Living in burnout.

“You’ve burned through all your serotonin.”

In one sentence, my therapist captured it all. She summarized the burdens of my life that were heavy and numerous. Too heavy. They weighed on me and sometimes felt like they were taking away my options. I was going through a deep level of burnout.

Most importantly, she emphasized that it wasn’t my fault. Instead, she explained the scenario – that she has seen far too often – where my brain had essentially burned through all its serotonin as I tried to meet more needs than possible.

It wasn’t my fault that my body has multiple chronic illnesses. Or that one of my kids is high needs and medically complex. Or any of the almost absurd amount of things that have been thrown at me over the past few years. It’s really not a surprise that my brain burned through all its happy chemicals trying to keep up with the hurdles.

Now, for someone other than me, this problem can usually be resolved. In our modern society, you can get artificial serotonin; it’s called antidepressant medication. However, I have not been able to tolerate any of the antidepressant medications I’ve tried due to my Sjögren’s dryness. Other coping mechanisms have also been out of reach due to money, time, or physical disabilities and illness.

The irony is not lost on me that last year I wrote a post about how angry I was at a doctor for trying to prescribe me antidepressant medication to treat an autoimmune disease just a few months before I found myself in need of that very medication to treat postpartum depression (PPD) last year.

How did I get here? The start of burnout.

I was steadfast in my declaration that I wasn’t depressed. I thought it wasn’t “real” depression or, even if it was, it didn’t last long enough to count or need treatment. It was just a season. I did end up trying an antidepressant for a few months after I lost my Dad in 2014, but it didn’t help, which also contributed to my hopefulness that depression wasn’t the problem. I was going through things that cause sadness for everyone. Right?

Years later, I have finally accepted that there is depression in my heart, soul, and body. I also realize that it started a long time ago. It surfaced vigorously a few times, especially as a rare side effect of Benlysta, and it would retreat to a certain depth while I was busy convincing myself it was gone for good.

With an autoimmune disease, there’s always the question of which came first: the depression or the chronic pain? Will we ever know? Does it truly matter?

I first got sick in 2015 and had my first lupus flare after we moved to Germany. It was a grueling year and a half until we moved back home and I got a lupus diagnosis, which enabled me to begin treating my disease. Then, before things were under control, I became pregnant with my first baby (after being told a decade earlier that a natural pregnancy was highly unlikely).

I fought for medical care during my pregnancy. I changed doctors and meds. I had my first beautiful baby boy. I went through postpartum. Caring for a baby brought more stress than I expected into my life. And my beautiful firstborn started to have issues I had to address: a speech delay, a developmental delay, hypotonia (low muscle tone), failure to thrive, autism, one rare disease – then another; the list goes on.

I was beginning to enter a deep burnout and I didn’t even realize it.

Then my rheumatologist quit. And a pandemic began. Overwhelmed with caring for my child, I decided to go on birth control, but it sent me into possibly my worst flare since I had begun treatment. So my new rheumatologist put me on Benlysta. Those Benlysta infusions were a disaster that kick-started my severe depression and also put me through a few weeks of awful suicidal ideation.

Would I get a break?

Well, actually, I got a second pregnancy. A blessing, a surprise, a gift that came with many doctor’s appointments and more health discoveries. More struggles. I had to have my second baby boy early because he was in distress due to a rare disease.

I was thrown into a world of figuring out how to care for a newborn with a painful condition at the same time that my then 3-year-old was diagnosed with autism and suddenly needed way more help than I could provide, all while my body felt like it was falling apart each day.

I felt like a candle that was burning all the way down with no rescue in sight. And, even though these events I listed – a partial glimpse into the stressors that were present in my life – put me through a lot, I believe that they only accelerated the inevitable emergence of my more intense mental health issues.

Seeking treatment for my depression.

When my youngest was one month old, I did start an antidepressant. It helped. But what started out as PPD started to turn into more at about 10 months postpartum. My doctor increased my dosage and I found myself nearly unable to open my eyes due to the drying effect of the medication.

I have an autoimmune disease called Sjögren’s that, among other things, attacks the glands that allow you to make tears and saliva. I decided to stop the antidepressant completely so that I could use my eyes. And I went to my eye doctor.

I asked if he could help me with my dry eye so that I could resume my antidepressant medication at a dosage that would help. Sure, he said. But it’s not covered by insurance. I wasn’t in a place to shell out hundreds of dollars for serum tears (after exhausting all the other things I could do for my dryness).

Then I went to a Sjögren’s specialist. I was so hopeful. I waited for months for that appointment and possibly put too many eggs in one basket. I finally asked him the question that had been at the forefront of my mind for months, “How do your Sjögren’s patients treat their depression when their dryness is uncontrolled?”

He didn’t have an answer for me.

I went to my rheumatologist and agreed to try an antidepressant that works in a slightly different way because it might not cause as much dryness. Nope. I couldn’t talk the day I took it due to the drying effect.

