Post-mental-exertion malaise

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I was wondering if anyone was in the same situation or had an explanation for this.

I do not suffer from post-physical exertion malaise, unless I push myself too much, however, I always suffer from post-mental-exertion malaise. That is, if I am under stress, or angry (for example today I got very upset at something my DH told me), I get a huge down following the short-term stressful event, including the following:

- intense fatigue
- feeling like my limbs are heavy and made of steel
- wanting to go to sleep
- nausea
- pain in my legs
- dizziness
- brain fog

It usually last for a day or so then gets better (I hope this time too, we'll see tomorrow).

I had my adrenal checked and they are fine. Everything else is fine on my mainstream tests. I do not have a CFS diagnosis but I have a long history and depression, fatigue, irritable bowel and food sensitivities, and a child with autism.

So, is there such a thing as post-mental-exertion malaise, and is it related to the usual CFS post-exterion malaise?

Thanks.
 

taniaaust1

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So, is there such a thing as post-mental-exertion malaise, and is it related to the usual CFS post-exterion malaise?

Thanks.
Yes to your question.

My CFS can come on with any kind of exertion.. both physical and mental exertion. Now days (cause i take care not to physically over do it and its harder for me to physically over do it nowdays unless i attempted something like aerobics..but i cant do that anyway) .. I suffer more so from post mental exertion malaise.. as my brain seems nowdays to be one of my worst affected CFS/ME systems. It's very easy for my brain symptoms to come in. If im had to think intensly eg studying hard or learning something new, or if Ive had to think fast eg if i was trying to argue with someone.. that would afterwards have me feeling ill.
 

Esther12

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I've been doing more physically recently and that, combined with a period of interrupted sleep, has left me feeling more emotionally fragile. I've been dealing with some building trouble that's gotten quite heated, and I can feel that I'm finding it a strain where as I'd normally be able to brush off that sort of conflict with ease.

I've felt less willing to get involved with internet debates too - feeling in advance that I don't have the strength for them. It is all rather confusing and unsettling to think that there's some trade off between physical activity and intellectual/psychological resilience. Would I rather be a cripple or a simpleton?
 

Athene

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Ester:
It is all rather confusing and unsettling to think that there's some trade off between physical activity and intellectual/psychological resilience. Would I rather be a cripple or a simpleton?
That's so well put, and so depressing!

I also get a general worsening of symptoms after mentally over-exerting myself, as well as physically doing so. Using your brain requires a lot more oxygen than you'd think, so I have often wondered if both these activities create an excess of D-lactic acid from anaerobic respiration, which maybe, for us, has this after effect until cleared out of the system?

I also reckon Sallysblooms is onto something with the neurotransmitters. I find that strong emotions often take a lot longer to wear off than they should, as in, they remain long after circumstances have rendered them irrelevant, which I suspect has something to do with an inefficiency in eliminating them from the body.
 

Sallysblooms

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Google "Neurotransmitters and stress." I read about it all the time. My doctor is helping me get them balanced and it is really great. They are in charge of messages for the body stress etc. Illness, stress, not eating and sleeping well all deplete them.

Seratonin etc, need to be available to handle stress. Even a dog bark or doorbell used to upset me and make me ill.
 
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I've always had exertional symptoms from a much smaller amount of mental activity than physical activity. So for years I thought I didn't have a legitimate case of CFS. How could I explain the fact that working more than half time made me feel sick, yet I was clearly out going for long walks everyday. Still I could never build much capacity for strenuous exercise like jogging or swimming.

I can work for a short time now, but within 3 hours or less, I start getting a dull, thick ache in my head and an unpleasantly dry mouth. This was my experience of the second half of every work day in my 20s... I thought other people were just better at dealing with it than I was. Now when I get the dull ache in my head I stop working. I have to, or I get sicker! So I really understand what you're saying. Loud noises or stressful conversations are also very taxing. Difficult when some people naturally converse in a loud, combative way, they don't understand they are making you sicker, very quickly!

I would like our brain related issues to be treated as neurological problems, not emotional ones. I think mental fog and post mental activity symptoms are one that most people really don't understand.
 
