Okay, so you're suffering from bipolar or major depression fatigue. Which is defined by completely debilitating fatigue that lasts for months and even years, so we're not just talking about feeling all pooped out following a tough week or feeling a bit run down occasionally. So let's understand this a bit more (I'll get to in a moment why it's so important to understand this very clearly).
Now we've established in Part I and Part II that mitochondrial dysfunction is very probably at the root of the fatigue (although there remains other factors that I'll get to) and that there are four probable reasons and factors involved in causing this dysfunction. To review, they are as follows:
A) - plain exhaustion (again, in the literal sense of supplies that are essential to cellular functioning run out) due to chronic overuse during manic episodes (in the brain, this is just as in any over-taxed cell that simply shuts down due to overuse). While the exact pathology is different, this is true in both bipolar and uni-polar depression.
B) - build up of toxic cellular waste products as a result of lack of sleep during manic episodes (or the chronic insomnia that often accompanies depression and anxiety) and other cumulative damage that results from cellular structures not getting the down time necessary that comes with sleep
C) - grave, long term damage due to chronically elevated levels of glucocorticoids due to chronically activated stress response system
D) - oxidative stress damage (which may in part be due to what we see in B)
And because I know you're still not convinced and because I know (and this is from my teaching days) that people need to hear a new concept multiple times from a variety of angles for it to start to "take firm root" (and the study of how brains assimilate new knowledge will bear this out as well), I'll just re-affirm what's going on with neuronal functioning and the role of mitochondria within that.
To reiterate the importance of mitochondrial functionality in neurons and in intra and inter-neuronal communication, I'll give you this from Jon Lieff's superb neuroscience blog (1) Searching for the Mind:
Mitochondria are essential energy producers for many of the key functions of the neuron, including the movement and recycling of the vesicles that carry neurotransmitters, the assembly and movement of the structural tubules, the generation of the electric charge in axons and dendrites, and the maintenance of synaptic plasticity. They are needed throughout the neuron to provide fuel. It is not widely appreciated that they are, also, critical for the metabolism of amino acids, lipids, and steroids. They regulate the calcium levels in the cell which trigger the axon signal firing. They also produce free radicals and regulate the process known as apoptosis, whereby a cell is systematically dismantled without forming scars.
It is nearly impossible to overstate just how vitally important all those factors are in how well neurons function. Just two massively important parts of inter-neuronal communication - neurotransmitters and electrical charges in axons and dendrites (the latter is what triggers the release of a neurotransmitter discharge in the synaptic cleft and thus a communicative leap from one neuron to others) - depend almost entirely on mitochondria doing its job.
And just to make it clear how important optimal neuronal functioning is to everything you think and do, let's review neurons for just a moment.
For every single thought, for every single movement of every single minuscule muscle in your entire body, there are groups and networks of neurons that are involved in or control that. We'll leave aside for now how all these individual regions work in concert to produce, for example, a golf swing that hits a little white ball two hundred yards to within several feet of its intended target (and does that consistently, not by fluke) and all the other dazzling physical feats humans are uniquely capable of or how the collective efforts of your hundred billion or so neurons produce what you experience as "consciousness", let's just focus on the roles of neurons in simple daily functions.
Every function is controlled by a specialized group of neurons. This is not theory, this is known via study into brain injuries, strokes and brain surgeries to remove brain regions. A bit of shrapnel takes out a tiny little brain region in the back upper right part of your neocortex and poof, there goes your ability to recognize faces (even your own). Remove this little bit of brain region (the hippocampus), and poof, there goes your ability to form new memories (which makes what Bill Murray experienced in the movie Groundhog Day look like a picnic). Suffer a stroke in this region (in which that entire region will suffer total neuronal death due to oxygen starvation), and poof, there goes all kinds of muscular functionality. And so on and so on and so on for every function we have, either physical, mental (as in higher cognitive functions) or emotional.
So every single thing you think or do is going to require specific brain regions made up of tens of thousands to millions of neurons to fire up and furthermore, the energy needed for those regions to communicate with other relevant brain regions. Just move your pinky on your left hand a smidgen. There, that fired up several thousand neurons. The conscious effort to absorb my instructions and for areas in your frontal lobes to send that message to that tiny region that controls your pinky necessitated firing up many other brain regions and thus tens of thousands of neurons.
Just attempting to digest what I'm telling you here is requiring brain-wide firing of all kinds of regions, all of which require high activation of specific neurons, ALL of which will require energy.
