Chronic Depression: Why You Have Felt Blue For So Long
Feeling sad, unhappy, or emotionally exhausted are things humans occasionally experience, but in some instances, these feelings intensify and do not subside which may lead to a diagnosis of a mood disorder. For many, depression is a daily challenge that affects their quality of life and overall perspective. In fact, millions of people worldwide experience depression. The World Health Organization estimates 300 million people (approximately 4% of the global population) are living with some type of depressive disorder as you read this. When symptoms of depression do not go away on their own, a treatment intervention can be incredibly helpful, including medications or mental health treatment. In this article, you will learn about a type of depression known as chronic depression, or persistent depressive disorder. Reading this material will help to increase your understanding of this chronic mood disorder and identify if you or a loved one may be experiencing symptoms and need to reach for mental health support.
This long-lasting form of depression is known by several names, including clinical depression, dysthymic disorder, and persistent depressive disorder (PDD). Although they were each previously categorized as separate disorders, clinical depression and dysthymic disorder have since been merged with PDD. In this article, we will refer to PDD as chronic depression since that is the term commonly used to describe long-lasting depression. We will also look at what chronic depression is, how it differs from major depressive disorder, and examine its symptoms, causes, and treatment options.
What Is Chronic Depression?
Chronic depression is the persistence of depressive symptoms for an extended period (usually years). If you are chronically depressed, you have likely lost interest in the things you used to love. In addition, you may experience the following:
Poor appetite or overeating
Oversleeping or insomnia
Low energy or fatigue
Have low self-esteem
Poor concentration or decision-making
Sometimes chronic depression and major depressive disorder (MDD) are confused with one another since they show some similarities. For instance, in both cases, women are more likely to be affected by the disorder than men. The treatment methods for MDD and chronic depression are also very similar. Despite this misconception, MDD and chronic depression are not the same things, and each disorder is characterized by its own symptoms and considered to be a separate condition. The symptoms of chronic depression can be mild, moderate, or severe. Traditionally, the term, now called dysthymic disorder, has been used to describe chronic mild symptoms. Dysthymic disorder is now a subcategory of persistent depressive disorder as categorized by the DSM-V-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision).
Some people experience a type of depression known as double depression. This occurs when people experiencing dysthymia begin to have worsening symptoms, which can lead to an episode of major depression. This episode, in conjunction with their existing dysthymic disorder, results in the 'double depression.' If you have experienced this and are seeking treatment, it is important to let your health care professional know about the episode in addition to the underlying chronic depression.
How Is Chronic Depression Different From Major Depressive Disorder?
Historically, many people did not distinguish between chronic depression and other types of episodic or shorter-term depression. However, today, when most people speak of depression, they are generally referring to major depressive disorder (MDD). Depressive symptoms that accompany MDD can occur once or fluctuate for short or long periods of time. These episodes come and go, with the symptoms themselves possibly being mild, moderate, or severe, and are thought to last more than two weeks, but less than two years.
To be diagnosed with chronic depression, the individual would have experienced nearly continuous symptoms of depression for over two years. Although you may not meet the requirements to be officially diagnosed with chronic depression (for example, having persistent depressive symptoms for a year and a half), this does not necessarily mean you are not chronically depressed. Unfortunately, the specific differences between the different types of depression are not always clearly defined and can be confusing. As a result, speaking with a mental health professional is the best way to find out exactly what diagnosis best matches your symptoms, as well as what the best treatment options are.
Chronic Depression Symptoms
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), is commonly used by psychiatrists and therapists as a reference to help diagnose mental health disorders and provide care to individuals in need. lists the definition and symptoms of chronic depression as follows:
A depressed mood that occurs for most of the day, for more days than not, for at least 2 years (at least 1 year for children and adolescents). The individual is symptom-free for no more than 2 months.
During periods of depressive mood, at least two of the following six symptoms are present:
Poor appetite or overeating
Insomnia (not sleeping) or hypersomnia (oversleeping)
Low energy or fatigue
Poor concentration or difficulty making decisions
Feelings of hopelessness
The symptoms of chronic depression can be mild, moderate, or severe. Many of these symptoms are present in non-chronic depression, such as major depressive disorder (MDD). However, episodes that occur as part of MDD also include different symptoms such as feeling worthless or guilty, or having thoughts of death, suicidal ideation or attempting suicide. The DSM-5 does not include suicidal thoughts or actions as part of the symptoms of chronic depression because it is less common.
If you are having suicidal thoughts, please speak with a health care professional, chat with someone who can help online, or call the suicide hotline right away: 1-800-273-TALK (8255).
Chronic Depression In Children And Teens
Unfortunately, some children and teens experience depression. As noted above, chronic depression may be present when depressive symptoms occur for a year or more. Although teens and children may experience similar symptoms compared with adults, the is often unique to members of this age group. Although depression is sometimes difficult to diagnose in teens, parents should be aware of their behavior, and note if depressive symptoms are present most of the time.
