Not long ago the newspapers reported that the president of Harvard University was unable to return to work. Amid speculations as to what might be wrong with him, his doctor issued a bulletin saying that he was exhausted from overwork. He was ‘running on empty’. Well, you don’t have to be the president of Harvard University to know how that feels. I have encountered this symptom in depressed patients I have treated from all walks of life. I recall a highly skilled psychotherapist who was in such great demand because of his expertise that he received many more referrals than he could comfortably handle. Unfortunately he was much more skilful at taking care of his patients than of himself, and had a hard time disappointing his referral sources. He seriously overbooked his schedule, leaving much too little time for rest, exercise and recreation. As a result, his depression was extremely difficult to treat. No matter what anti-depressants I gave him, he always seemed to be running on empty.
Population studies suggest that depression is becoming more common with each successive generation, our youngest people being most frequently affected. No one knows why this should be happening. One possible reason is that it is a cost of upward mobility. As we become an increasingly sophisticated technological society, the newly created opportunities carry with them certain risks and hazards. Increasingly, there are businesses that stay open until all hours of the night. People take their computers on holiday with them so that they can plug into their e-mail and connect to the Internet from the most remote places. They carry cellular phones and are always on-call, wired in and connected to their business associates and customers. And businesses themselves, in an attempt to become more competitive, squeeze the most they can out of each employee. One patient of mine, a chemist who supervised several pharmacies, kept being given more and more shops to supervise. Just as with the psychotherapist I mentioned, her depression was very hard to treat and only responded, finally and completely, when she quit her job.
The curious thing about depression, though, is that you can end up running on empty regardless of how great your burdens are in any objective sense. Each of us has our comfort zone in which we can function happily and efficiently, and each has our limit beyond which our capacity to function breaks down. When someone becomes depressed, that breaking point has been exceeded. It does no good to debate whether or not you should be able to handle the level of stress. Regardless of the objective level of stress that you are currently under, if your capacity for handling that stress has been exceeded, you will feel as though you are running on empty and that may be an indication that you are clinically depressed, especially when it is combined with some of the other tell-tale signs of depression.
One of the hardest things to do when you are running on empty is to start new projects. New initiatives invariably require a new burst of energy, which is especially difficult to muster when you are down.
It is also important to remember that running on empty may be a symptom of other illnesses. Chronic infections, such as glandular fever, may strip you of energy, as may many other medical disorders. Chronic fatigue syndrome (CFS; also known as ME) is a particularly vexing condition, in which low energy level is the cardinal and sometimes the only symptom. Low thyroid function and other hormonal conditions may also result in fatigue and low energy levels. These can generally be diagnosed by simple blood tests. This is one reason why, in the best of all possible worlds, you should get a medical evaluation before reaching a definitive diagnosis of depression. Or, if you don’t choose to do that, to re-evaluate the situation if you try to treat your depression and it hasn’t improved substantially within a month or two.
If you have been running on empty for more than a few weeks, consider the possibility that you may be clinically depressed.
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