Fatigue/Lack of Motivation Not Determined By Tests

**Background & Summary of Issue:**

I'll start off by saying that this is problem began developing in my sophomore year of high school and really hit hard my senior year of high school. I never had a problem with grades or with school before my senior year, then all of a sudden I began feeling tired, A LOT. Most of the time I would be getting 7 to 10 hours of sleep and become tired once again within two hours of waking. Another BIG symptom was my lack of motivation to do the work. From sophomore year til [present day], I would lack the ability to focus on anything in front of me. I had to teach things to myself out of a book while drinking a cup of coffee after school (which always worked out fine until Calculus) because I just did not have motivation/energy in class to learn the material. I had football practices after class during high school and I would not have made it through if it weren't for caffeine pills.

Now, sophomore year of high school was four years ago. The problem has not become "worse" so much as it has developed. It is now affecting my ability to participate in class, ability to do homework, and general attitude. I visited the doctor and have a mental health meeting coming up within a month.

**Things *Ruled Out* By Tests and/or Questions During Visit:**

* Hypothyroidism (TSH is in normal range).
* Depression (Quite happy in all aspects).
* STDs (Got checked less than a year ago and I'm clean 100%).
* Diabetes (Normal levels).
* Sleep Deprivation (I get plenty of sleep).
* Over-Stimulation (I have tried a month-long break from ALL stimulants [including coffee] twice and both times it did not ease the symptoms. It helped me conclude that stimulants were not the cause, but the only remedy available to me without doctor-intervention).
* Anything Blood Level-Related (Have had blood checked twice, all is well both times, according to the doctors).

I truly believe it is ADD, but wanted to get a second opinion. My doctor said there was a high chance that it could be ADD if it wasn't my TSH levels. My mother DID have hypothyroidism (until she treated it) so I thought it could be this. But, upon reading the results (2.4), it isn't. The only other thing I had was Kidney Hydronephrosis, which was virtually gone by the time I was six. Have I done everything necessary to draw the conclusion that ADD is the primary suspect?

TLDR; Lack of Motivation/Fatigue that is NOT brought on by: Sleep Disorders, Over-Stimulation, Blood Level-Related Issues, Depression, or Thyroid Disorder). Is it ADD?

*edited to insert a TLDR;

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ADD would show up way earlier like by the age of 6-7. Have they checked out your heart? What about Chronic Fatigue Syndrome?

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My heart has been fine as far as I know, no diseases run in the family related to any heart issues. I have not considered Chronic Fatigue Syndrome however. How would that be tested?

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Your doctor needs to be ruling everything out including the heart regardless of family history. I've never seen any doctor answer questions here. You might want to try a new doctor if your doc isn't being proactive enough. I'm fairly certain there is no "test" for CFC since it is idiopathic in nature. Maybe you can post this in ask reddit and try that.

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As a psychiatrist, I'd look at these aspects.

Sleep- have you had a sleep study? Some breathing disorders can cause multiple dozens of awakenings during the night seriously impacting sleep architecture. A monitored sleep in a lab could shed light on this.

Depression- maybe you feel happy, but you make reference to the effects of this condition on your attitude, poor motivation, etc, which can be less obvious symptoms of mood disorders. Might be worth trying to open this up a bit.

Your symptoms don't altogether sound like ADD although it's not clear exactly what they are. A stimulant would probably be helpful at least temporarily and you wouldn't need a formalized diagnosis of ADD to be prescribed one. I don't hear many indications for elaborate cardiac workup particularly since you were able to go to football practice though if by fatigue you mean that you were constantly out of breath, dizzy, pale, etc.

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Not a doctor - I am taking Ritalin for "brain fog" caused not by ADD but underlying disorders (Sjogren's Syndrome/fibromylagia/IBS). If you want my two cents, the kidney hydrophrenosis at such a young age, even if long resolved, could possibly point to Sjorgren's. I would have your GP explore that angle, especially if you have dry eyes/dry mouth. Sjorgren's can be and often is sero-negative. A lip biopsy can diagnose it.

And if they do wind up putting you on ADHD stimulants, it really does help. I feel so much better and wish my GP had thought to suggest the Ritalin ages ago.

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I apologize for not replying sooner, but thank you for taking the time to answer my question. I do agree with you on running more tests before making conclusions. I switched over about two years ago from the primary care physician I had since birth, so I am still trying to figure him out. I will go see him again to ask more questions and figure out if he is right for me.

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Thank you for the response and I apologize for not replying sooner. I have never had observable problems with sleep (aside from entering college and beginning to have those late-night study sessions), but having lived with a girlfriend she had mentioned I do twitch in my sleep a few times a night and am not a "snorer." I'm not sure if this makes a difference, but possibly it gives you better insight if sleep is a factor.

Regarding depression, I think it has to do with my inability to make good conversation and/or focus on what they are saying to me. I have never had anyone tell me I have a shift in moods per say, but I rather know that I can sometimes be unsociable if I am feeling extra unfocused and/or tired at any point. I was hoping that was normal and not up for consideration! :(

And to clarify the fatigue for football practice, I never had any issues exercising and lack of ability for football. I am actually quite active, even now that I'm not playing football anymore I still go to the gym and do regular cardiovascular exercise about five times a week. I also ate (and still eat) pretty healthy, as I have always been interested in nutrition and make healthier choices more often than not. Never experienced dizziness, paleness, loss of breath, or even muscle cramps. I think my body isn't the problem, but rather the mental aspect of doing the work and it requires a push so that it can match with my body's ability to perform.

As a side note, I do have my psychological appointment coming up before the end of the month. Being a psychiatrist yourself, would you recommend any vital information that I should tell the doctor besides the routine questions? Should I expect some sort of "test" on my first visit? Thank you very much for your help and explanations for various questions, I haven't gotten anywhere with my question so far outside of this post!

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This is very interesting, I had never heard of this disease before. I will definitely take it into consideration, however my only symptoms that link to it are concentration. I am not sure I would consider dry mouth to be a symptom that I have, as the only time I get that is if I do not consume at least two or three cups of water in the day. I did have blood tests done (as well as an inflammation test) and no odd blood cell counts and/or inflammation was present. As it seems like this disease is linked to white blood cells attacking moisture-producing glands, I will have to see if it is possibly undetectable through the tests I have gone through.

Thank you for the valuable insight, I will definitely bring it up to my doctor.

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I'm sorry you're going through this it can be very frustrating finding a doctor who will really listen to you and be proactive on your behalf. Especially if your dealing with something that doesn't have easy answers.

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That is a good point about rheumatological disease, it's not likely that your GP has thought deeply about that and if you were able to present some of these symptoms to him/her at your next appointment along with the outline of a game plan it might help them come up with the next step.

I'm trying to put on my internist hat for a second and think about how I'd like to hear about the symptoms. In this thread we've elaborated a bit on some pertinent positives and negatives particularly that you've been getting adequate sleep, don't appear to have sleep apnea, normal cardiovascular function, etc. I feel like renal hydronephrosis happens in children with some frequency, and can be caused just by anatomical problems which resolve with growth (don't quote me on that), and if your physical exam findings are otherwise negative you might have to be content with having the symptoms medically unexplained or undiagnosable at least at present and waiting to see if they change. Often information about the trajectory really helps us make a diagnosis when symptoms considered at a point in timer are sort of a baffling mixture.

To echo the other commenters stimulants can be useful even in the absence of formal ADHD diagnosis. The diagnosis is made by interview and clinical impression. Formal testing is usually not required.

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