Causes Of Chronic Depression
The root cause of depression can vary depending on your genetic makeup, life experiences, and other factors. Episodes of major depression can be caused by the following factors:
Genes: A family history of depression increases the chance that an individual will have depression. Studies that have observed depression in identical twins have noted that depression is likely to occur in one twin if the other has depression. Genetically inherited depression is likely higher for women than men.
Situational: Certain life events like divorce, loss of a loved one, or losing a job can cause a depressive episode.
Social: Prolonged loneliness or lack of social support has been found to lead to depressive symptoms.
- Physical Illness: Many types of physical illnesses can cause depression. For example, people who are heart disease or have had a previous heart attack are an increased risk for depression. John Hopkins Medicine reports that 1 in 5 people will have a depressive episode after a heart attack.
The factors that can lead to the development of major depression and chronic depression are very similar. However, some factors may be more or less likely to contribute to chronic depression. For instance, depression caused by situational factors like divorce is often short-lived, and in most cases, does not lead to chronic depression. Social factors, on the other hand, often lead to chronic depression if the individual's social situation does not change. Additionally, those who have depression often view their disorder as a burden, which can make them more reluctant to open up about their troubles or speak with others.
Chronic depression is also more likely to occur in individuals who have chronic physical illnesses. For example, chronic pain and depression have been found to co-occur in many individuals, particularly for older individuals. Although alleviation of pain may help these individuals, some research shows that depression can cause pain, particularly for those going through chronic depression.
Are you wondering if you have chronic depression? Or are you thinking of what kind of treatment options may be available for you? In either situation, talking to a doctor and getting professional help is a must. However, taking an online chronic depression test can help to answer some questions you may have and give you a better idea of your symptoms before you speak with someone professionally.
Keep in mind that an online test result is not a medical diagnosis, and a proper diagnosis should only be rendered by a mental health professional. Once you receive an accurate diagnosis from your doctor, they will discuss your treatment options, which will include antidepressants (depending on your situation) as well as psychotherapy to get to the root of your depression and help you overcome it. While you wait to speak to a doctor or in addition to your treatment plan, there are a few things you can do on your own and at home to better manage or find relief from your symptoms.
Work towards a healthy lifestyle through changes such as improved eating habits and exercise.
Exercise can help produce feel-good hormones in your body.
A healthy diet lets the entire body function better, including your mood.
Get appropriate sleep and practice good sleep habits.
Get 7-9 hours of sleep each night.
Go to bed at the same time and wake up at the same time each day.
Remove television and screens from your bedroom.
Do not consume any caffeine after 2 pm.
Reduce stressors through relaxation techniques such as:
Deep breathing and meditation exercises
Progressive muscle relaxation
Engage in social activities and/or support groups.
Join an in-person or online support group to connect with other people going through depression.
Join local groups to participate in activities you might enjoy and to make friends.
Learn coping and problem-solving skills.
You and your therapist can develop skills to meet your individual needs.
You can develop coping skills for when you feel your depression worsening.
You can learn problem-solving choices that are in the interest of reducing your depression.
Reaching For Help
When you are living with symptoms of a depressive disorder, you may begin to feel isolated, especially if you do not have support resources in place. It is very important that you remember you are not alone in feeling this way. Millions of people live with depressive order and find relief and recovery from depression by seeking the help of a mental health professional. With therapy, you can learn strategies to managing your symptoms and discover tools that can help you improve the quality of your life.
There are several options for you to choose from when seeking therapy, including online therapy. People with depression often struggle with finding the energy to attend in-person appointments on a regular basis. Research also supports the efficacy of online therapeutic interventions in the treatment of depression. In a study published in JAMA Psychiatry, an extensive review revealed that people managing depressive disorder who received internet-based cognitive behavioral therapy (ICBT) showed an improvement in symptoms. Researchers also reported the treatment cost less while reaching a diverse and large number of people.
If you are interested in therapy online, consider reaching out to one of our BetterHelp counselors who can give you more information and advice on what your next steps should be. If you or a loved one has been depressed for years (or even weeks or months), it is never too late to seek help from a professional. If searching for and speaking in person with a mental health professional is too intimidating or inconvenient, talking online with someone at BetterHelp might be a better option for you. Hundreds of people have spoken to the licensed and professional counselors at BetterHelp and have come away feeling more empowered, more positive, and in control of their life. Read below for some reviews of BetterHelp counselors, from people experiencing similar issues.
"Colleen has been an intricate part of my healing, and I know that I would not be as successful as I am without her encouragement, support, and advice. She is always there when I need her without hesitation and fully understands the goals I have and the challenges I face. She has wonderful techniques in helping me release and cope with stress and anxiety, and it has greatly reduced my depression. Colleen is an absolutely fantastic therapist, and I can't recommend her highly enough!"
