Hi Watson, 

Thank you for reaching out to us with your questions, I’ll do my very best to answer them!

If I understand correctly, you’ve been feeling exhausted every day for several years now. It’s making it very hard for you to go through your daily responsibilities, and even enjoy hobbies. Everything requires a ton of effort, more so than other people. You’re trying to determine the cause of this severe tiredness, thinking it might be a medical condition, a psychological condition, or poor habits. You’re scared it could be the last option, because then it would mean you’re at fault for not taking care of yourself. You’re hoping I can help determine the cause with you, or at least offer some solutions. Does that sound about right?

I’m really sorry you’re going through something so difficult without receiving much support from your parents (at least from your mom). Being blamed for a condition that seriously affects you can easily bring feelings of guilt and defeat. Plus, it must be very lonely laying for hours unable to do anything. I hope you nonetheless have at least one person who understands what you’re going through and whom you can talk to about this. It’s okay to feel frustrated and even hopeless when it’s been so many years since this situation has been going on, and no cause has been determined. I can see why you’d be worried that it could come from unhealthy habits, especially since it’s already very hard for you to do those habits because they require so much effort. It’s so valid to feel scared because you might be wrong, but trust what you’re experiencing. You know your symptoms best. 

I’d first like to say that I am not a health professional, and I unfortunately can’t diagnose the cause of your condition. However, I can share some knowledge about what I think could be happening, and some potential solutions you could explore. In addition, there are probably multiple causes to what’s happening to you, all contributing to your exhaustion level. As such, it’s hard to pinpoint exactly what the source of your tiredness is. But I do have some ideas. 

To begin, I don’t think that your situation is purely caused by unhealthy habits, because a lot of people have unhealthy habits and don’t feel as tired as you do (once again, I’m not a professional so I could be wrong). Of course, having healthy habits can help with reducing tiredness, but it’s also super understandable to feel like even those basic habits take so much effort. I hope it’s okay if I nonetheless offer some options for how you could eventually improve such habits, once that tiredness has reduced, or if you aren’t able to get diagnosed and treated properly :

Reducing the more severe symptoms to improve habit acquisition : A proper diagnosis and treatment might greatly help in acquiring healthy habits that once required a lot of effort. For example, this is used for people suffering with severe anxiety, where medication can help with integrating coping mechanisms, otherwise the symptoms are too overwhelming and hinder their healing progress.

1. Taking it one habit at a time : Simple actions are the best way to form a habit without being overwhelmed and rapidly exhausted. For example, going for a walk once in a while, whenever it’s nice outside, with a friend, etc. Even if walking might not seem like a proper workout, it’s better than not doing anything. Another example would be to drink more liquids, such as juice, smoothies, water, and such. If you don’t like the taste of water (some people find it boring which is valid), you could add flavoring to it. Finally, picking up a hobby like crocheting, embroidery, drawing, or reading might help reduce tiredness, or at least avoid the whole doom scrolling many of us deal with. I think most people nowadays spend a lot of time in front of a screen either way so I don’t think it’s very dramatic if you do as well, although if you’re spending all day on social media on posts that makes you feel bad about yourself, it might be worth considering changing that habit. To summarize, keep it easy and listen to your body’s limits. 
2. On another note, it’s always important to ask : do you sleep enough hours? Do you feel rested after sleeping? Considering you have no sleeping disorders and if you sleep well but are still tired, it might be something unrelated to your sleep. You further mention having little appetite, but does that mean you eat less, more often? Such as having snacks in between meals, or more than 2-3 meals per day? That could help avoid nutritional deficiencies, or a lack of enough calories to go about your day. 

You’ve further mentioned that you’ve done a self-test for determining if you have POTS. I’d still recommend doing an official test with a doctor just to be sure. Unfortunately, that’ll mean convincing your mother. Considering how a lot of your symptoms match with those of the syndrome, it’s better to do an official test to rule it out, or even just to get a diagnosis (if that’s what is causing all of this) (here’s a link for more information, by dysautonomia International).

As you’ve mentioned, this could all be a sign of depression as some symptoms do seem to match, but considering that the tiredness is extreme, depression might be more so a side effect of this fatigue than its main cause. I’m basing this on my interpretation that you were falling asleep in the middle of the day when you were younger, which seems unusual for major depression. Being tired is common, but maybe not to that extent. You could nonetheless contact a therapist or psychologist to be sure. You might have access to one for free at your school, and your privacy will be respected.

Another possibility is chronic fatigue syndrome, and this one seems the most likely from my point of view. I’d highly recommend asking your doctor about this. In addition to tiredness, you may have dizziness when standing up, muscle or joint pain, and feeling very tired from working out (Mayo Clinic). This is a syndrome, meaning that it’s a combination of symptoms but the cause itself isn’t known.

If you’ve gotten COVID-19, it’s also possible to have a long-term side effect that consists of excessive tiredness, and that can make your symptoms worse unfortunately (Government of Canada). It might not be the cause, but it could be making your symptoms way worse.

Finally, have you done tests to determine if you have any vitamin deficiency? That is also associated with tiredness, especially vitamin B12 and D deficiencies (Mayo Clinic).

Once again, I’d like to emphasize that I’m not a health professional, and so I still very much recommend asking a doctor about your condition. I would even recommend contacting another doctor than the one you’ve seen so far. Sometimes getting a second or even third opinion might be a life changer. Unfortunately, with complex and misunderstood conditions, many have to go through several appointments with several doctors until they’re properly diagnosed. I hope that’s not the case for you, but it’s also better than just being plainly undiagnosed or even misdiagnosed.

I hope that I was able to offer you some comfort and a few potential pathways to follow to improve your situation. Do contact us again if you have any more questions! I wish you all the best.

Lorena (they), sexology student