(2018-06-28) Kaufman Debugging Dysthymic Depression Overcoming Chronic Fatigue

Josh Kaufman: Debugging Dysthymia: Overcoming Chronic Fatigue. I've been exhausted for over a decade.

I've struggled with low-level chronic fatigue since college

A New Hypothesis: Dysthymia

One of the first potential causes you find in any sort of research about low energy / sleep disturbance / insomnia is depression: they're very common symptoms of major depressive disorder.

The diagnosis didn't fit, though: I didn't have any of the other symptoms

Dysthymic disorder (abbreviated as DD) is chronic low-grade depression. It is one subtype of what the DSM-5 now calls "Persistent Depressive Disorder," or PDD.

The main symptoms of DD include: depressed mood (lasting 2 or more years); feelings of hopelessness; poor concentration or difficulty making decisions; low self-esteem; low energy or fatigue; poor sleep; and poor appetite or overeating.

PDD is one of the most common mood disorders. It affects as many as 3 to 5% of the general population.

dysthymic disorder was added to the DSM-5 in 2013.

I narrowed my "first things to try" list to three options, each of which had performed in clinical testing as well (or better) than both standard medication and placebo, with excellent safety and minimal reported side effects:

• St. John's Wort
• SAM-e
• Saffron*

St. John's Wort, which has many of the same effects as prescription antidepressants like SSRIs, produced terrible side effects: acute, persistent feelings of anxiety along with severe insomnia. I discontinued after two days.

SAM-e was another story.

S-Adenosyl Methionine (SAM-e) is a vital part of the human body's one-carbon cycle

I took 400mg of enteric-coated SAM-e, then waited. It didn't take long: I felt better within hours of the first dose

After experimenting with dosage, 800mg of SAM-e twice a day on an empty stomach + a B-vitamin complex for cofactors produced the best results.