My usual burnout post; much of burnout is really chronic fatigue (ME/CFS) and much of chronic fatigue is from a genetic predisposition and a trigger. hEDS/HSD appears to be the most common genetic predisposition.
This stuff occurs in smart people more than it should, usually with some sort of anxiety disorder or ADHD. Some of the best public info on this is from Dr Jessica Eccles who examines the relationship between cognition, emotions, and the autonomic nervous system. This stuff shows up in a lot of stats, eg a huge portion of people with long Covid have some sort of hypermobility.
There are effective psychopharmacological treatments for dysautonomia which is usually the underlying mechanism.
I'm probably prone to this, with every single predisposition you listed.
I can't overstate how much getting fit helped me. I absolutely still get burned out, with the same depression, anxiety, and existential malaise, but the lows are never as low, and it is always much, much easier to bounce back.
I don't know how much of it is a purely psychological sense of resilience you build up by regularly putting yourself through difficult physical stressors in small doses, and how much of it is from physical changes that (presumably) improve your autonomic function and balance... but whatever it is, it's been life changing, going on about 10+ years now, depending how I count it.
Just want to add, for some there is the issue of post exertional malaise (PEM) when cardio becomes counter productive. Those can often still weightlift without triggering PEM. This is predominantly how I managed it for most of my life and worked ok until the covid vaccine triggered another setback.
It's directly linked to stress, I think the predispositions are linked to not being able to ameliorate stress so anything that helps manage stress will help.
>much of burnout is really chronic fatigue (ME/CFS)
Sorry, I don't see how that could possibly be true. People with CFS have fatigue to the point where they can't get out of bed. The fatigue from burnout is usually driven by workplace conditions. Like sure, they both have some kind of environmental trigger. But CFS can almost become a disability, whereas burnout is much more narrow and temporary.
That is certainly what people think and why I feel I need to pipe up whenever these threads get started.
While certainly some with ME/CFS are so bad that they cannot get out of bed the vast majority have good and bad days and you don't see them on their bad days and they look just like everyone else on their good days. One of the reasons it's considered an invisible disease. It's a spectrum and some people manage it better than others.
Sometimes the burnout isn't so temporary - even this article talks about how repeated burnout becomes an problem with the person entering a state of depression which bares a lot of similarities to ME/CFS.
Most people with ME/CFS will never be diagnosed and those people will often think they just have issues with burnout. That's what I though for over 20 years and I have a severe form of it. I though I was managing burnout and then graves disease. It never occurred to me that I would have something like ME/CFS until I stumbled on a random twitter comment that linked ME/CFS with hypermobility which I also have a severe form of. So here I am adding my comments to the internet.
There are generally a whole bunch of rather weird and rather rare comorbidities that occur in people i.e. it is known by its associates. That's what a lot of Dr. Jessica Eccles work goes into.
Isn't it a bit of a stretch from going from your personal experiences to generalization to "much of burnout is"?
Fairly certain it wasn't the case for me anyway, I can see what caused me burning out, and can also see what I did to help me get out + prevent it from happening again.
I'm clearly not basing everything on my experience and pointed to a medical researcher Dr. Jessica Eccles who is doing large studies. Like many people who end up in this state I talk to many other people who also ended up in this state.
The advent of covid and the long covid that has brought with it has resulted in a large number of people who were previously well and are now very sick. There are public studies done around this cohort and I've done a number of private studies of > 60 people with long covid and I have the WGS of > 15 people who have the SNPs that I'm interested in - which is a rather large number for a 'rare' disease and especially large for a private person.
Attribution is difficult, it's very easy to mistake one thing for another, disambiguation requires careful consideration.
Yeah, I believe that's some kind of personal bias. For example,I think that much of burnout (and anxiety) is caused by undiagnosed CPTSD (Complex/Childhood PTSD). But that's probably because it's a source of my problems and now I see it everywhere.
Dysautonomia is extremely hard to treat. Symptoms vary from patient to patient and the number of physician is really lacking.
Individuals can have symptoms like fatigue, GERD, poor circulation, neurological problems, psychological effects.
There are many causes too, certain antibiotics, chemo drugs, covid, autoimmune. It is extremely unrecognized.
A specialist in my area used to have a 1+ year waitlist. Now, he moved to a different state.
There is an exciting treatment in the pipeline. WinSanTor is developing a cream with pirenzepine. In clinical studies there was a systemic recovery of nerve damage. I have spoken to a chemist who had nerve damage from flouroquinolone antibiotics, which caused his dysautonomia and he recovered using oral pirenzepine. Keep in mind WinSanTor is targeting diabetic neuropathy in their studies but it should work for other neuropathies.
That's exciting. I got blind-sided by that. A doctor just said he was prescribing 'an antibiotic' like it was no big deal, and I had never had issues with any other antibiotics. I was told by the pharmacist do not exercise while taking these (found out a few days later it can damage your tendons, several people ended up with snapped achilles tendons) but otherwise nothing else.
