Strange fatigue patterns, depression?

[Shane]

This may sound weird, but I have noticed something strange...

I am around the house all day (alone nothing to do), I get fairly fatigued but I don't "crash" (meaning not laid up on the couch all day) OR...

I leave the house for the day, feel pretty normal (almost never fatigued during the event) but within minutes of arriving home I crash (laid up on the couch)

The strange caveat here is if I arrive home at 2pm I crash WORSE than if I arrive at 6pm!  So it isn't like the amount of energy I expended has anything to do with how fatigued I am...like home just triggers it.

It seems the more engaged I am, the much better I feel (physically). Almost like coming home or not being engaged in something gives me some kind massive metabolic or adrenal drop that wipes me out.  People have told me this might be depression instead, since this pattern has been going on to a lesser extent even before I developed acute ANS symptoms two months ago. At some level I am inclined to agree, although I don't "feel" depressed I just can't see how ANS dysfunction could affect me in the strange way.

Thoughts? Thanks.

[StayAtHomeMom]

I think to test your theory I would go on vacation. Make sure you spend half the time going out and about and then see if you crash when you get back to your hotel. 

I notice similar things but the amount of energy expended usually matters. It is kind of like, "OK I am home, I can relax" and you take a deep breath and your body just crashes. 

[Pistol]

When I used to work I had the same thing - I worked 12 hour shifts 3 times a week in a high-stress environment and would function only on adrenaline. As soon as I got home ( after a 1 hour drive that helped my levels come down ) I would literally collapse into bed but without sleeping. On my days off I would drag myself from chore to chore, feeling terribly fatigues and disinterested in anything. Then - when I returned to work - I was "superwoman" again. This was in the early stages of my dysautonomia. If I would have known then what I know now I would have done it different. It may be similar in your case, when you are out of the home you function with higher norepinephrine levels and when you get home they drop. Especially since you live alone and do not have to make yourself do things. I think though that depression plays a big role in dysautonomia because if we get fatigues we do not feel good and because of that and the limitations of this condition it is pretty understandable that one would develop depression. -- Do you take any meds? In addition to several cardiac meds what helped me with the hyper/hypo thing is Escitalopram ( SSRI ) for the fatigue and Methylphenadine ( Ritalin ) for energy. This combo has very much levelled me out. --- Also - on days when you are not working you may benefit from exercising to fight fatigue or depression. Best of luck to you!!!

[katyroq]

I relate quite a bit to what you said @Pistol. I find this one of the weirdest things about my fatigue symptoms. I work a couple days a week and on those days can do almost anything I want or need to, but if I don't have anything in particular to do I have much more trouble in the morning. It seems like just a little bit of adrenaline from having to be somewhere at a certain time helps a lot. Not that I don't crash later, but it really affects my ability to function in the morning. 

[joiedevivre]

I would crash more at 2pm than at 6pm because I always feel worse at 2pm than 6pm. So maybe if effect you're riding out the crash when you stay out until 6? Like you I sometimes can feel much better when I'm out and about ( it really depends on the precise details of the situation) and almost think I must be getting better, but then I come home and totally crash and I realize, no I was using "energy " I didn't actually have, all along. I don't think it's my apartment though, I will feel a similar crash at other quiet and comfortable places, like in a quiet corner of the library in an arm chair. I think I have so little energy that when I'm out and about I'm holding myself with extreme tension just to walk, sit, wait in line, look normal, etc that that tension causes my blood pressure to rise as well as sympathetic nervous system to be activated ( not just heart rate but feeling "alert " ) and that makes me feel like I have more energy. But then I get home and the assault of the trial is over and I just crash because it wasn't real energy in the first place. I also think the crash is worse because I'm alone. I think it would feel less intense if I had a close friend I was talking on the phone with or something but I never do. 

[StayAtHomeMom]

6 hours ago, joiedevivre said:

when I'm out and about I'm holding myself with extreme tension just to walk, sit, wait in line, look normal, etc that that tension causes my blood pressure to rise as well as sympathetic nervous system to be activated ( not just heart rate but feeling "alert " ) and that makes me feel like I have more energy. But then I get home and the assault of the trial is over and I just crash because it wasn't real energy in the first place.

I think that is a great explanation. And a rational idea to what is happening too. 

[Shane]

@everyone thank you. descriptions are great. I think the only way I vary from what you are saying is when I am out I don't feel like I a making much effort or tension to walk, sit, etc. my HR is up at bit (90-95) as you'd expect going to doctor and such, but I just "feel" better. In fact, since this happened when I am out I'd argue I use roughly the same amount of energy when I am home (try to walk the house around to get steps on my Fitbit up) and not like am at a job, or stressing my body that much during an event.  Even weirder, this was happening in a smaller way, before this acute event. Days I didn't have class I felt worse that when I went to class all day and my best days were when I came home around 6 vs. 2 (granted then I just did "feel" as good no crash).  Actually, the more I think about it this pattern (albeit different in intensity) has been happening for a long time.

[Pistol]

This is not any type of knowledgeable advice but maybe an observation to explore: you mentioned depression as well as being alone at home. Could it be possible that you feel more "down" when you get home at 2 pm vs 6 pm because you have longer to go home alone at 2 and less at 6? Also - could it just be your biological rhythm? When you get home at 2 pm you crash but when you are at work at 2 pm you ignore your natural rhythm and keep going and by the time you get home at 6 pm you have already overcome your "slump" period of the day? Most people have their least energy around 3 pm, that has been proven by scientists. It has to do with the circadian rhythm. So - when you get home early you experience that low and when you come home later you no longer have it? I am just thinking out-loud here.  

[Shane]

@Pistol thank you. this is interesting, even though the endocrinologist has been returning negatives so far, I got my saliva cortisol test back and 3 of the 4 samples were normal BUT the one I took at 3PM was 2X normal. I don't think that is just a coincidence when I normally "crash". Also, I had ordered a Thyroid panel which was pretty normal except High T4 free and High reverse T3. Pretty sure the medical community (and my endo.) could care less about those readings, but it makes me wonder. Hopefully, the CRH Stimulation test comes back next week, or I find out something at BIDMC when I have my workup on Thursday.