And to take this even further, every single one of your five senses is bringing in a constant barrage of "sensory data" - the vast majority of it below your conscious awareness - and all of THAT has to be processed by those overtaxed neurons and brain systems. Everything you see, everything you hear, everything you smell, everything you touch, everything you taste. All of it requires some level of neuronal processing and filing (though most particularly sight and sound).
Plain and simple - and this is super basic neuroscience - everything you do and sense depends on neurons firing in a specific region and for neurons to fire and communicate with other regions, they require energy within the neurons themselves and brain wide to facilitate broader system communication and ALL that energy relies on mitochondria (as outlined in the excerpt above), and again, this is just very basic neuroscience (though too often overlooked in our rush to pin mental issues on other factors).
By now you should better understand why your brain consumes a whopping twenty percent of all your energy!
So to expect yourself to function optimally on any level - physically, cognitively or emotionally - for any sustained period without a healthy "fuel system" in your neurons, without properly functioning mitochondria, is simply not realistic. It's akin to expecting the engine in your car to function without a carburetor system to convert gasoline into a combustible vapour and then expect your car to run without a functioning motor. You may have fuel (gasoline), but if you cannot convert that fuel into energy, then you have no functioning automobile.
So why do I go into such great detail and on at such length about all this? For a couple of reasons.
Let me return for a moment to my personal story.
I've lived with bipolar and depression almost all my life with it becoming more and more difficult starting in my late twenties and becoming extremely difficult in the last six years (that's a run of twenty-six years for those who don't know). The depressive phases have always been very, very difficult for me. And I never, ever understood them.
They had gotten progressively worse over the years and the fatigue has been steadily worsening the last four years or so (it was spring of 2010 that I really began to notice it). In a man who's been a proud working man since he was fourteen and in a highly driven individual, this fatigue, this being floored and utterly unable to "answer the bell" to go to work for days, then weeks, then months, and now stretching on into years, has been exceptionally difficult on me.
With the worst of the depression pounding me anyways, with the fatigue there was all the more reason for the already brutal self-flagellation inflicted on me. Because I couldn't work, or had great difficulty working (it's been since the end of 2011 that I've been able to work more than a few days in a row and more than a year since I've been able to work more than a few hours at a time ... or do anything for more than a few hours at a time), I beat myself up unmercifully on account of this. I mean I tied myself to the whipping post and flogged the absolute living shit out of myself with language that would peel paint off a battleship.
The fatigue and inability to work caused, I now know, the worst of the suicidal hopelessness.
And why? All because of simple ignorance. Plain and simple ignorance. I beat myself almost literally to death because I simply didn't know why or what was going on in my body and brain. (which just reaffirms what useless tits psychiatrists are - nineteen of them in three and half years and none of them told me anything about this. Just "take these pills and see me in a month").
For years I've had to put up with people telling me flat out that I was "just lazy", "to just push through it", "everybody gets tired" and endless amounts of other bullshit that drove my already hammered mental states lower still.
So I vow that no one will go through that or continue to go through that if I can help it. If I can help just one single person avoid all the suffering I had to go through on account of ignorance, that suffering will have been worth it.
This is what drives me to scour the four corners of the earth and the most bleeding edge science I can find - so that others don't have to suffer in ignorance.
So if you're suffering through the crippling (and I can think of no better word for it when it's at its worse) fatigue of bipolar depression or major depressive disorder, you can now understand why. It's not because you are "weak" or "wimpy" or a "drama queen" and all that other bullshit you may be getting told, it's because of very serious damage right down to the cellular level, damage that there's nothing you can do about by just "bucking up and getting over it". This is a serious medical problem.
So many of the problems we suffer during the down or depressive cycle of bipolar are to do with the energy engines of our brains simply not being able to manufacture the energy for proper cognitive functionality. It is important for you to understand this. It's not "you", it's a fundamental brain energy problem. Memory problems, focus problems, simply not being able to think, reduced cognitive abilities (not being able to perform mental functions you did well in the past, if at all). This is not because there is something wrong with "you", it is malfunctioning on the cellular level.
Now while you can't just get over it by attitude alone, there ARE things you can do about it.
The other reason is that I really want - and need - you to truly understand what's going on (on at least a basic level) so that you'll understand what you need to do and, more importantly, believe what you need to do. But that is for the next column.
In the meantime, you can start today, right now, practicing more self-compassion with yourself. It's NOT your fault.
(1) - The neuroscience blog Searching for the Mind has recently been named among the top one hundred online neuroscience resources.