Took a single pill and within a few hours I felt fairly strong neuropathy all over my body. Took a few more days and a few more pills before I determined for sure that it was caused by the pills and not something else, and got the antibiotic switched to doxy. I continued to get neuropathy in my limbs quite often for years after that. It's mostly reduced now but I think it might have caused damage in other parts of my body, and may have helped lead to me getting the Tinnitus I've been dealing with for four years now (there's a causal link between the two).
Since they prescribed it to me the surgeon general has slapped big warnings on the pills, but I was shocked a doctor didn't think to warn me about the possibility that there could be any serious side effects (it was also the first medicine I took where I had serious side effects by it, took me by surprise).
Seems it's actually not that uncommon that people have bad reactions to flouroquinolone antibiotics, it just wasn't recognized for many years. Wish I was given an appropriate warning. I might not have risked it, or asked for a different antibiotic I know didn't have issues at least.
Unfortunately, your story is quite common. I am a mod and veteran on r/floxies, it is a subreddit dedicated to helping sufferers of these drugs.
Obviously, not every individual will suffer from side effects but even if its 1 in 100 that gets neuropathy from a single pill when other drugs are available is pretty wild.
It is extremely common doctors even fail to accept that these drugs can cause side effects listed on the drug label.
It can be really hard to even get diagnosed with dysautonomia, and absolutely it's hard to treat. A total zoo of seemingly unrelated symptoms made all the more difficult with things like brain fog and psychological impairments.
Interesting, pirenzepine is a antimuscarinic agent (M1 selective antagonist). Neatly in the class of psychopharmacological drugs.
I predominately use Amitriptyline and Modafinil as well as Low Dose Naltrexone (LDN) and a very strict diet. Modafinil is a no-go for anyone with gut issues and I don't know the alternatives very well. Modafinil in the morning and Amitriptyline at night help push my autonomic system into the sympathetic and parasympathetic states respectively. I have a very complicated rational around choosing these meds which is not fully fleshed out yet, but they worked for me and work for some others in the long covid cohort. So for now it is good enough and what I'm sticking with. As I understand the science better I might consider switching up the meds and seeing what happens. I still get PEM and would love to be able to fix that.
That info about flouroquinolone is interesting. I've discovered that I was treated years ago using antibiotics that would definitely not be prescribed today. I will keep an eye on the drugs like Pirenzepine.
Flouroquinolones are a pretty high risk drug. Over the years the warnings have been increased. If my memory serves me right, half of all flouroquinolone drugs have been taken off the market due to adverse reactions.
Generally, this family of drugs should no longer be used as first line treatment. Doctors still often use it as first line for UTI though. It carries a very high risk of damage to tendons and neurological system.
It is also the only antibiotic which is topoisomerase inhibitor, other drugs which are topoisomerase inhibitors are chemo drugs. It means that it blocks the enzymes needed to divide and regrow cells.
Could you recommend some psychopharmacological treatments? I’m dealing with some flavor of this which is making my life difficult. I’m working with a neurologist, but I’m interested in your thoughts.
Diet is probably number one, sugar cravings caused by dopamine dysregulation and can also induce dopamine dysregulation causing a rather vicious cycle. Those most addicted to sugar are the most harmed by it.
Low Dose Naltrexone (LDN) is probably the most used and widely accepted med within the patient communities and due to having a rather mild side effect profile is a great place to start. Such side effects include really crazy dreams, insomnia, and nausea. The stronger the side effects the more likely it'll work and the negative side effects will go away in time.
I predominately use amitriptyline and modafinil but I don't have the gut comorbidities that would preclude the use of modafinil. I'm not familiar with alternatives to modafinil but a friend who previously had success with modafinil, until the gut issues became too much for him, switched to levosulpiride and he says that worked great. This appears to be counterintuitive for me but psychopharmacological meds are a tough one because they almost always have more than one receptor binding affinity and there is the interplay between ligands of different types and strengths as well as how the brain and body reacts with it. In general I prefer the weaker ligands than the stronger ones and don't try to over-optimize such that every day is good, I target 80% of them.
I basically looked up what books are used in that field and read a bunch of those; Stahl's Essential Psychopharmacology being one of the better ones. There are also books on dysautonomia but I don't know if there is a particular one I would recommend - the whole dysautonomia space is rather nebulous. My big takeaway from that is that is dysautonomia is super complex and hardly anyone understands it.
The official criteria is based on the Beighton score, I think the official thresholds are too high so this test has a bunch of false negatives. I think people can be only mildly hypermobile, especially men, and still show up in the long covid cohorts much more often than they should. It's considered a spectrum, hypermobility spectrum disorder (HSD), where on one end you have Hypermobile Ehlers-Danlos syndrome hEDS and on the other end you have generalized joint hypermobility (GJH). Even GJH shows up in Dr. Jessica Eccles Long covid research far more that they should which would be weird if such hypermobility was truly benign.
Sounds like you're in the UK? Any chance you could send me the details of your doctor(s) to ivan.ristic@gmail.com? I've been struggling to find a doctor willing to diagnose me properly. Much appreciated.