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Thanks to everybody who replied. I definitely need antidepressant drugs or I cannot function. But I was wondering if there was more than neurotransmitters involved, maybe some inflamation in some parts of the brain, that would be triggered by a peak of one stress hormone or something like that... Maybe next time this happens I could try taking an Advil and see if it helps the above symptoms. I did not think of it this time...

Thanks again, guys.
 

richvank

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Hi, Karin.

You mentioned that you had your adrenals checked, and they were O.K. How exactly were they checked? Did you have a cortrosyn or ACTH stimulation test? This type of test evaluates whether the adrenals can respond if properly stimulated by ACTH. However, in CFS, I think the problem in the HPA axis is not usually in the adrenals themselves, but higher up, in the pituitary and/or the hypothalamus. This test does not look at issues with these organs.

Have you had a 24-hour saliva cortisol test, such as the Diagnos-techs Adrenal Stress Index test, or the saliva test offered by SabreScience? These measure the variation of the level of free (unbound) cortisol throughout the day. Most people with CFS do not have a normal diurnal variation of cortisol. The SaberScience saliva test is available without a doctor's order from www.directlabs.com It measures the cortisol level in the saliva every four hours around the clock.

Best regards,

Rich
 
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Hi, Karin.

You mentioned that you had your adrenals checked, and they were O.K. How exactly were they checked? Did you have a cortrosyn or ACTH stimulation test? This type of test evaluates whether the adrenals can respond if properly stimulated by ACTH. However, in CFS, I think the problem in the HPA axis is not usually in the adrenals themselves, but higher up, in the pituitary and/or the hypothalamus. This test does not look at issues with these organs.

Have you had a 24-hour saliva cortisol test, such as the Diagnos-techs Adrenal Stress Index test, or the saliva test offered by SabreScience? These measure the variation of the level of free (unbound) cortisol throughout the day. Most people with CFS do not have a normal diurnal variation of cortisol. The SaberScience saliva test is available without a doctor's order from www.directlabs.com It measures the cortisol level in the saliva every four hours around the clock.

Best regards,

Rich
Thanks Rich. My doctor prescribed a test where I had to spit in tubes 4 times over the course of 24 hours. The cortisol variations throughout the day were normal...
 

richvank

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Thanks Rich. My doctor prescribed a test where I had to spit in tubes 4 times over the course of 24 hours. The cortisol variations throughout the day were normal...
Hi, Karin.

O.K., sounds like you got the right test for cortisol. Since your cortisol diurnal variation is O.K., I'm with Sallysblooms, that neurotransmitter abnormalities are likely involved. The fact that you respond to antidepressant drugs supports this, also.

In CFS, most cases appear to involve a partial block in the methylation cycle, which impacts the folate metabolism as well. The folate metabolism in turn impacts the biopterin cycle, and this affects the neurotransmitters, because tetrahydrobiopterin is needed to make both serotonin and the catecholamine neurotransmitters (dopamine and norepinephrine). In addition, methylation is also needed for the metabolism (breakdown) of the neurotransmitters.

In some cases, improvement can be obtained by supplementing the amino acids from which the neurotransmitters are made (such as tryptophan, tyrosine and phenylalanine), and some people are helped by supplementing either biopterin or tetrahydrobiopterin, but the ultimate answer to this situation in CFS is to lift the partial methylation cycle block, which will correct the dysfunction in the folate metabolism and restore the biopterin cycle.

You are probably already aware of this, but more information on this hypothesis and treatment based on it is available at www.cfsresearch.org by clicking on CFS/M.E. and then on my name.

Best regards,

Rich
 

BEG

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It is all rather confusing and unsettling to think that there's some trade off between physical activity and intellectual/psychological resilience. Would I rather be a cripple or a simpleton?
I have to say, Esther, this is a great quote. I don't know how it could be said any better. I've been like this for years. It's absolutely necessary to factor in brain usage right along with physical and social uses of energy. I also find I can only have one "project" going at a time. When that is finished, I can move onto something else and work on that periodically for awhile.

One of these days, hopefully soon, I am going to study Rich's literature.
 
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Hi, Karin.

O.K., sounds like you got the right test for cortisol. Since your cortisol diurnal variation is O.K., I'm with Sallysblooms, that neurotransmitter abnormalities are likely involved. The fact that you respond to antidepressant drugs supports this, also.

