy, or a ‘high’ feeling.

The assumption many erroneously make is that only psychological fatigue is a sign of mental health problems. But physical fatigue can also very much be a sign of depression, anxiety, and PTSD.

Sufferers report such things as ‘feeling like my body is made of lead’, or ‘it’s like I am carrying bags of sand on my shoulders’ and ‘everything feels weak’. Others report medically unexplainable aches and pains in their body that make them physically less capable.

How is it possible that low moods can make our body exhausted?

Low moods are generally linked to life stress and trauma, whether it is a recent experience or from the past. For example, perhaps your depression was triggered by a major life change like a breakup, redundancy, or bereavement.

Or it might just be that your low moods themselves are leaving you stressed. You might feel ashamed to not feel happy, worried your family or children will find out you are not yourself, or be anxious about the stigma mental health issues sadly still attract.

Stress of any kind causes the body to go into ‘fight or flight’ mode. It sees you experiencing a flood of adrenaline, a beating heart, tense muscles, and higher levels of cortisol. High levels of cortisol in particular, caused by any sort of ongoing stress, means the body doesn’t have a chance to return to a normal relaxed state. This inevitably results in not just fatigue but many other health issues.

With certain types of trauma, you might be in a constant state of emotional shock or have PTSD, which leaves you always on a ‘fight or flight’ high – understandably draining on your body. Emotional shock also causes your neurons to fire more rapidly so you feel ‘hyper vigilant’ to deal with the perceived threat. It leads to cycles of feeling very ‘on’ then crashing into exhaustion.

Tired vs depressed – what’s the difference?

If your schedule is hectic, you are under any sort of stress that is disturbing your sleep, or you have changed your exercise routine or a medication, you might just have general exhaustion.

But if your sense of fatigue carries on for more than a few weeks, start to look for other signs which can signal you are actually experiencing depression or emotional shock.

One of the main things to look for is your levels of enthusiasm. Are you still interested in things you have always loved? Do you still want to see your friends when you have a spare moment, crave your favorite dance class at the gym? Or do you find yourself feeling listless and apathetic, possibly avoiding friends and loved ones?

Also look for changes in the basics, food and sex drive. Are you eating more or less than usual? Is your libido totally gone, or are you suddenly using sexual encounters in a non positive way?

(read our comprehensive Guide to Depression to learn other signs of depression).

Be wary of assuming your fatigue is just from far too much stress and not taking it seriously. High levels of stress is itself is enough to trigger clinical depression and anxiety disorders.

Feeling tired even when the worst of your stress has died down is a sign you need to look at whether you need mental health support.

But I’m only tired because I don’t sleep well. Surely that isn’t psychological?

One of the main reasons we feel tired is because of losing sleep.

But then the question becomes, why are you you losing sleep, really?

Low moods and anxiety are often behind sleep problems. For example, the negative thinking and and worries depression brings can keep you up at night.

(Can’t sleep? Read our comprehensive Guide to Sleep Problems).

Of course one could argue they it’s the other way around – they are depressed because of losing sleep. Tiredness means you can’t think straight, which can lead to being late for things, or messing up at work or with social arrangements, or overeating. This all understandably can leave you frustrated and miserable. So in this case, it seems like not sleeping caused the depression.

Depression and insomnia are often so intertwined it’s often a chicken or egg situation over which came first, or what scientists call a ‘bidirectional’ relationship. So in most cases it can’t hurt to look at ways to feel better about yourself and your life if sleeping has becoming a challenge.

If you have not slept well for six weeks or more, and have tried all sleep advice to no avail, it is a good idea to talk to your GP. He or she can recommend sleep specialists or perhaps a short round of sleep medication. They will also ask you questions to help determine if there is psychological reason you aren’t sleeping, and if a mental health intervention such as a round of CBT or a private therapist would be useful for you.

But maybe it isn’t depression at all that has me exhausted, but chronic fatigue syndrome?

Despite new research, it’s still not completely certain what causes chronic fatigue syndrome. Whereas at one point sufferers were left to feel ‘it’s all in their head’, The World Health Organisation (WHO) now classifies CFS as a neurological illness.

At the same time, it is recognised that mental health issues are often one of the main contributing causes of chronic fatigue syndrome, if not something that develops hand in hand with it due to the stress the condition can bring to the sufferers life.

Here in the UK, the National Institute for Health and Care Excellence (NICE) advises a treatment program that equally manages the physical and mental care of the client, and the NHS offers cognitive behavioural therapy (CBT) as a main part of treatment.

Can therapy give me more energy?

Long term, absolutely. Therapy can help you feel more energised in several ways.

First, it can help you learn to recognise your patterns of negative thinking that lead to stress as well as your negative decision making which can be the cause of more stress (CBT in particular focuses on this art of thought recognition).

Second, it can help you start to see and stand up for the ‘you’ in ‘your life’. Where are you doing what you really want, and where are you doing what you feel you should do, or what your parents or family want you to do? Are you living from your own values, or those of others? Do you even know your own perspective?

Therapy helps you make steps towards a life that is suited to you, and not to the pressures you have felt. And there is nothing more energising than waking up to a life that matches you perfectly.

Third, therapy helps you to have better relationships. While it can seem easier to go through life just saying yes to everyone rather than upsetting them, the price is always being drained and losing sight of your own identity. Therapy helps you work on any codependency issues you might have, and teaches you how to set boundaries.

All this aside, therapy is not a skip through the park. At first, it can seem very overwhelming to face up to all the thoughts, feelings, and memories you might have spent great effort avoiding. Many people report feeling utterly exhausted for the first few months.

But this, at least, is a good kind of exhaustion, because it’s the result of hard work on yourself that leads you towards the life you want and energy levels you might not have realised you were missing out on.

Photos by Charlotte Marillet, Dan4th Nicholas, Julian Stallabrass, jinterwas

Andrea M. Darcy is a health and wellbeing expert, who has done some training in person-centred counselling and coaching. She often writes about trauma, relationships, and ADHD, and advises people on how to plan their therapy journey. Find her on Instagram @am_darcy