Not in the UK - the UK is weird in that they have some of the worst gaslighting but also that's where Dr. Jessica Eccles is based and they have a decent Low Dose Naltrexone (LDN) medical community https://ldnresearchtrust.org/. While that is starting from a treatment and working backwards doctors who know about LDN and how and why to use it are most likely to know the other things they need to know. I'll send you an email and can probably put you in touch with other UK people in a similar boat.
Yeah, HSV viruses in addition to the SARS viruses are well known ME/CFS triggers. It also appears with toxic mold syndrome and heavy metal stuff.
I suppose it’s theoretically possible for someone to get a IQ bump from HSV I think the correlation is more from selection criteria biased on severity.
There does seem to be a non-zero optimal for brain inflammations effect on IQ which could explain why smart kids have are likely to burn out when an existing predisposition to brain inflammation is made worse with age.
Is long covid still a thing? I thought it was a coping mechanism for managing the regret of taking the vaccine AND then getting covid and/or injured.
Is there a proper differential diagnosis?
Long covid is no longer a thing the same way ME/CFS is no longer a thing. The world moves on without you (me). I did have an adverse reaction and I knew before taking it that I was in a high risk category for adverse effects, i.e. I already knew I had ME/CFS. My main consideration was that I'm also in the high risk category for adverse effect from covid. I'm open to the idea that the pericarditis that I got from the vaccine I would not have gotten from covid but I really don't know. I wish this was something that society would talk about openly and honestly.
Not something I particularly wanted to get into but the genetic predispositions for long covid do seem to appear most frequently in the more intelligent. And since our society is so stratified by intelligence a large portion of the population does not directly interact with intelligent people and are truly sincere when they report that they don't personally know anyone with long covid. My experience is quite different as 1/3rd of my friends that I knew prior to my own issues have developed such long covid/ME/CFS issues of their own. I went through the whole gifted / magnet schooling system so my peer group is substantially biased.
> genetic predispositions for long covid do seem to appear most frequently in the more intelligent
I am not surprised, since many of them were easily manipulated into a pretty bad risk trade off that even a plumber would not take. Regret is bound to be high for that kind of people.
Historically speaking many of the brief episodes of strange psycho-somatic “illness” with vague descriptions were found among the equivalent of the laptop class and suburban wine moms.
I believe the word you're looking for is 'credulous'.
Yes, there is a general question of why do otherwise smart people believe ridiculous things. There is a common refrain that because they're smart they can more easily rationalize their beliefs but I don't believe that is true.
I think diminished ability to ameliorate stress leads to stress aversion behaviors and a strong attraction to rules, structure, and authority. I think when the effect of that is greater than their intelligence they become prone to believing many untrue things but once intelligence goes over a certain threshold that effect is lost. I think that's why a lot of the bell curve memes ring true to many people where both the very smart and the very dim share the same beliefs but for different reasons.
Historically speaking most of those people, generally considered hypochondriacs, did have the conditions they complained of. Historically medicine has been literally blowing smoke up peoples asses, draining their blood, and feeding them mercury.
I think it's a bit weird that you're using evidence from the same medical system you don't trust to get covid and the vaccines right to unwittingly gaslight on their behalf.
You are simultaneously dismissing others personal anecdotes while providing your own as evidence. I believe you are reporting honestly of your observations, just as I believe these wine drinking suburban moms do have the conditions they complain of. This stuff does affect women worse than men and for the aforementioned stratification reasons those affected are more likely to be in the upper middle class and above.
Your immune system does not generally prevent you from catching anything; it allows your body to fight the infection more effectively the next time you catch it, thereby reducing or eliminating the symptoms. In your lifetime you will likely have caught some illnesses that you are vaccinated against without realising it, because you successfully fought the infection before it became serious. The COVID vaccine in particular never claimed to eliminate the symptoms altogether but reduces the severity so that rather than breathing through a tube for three weeks, you get a nasty cold. Long COVID is still a possibility and yes, very much a real thing albeit not well understood yet; I know at least one person who is recovering from it now.
> In your lifetime you will likely have caught some illnesses that you are vaccinated against without realising it, because you successfully fought the infection before it became serious.
>The COVID vaccine in particular never claimed to eliminate the symptoms altogether but reduces the severity so that rather than breathing through a tube for three weeks, you get a nasty cold.
Good examples of propositions that cannot be falsified.
Indeed, and you cannot prove that a specific car crash would have been worse for the passengers without seatbelts, however a proper understanding of how seatbelts work makes the conclusion nonetheless fairly obvious.
Also, statistics are a thing; propositions like 'vaccination reduces severity of illness' can in fact be proven or falsified by studying a sufficiently large cohort, such as is readily available during, say, a pandemic.
This stuff occurs in smart people more than it should, usually with some sort of anxiety disorder or ADHD. Some of the best public info on this is from Dr Jessica Eccles who examines the relationship between cognition, emotions, and the autonomic nervous system. This stuff shows up in a lot of stats, eg a huge portion of people with long Covid have some sort of hypermobility.
There are effective psychopharmacological treatments for dysautonomia which is usually the underlying mechanism.