In CFS, most cases appear to involve a partial block in the methylation cycle, which impacts the folate metabolism as well. The folate metabolism in turn impacts the biopterin cycle, and this affects the neurotransmitters, because tetrahydrobiopterin is needed to make both serotonin and the catecholamine neurotransmitters (dopamine and norepinephrine). In addition, methylation is also needed for the metabolism (breakdown) of the neurotransmitters.

In some cases, improvement can be obtained by supplementing the amino acids from which the neurotransmitters are made (such as tryptophan, tyrosine and phenylalanine), and some people are helped by supplementing either biopterin or tetrahydrobiopterin, but the ultimate answer to this situation in CFS is to lift the partial methylation cycle block, which will correct the dysfunction in the folate metabolism and restore the biopterin cycle.

You are probably already aware of this, but more information on this hypothesis and treatment based on it is available at www.cfsresearch.org by clicking on CFS/M.E. and then on my name.

Best regards,

Rich
Thanks you again so much, Rich, for your replies. I appreciate a lot. If only I could understand more about what is going on with me, maybe it could also help my son.

Here is what I am already doing: methylB12 injections every three days to help the methylation cycle (have done so for over two years). I am also taking plenty of supplements supporting the cycles, B vitamins, and so on. Interestingly, I feel bad with folic acid, but great with folinic acid. So this is what I am taking.

I have tried 5-HTP (when off antidepressant, and it does not help). I have also tried tyrosine and gaba. Again, not much difference. Now Zoloft makes a huge difference within 24 hours, which is amazing (and not typical, I heard). Dark chocolate does help me a lot, but not tyrosine, go figure...

Now concerning what does help (other than zoloft):

- High dose EPA (but not DHA)
- 100g of dark chocolate a day
- raw garlic (only for a few days, then I get really a yuck feeling)
- MK7 (vitamin K2 from Natto): WOWZA!

What does affect me lot, usually negatively, is food sensitivities, intestinal infections, too much sugar, it all affects my brain as well and gives me mood swings, brain fog and fatigue (again, the feeling of being so heavy and slow).

It is all so mysterious...
 

Sallysblooms

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I am still working on my POTS problems but addressing the Norepenephrine and serotonin have done wonders for the fog, and mental tiredness. Addressing my heart was important too. Out of breath less often, more oxygen in the brain. Quite nice. I can laugh again and talk a lot, ha. More verbal, just ask my hubby!:D

I used to stay quiet quiet a bit. Laughing was hard, made me sick.

I can go to church again and I can even sing. The fun thing is that I used to be in the choir and I have begun to sing alto again and harmonize. I am in the audience, but still it is good. That doesn't sound hard, but it is, more for the brain to do. The brain is facinating.

I do hope you can figure is out soon. :Retro smile:I hope you find a good doctor because if they know what to do, they will give the right supplement doses at the right time of day.
 

silicon

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I'm becoming more and more aware that I have to conserve not only my physical resources but my mental and emotional resources. ALL types of exertion wipe me out.
My ability to tolerate emotional stress is not very high. (It does improve as the day goes on, as I am at my worst in the morning.) Working through interpersonal conflicts can be quite depleting to me.
 

biophile

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Now concerning what does help (other than zoloft): High dose EPA (but not DHA) ...
I have noticed the opposite effect, EPA made me feel more irritable and more flu-like when I tried it. Instead I take high dose DHA with minimal EPA, it seems to act as a mild "buffer" to stresses such as sensory overload.
 

shiso

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I'm becoming more and more aware that I have to conserve not only my physical resources but my mental and emotional resources. ALL types of exertion wipe me out.
Same for me. Even though physical overexertion has more consistent and obvious physical and cognitive effects, something as simple as staying up late writing a long email or letter where I have to sound smart and end up checking and re-checking for mistakes (a habit from when I worked) or dealing with a mentally taxing conflict will result in physically feeling totally depleted (more than my usual "baseline") the next day or for days afterwards. You really realize with this disease that your brain is just another organ prone to systemwide PEM.

I get so excited and happy when my brain feels like it's "back" for a temporary visit or when I'm feeling some relief physically though, that I tend to use up whatever resources I'm presented with at the time because the elation is worth the sacrifice (until it's not).