When Rest Doesn’t Help: How to Manage Major Depressive Disorder–Related Fatigue

Fatigue is more than just being tired, says Jarrod Ehrie, MD, a clinical assistant professor of psychiatry and behavioral sciences at Stanford University in California. “Tiredness can be improved with sleep or reduced exertion; fatigue doesn’t improve with rest,” he says.

MDD-related fatigue “can feel like this cloud that's hanging over you that doesn’t really go away,” says Naomi Torres-Mackie, PhD, a clinical psychologist at Northwell Health’s Lenox Hill Hospital in New York City. “It’s ever present throughout the day.”

It can be frustrating to take it easy and prioritize sleep yet still lack energy. The good news is that a strategic approach to your days can help you conserve energy and stay more alert and engaged.

Think of your energy as a daily allowance that you need to spread out wisely. “The idea is that if you have a limited amount of time and energy, you make sure to use it on the most important or rewarding things in your day,” says Dr. Ehrie. Here are a few ways to budget your energy.

Try Activity Scheduling

Start by listing activities you did in the past week and rating them on a scale of 1 to 10 for how much pleasure you got from each and how much sense of accomplishment you got from each, advises Ehrie. Then cut out activities that rank low for both as much as you can. For instance, if you determine that looking at social media or the news is draining, make a point to limit scrolling.

Next, start to prioritize activities that are high on both of those scales. “The more someone feels accomplished, the more they have pleasure,” says Ehrie. “And the more they feel they can do things and look forward to things, the less crushing responsibilities feel, and the more they can do the next week and the next week.”

Prioritize Your Task List Accordingly

Take a look at everything that needs to get done, such as work assignments, chores at home, and social commitments. Consider which tasks are essential, as well as those you actually enjoy. For example, if a highlight at work is collaborating with a colleague, try to schedule those talks early in the day or use them to break up less rewarding tasks, suggests Ehrie.

Making plans to get out might seem daunting when you’re fatigued, but avoiding them can wind up making you feel more depressed — a vicious cycle, says Dr. Torres-Mackie. Here are some strategic ways to stay active.

• Fake it till you make it. That’s the name of the game with behavioral activation, says Torres-Mackie. It’s a widely used tactic for depression that aims to increase positive interactions between you and your environment, and it’s been shown to have significant positive effects. “It involves looking at the things that you enjoy engaging in and making yourself do them, even if you have low motivation and you're not feeling like it,” says Torres-Mackie. It works, she says, by “providing a break in this cycle, because depression makes you want to do less. And when you do less, that actually increases depressive symptoms.”

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• Build in social time. “If you’re experiencing depression, spending time with friends, family, and colleagues can definitely boost your energy,” says Torres-Mackie. So fill your cup by making sure to prioritize socializing and connecting with your circle.
• Exercise and eat well. “Exercise and moving your body can be very helpful,” says Torres-Mackie. Eating nutritious foods can give you a sense of energy, she adds, though you might want to sidestep foods and drinks that you’ve traditionally turned to for an energy boost, like those with caffeine. “When it comes to depression and fatigue, it can be very tempting to overload on caffeine,” she says. “But then you can crash from that, and it can become a negative cycle — so we don't really recommend it.”

It’s not always obvious whether fatigue is caused by MDD or something else. Sometimes fatigue could point to another underlying health condition or be a sign that your antidepressant medications (if you’re taking them) need an adjustment.

“A number of so-called medical mimics can look a lot like depression and are often characterized by prominent fatigue, like obstructive sleep apnea and hypothyroidism,” says Ehrie. And some other disorders, like chronic fatigue syndrome, include fatigue as a primary symptom. “The first stop should be to see your primary care physician and rule out other causes.” says Ehrie.

If your fatigue is so strong that you can’t stay awake or it’s interfering with your daily life, speak up. “We all experience fatigue at some point in life, of course, and have different strategies for managing it,” says Torres-Mackie. "But if the fatigue feels so strong that you can't get work done or you can't take care of yourself or your family, definitely talk with your healthcare provider.”

To make the most of your appointment, bring notes about your sleep and energy patterns and your current medications. “Some antidepressants can cause more fatigue, and other antidepressants tend to be more helpful with energy levels,” says Ehrie. “So highlighting fatigue to your prescribing provider can help them rethink if they need to change things up.”

While these strategies and behavioral adjustments can help you deal with fatigue and make the most of the energy you have, keep in mind that the best long-term solution is addressing the root of the problem. “What we really want to see for the most drastic improvement in fatigue is treating the depression itself,” says Torres-Mackie.

• Fatigue is common if you have MDD, and it’s more than just being tired — it involves feeling wiped out all day, and it doesn’t get better with sleep or rest.
• Being strategic with your energy by incorporating techniques like energy budgeting, activity scheduling, prioritizing social time, gentle exercise, and behavioral activation can make your days feel more manageable and even boost alertness.
• If you have severe or persistent fatigue, it’s worth checking in with a healthcare provider to rule out other conditions, review medications, and make any necessary adjustments to your MDD treatment plan.