I went to a psychiatrist’s office that turned me away when I expressed my need for alternative treatments. I tried to go to two other ones, but they stopped returning my phone calls. I felt like no one could be bothered to help someone with an atypical health situation.

I brought my wildly untreated depression up to everyone. My neurologist. My sports medicine doctor. My therapist. Finally, things got scary and I found myself at a rock bottom of sorts talking to a mobile crisis team on a Sunday morning.

They didn’t follow up with me.

I felt so alone. All these people, all these resources, all these Sjögren’s patients who have surely been trying to cope with depression decades before I came along… Why isn’t there an answer?

I tried for so long to find a treatment for my depression despite the unique circumstances of my life, but I haven’t succeeded. It’s taken a toll on me and my family. A few months ago, depression and burnout finally took me to an unmanageable place.

My descent into unmanageable symptoms.

My heart felt so heavy I thought it would push me down forever. Like I had a weight placed on me and I’d never be able to get up again.

I couldn’t pull myself out of my depression. I couldn’t find answers. I was angry. I snapped at my husband and found myself having to step away from my children to reign in my anger about a behavior that I would have had the patience for in the past. It was scary.

I couldn’t handle disappointment – even tiny ones. Everything felt like a disaster. It was like my mind couldn’t heal.

I was, and am, so sad that it’s hard to describe. I find myself crying endlessly, despite my diminished ability to produce tears. Often I can’t make myself do simple tasks. Even if those tasks involve my own hygiene.  Living like this has been a misery that is also hard to describe. It just goes on and on.

How do you eat when you’re living in chronic burnout? How do you work? How do you remain proactive, do laundry, keep your home clean, and do the things that are necessary for a life? You don’t. At least I didn’t. Everything felt like finding out you had 10 minutes to be somewhere that you needed 30 minutes to prepare for – impossible, stressful, and a mess.

It reminded me of the depths of my lupus pain. That was more physical, but definitely had its share of mental distress.

I have been so sad that I stopped caring about what was good and bad for my body and my mind. This quote sums it up pretty well:

“During the most intense part of a major-depressive episode, what I’ve felt is nothing at all like sadness. Mostly, it’s a kind of numbness, and utter lack of desire and will. Underneath that numbness, there’s the sense that something awful is happening – there’s a very small voice screaming in the back of your mind, but you hear it only faintly. There’s an uncomfortable wrongness to everything, like the world is twisted and broken in some terrible but unidentifiable way.

A few thoughts on depression

Not caring at all was a turning point for me.

When I stopped caring, it scared me enough to keep trying.

There was only one alternative treatment that I knew to try next: ketamine. It’s been used safely since 1970 for anesthesia and has been used off-label, with success, for depression. It can also help with chronic pain and migraines. It wasn’t covered by insurance, but I was scared of what would happen if I didn’t try something.

My path to trying ketamine has been full of more discouragements, setbacks, and mini- disasters. I wanted to give up. There was almost nothing within myself to pull from to keep doing the work. But I had to save me, for me. So I eventually found a program that provides low-dose ketamine lozenges via virtual visits. It felt like the only option left.

I’ve had one session, and I’m anxiously waiting for the next sessions to help me know if it will work or not. I hope they will work or that I’ll be able to find something else that will. I know I can’t live in chronic burnout much longer.

I don’t think anyone can truly live in chronic burnout at all. At least, not without severe repercussions to their life and health.

How do I reignite myself?

Recovering from this level of depletion and depression will be complex. It’s also going to take a long time. I feel mentally and emotionally malnourished and I’m not sure how I’ll go from burnout to a life fueled with fire.

I’m going to individual therapy, pursuing psychiatric care, changing my medication, adding supportive health treatments, trying to build a support system, increasing my childcare, and adding coping methods – I won’t rule anything out until I figure it out. I just hope and pray that I have enough strength to get there.

I do earnestly believe that it was in Jesus’ darkest hour that God was doing His greatest work. Having faith means I believe in something I cannot see and it requires more trust than I think I have. But God can have it for me because He cares for and guides His children. Burnout has helped me see that I need him to do, well, just about anything.

That being said, it is very dark. I can’t see the work being done, which makes it easy to question it. So I just do the best I can.

Wake up, try to accept the day, rest, and try things that might help. Rinse and repeat.

I’m in the trenches. I’m struggling. I’m not okay, but I desperately want to be okay. I don’t have amazing encouragement to offer you as I wrap up this post. But I am hoping to dig myself out of this hole, which Liz Fosslien has so beautifully represented here:

View this post on Instagram

A post shared by Liz and Mollie (@lizandmollie)

And I also have this article to share that I’ve turned to as I’ve tried so hard to end my chronic burnout: How to recover from burnout and love your life again.

Are you in burnout? Or have you been through it before? Share your stories or tips in the comments.

---

Living in burnout; chronic illness, depression, and trying to recover from it all. Share on X

Featured photo and pin photos via Pexels licensed under CC0.