"I put off finding a therapist for a long time. I dreaded my first conversation with Neil and all the awkward, clunky explanations I'd have to give about my depression and anxiety. All of the things that felt like dirty little secrets that caused me so much pain. But I was so pleasantly surprised by the way Neil accurately picked up on what I was saying and gave me more insight into how my brain was working. It made my issue feel so much less of a personal problem and more of a universal problem we could examine together. He always gives me a thoughtful response within a day or two any time I send a message. I actually think we've made more progress in between sessions just by being able to communicate things that are coming up in real time. Neil is intelligent and kind. I really appreciate his communication style and highly recommend him."
If you are going through depression or think you might be experiencing the symptoms of it, simply reading this article is a great first step towards gaining a better understanding of the condition and getting on the path to recovery. In your most difficult moments, tell yourself that you are not alone, and you will get better. All you need are the right tools. Take the first step.
Frequently Asked Questions (FAQs)
What is the meaning of chronic depression?
The majority of people with depression report symptoms lasting for short periods of time. As described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a person will only be diagnosed with a mental disorder if they exhibit signs of depression for at least two weeks. People who only have brief instances of depression are said to have “episodic depression”. Those who receive a chronic depression diagnosis experience symptoms for much longer, usually two or more years. Chronic depression is typically associated with some degree of childhood trauma or a record of mood disorders in a person’s family history. Due to the prolonged nature of these chronic symptoms, treatment may be more intensive, and the risk of relapse or treatment resistant depression is higher than people living with milder forms of depression.
Chronic depression affects everyone differently, but treatment methods include psychotherapy, antidepressant prescriptions, or a combination of both. With the many subsets of chronic depression, doctors may prescribe a variety of therapy strategies to help people cope with its symptoms. Some subsets of chronic depression include dysthymic disorder, a milder form of depression that still presents over extended periods, double depression, chronic major depression, and partial recovery. While not all of those classifications are recognized by the DSM-5, mental health professionals notice certain behavioral and emotional patterns that affect the severity and frequency of chronic depression.
Even with a successful treatment plan, management therapy is required to ensure people living with chronic depression stay healthy and do not succumb to various risk factors attributed with relapse or mental health decline. Before issuing a chronic depression diagnosis, health care professionals will perform exams to determine if the person exhibiting signs has other medical conditions like a sleep disorder or thyroid disease, which can present other symptoms like weight gain, changing mood, and lack of energy. To be sure about whether or not a person has chronic depression, speak with a doctor to be evaluated.
What are the 4 types of depression?
Almost everyone will experience some degree of depression in their lifetime. The difference between causal cases of depression and depressive disorders outlined in the DSM-5 is defined by various signs and symptoms that remain present for extended periods of time. People who continuously exhibit signs of depression for at least two consecutive weeks are classified among many different subsets of depression. Each classification is described by various personality, psychological, physical, and emotional effects attributed with depression.
Types of depression include:
- Major depressive disorder
- Bipolar disorder and bipolar depression
- Seasonal affective disorder (SAD)
- Premenstrual dysphoric disorder
- Postpartum depression
- Psychotic depression
- Atypical depression
- Treatment-resistant depression
- Persistent depressive disorder or chronic major depression
One type is known as Major Depression or “major depressive disorder”. This form of depression may cause loss of interest in activities people once enjoyed. They may also experience fluctuating weight, have trouble sleeping, or deal with bouts of fatigue throughout the day. People with these symptoms may also be diagnosed with atypical depression, a subgroup of major depressive disorder. This diagnosis usually affects people who experienced depression as a child or teenager with symptoms that intensify as they mature into adults.
Persistent Depressive Disorder (PDD) is a second form of depression, signifying symptoms that have remained for two or more years. The prolonged nature of PDD can negatively affect a person’s self-esteem, cause difficulty concentrating or making decisions, depleting their energy, and leaving those living with the disorder feeling hopeless. PDD requires long-term therapy and constant support.
Bipolar Disorder is a subset of the main depressive disorders that affects a large number of adults, most of whom remain undiagnosed. Also known as “manic depression”, this disorder causes frequent shifts in mood and behavior, with fluctuating highs and lows. The low phases closely mimic symptoms of MDD. High stages, or instances of “hypomania”, can present unstable bursts of energy, hyperactivity, and irrational behaviors like overspending or self-harm. Clinical trials suggest that most antidepressants may not be effective in treating people living with bipolar. Because of inclusive success rates in the use of antidepressants and placebos, doctors usually prescribe alternative medicines like lithium, which seem to be much more effective in alleviating its signs.
Seasonal Affective Disorder (SAD) is a seasonal or temporary form of major depression that usually occurs during the winter months. With shorter days and limited sunlight, some people can experience drastic declines in their mood or behavior. This form of depression usually subsides by spring or summer.
While each type of depression can show similar signs and symptoms, or exist alongside various other mental health concerns such as anxiety disorders, the only way to determine exactly which type of depression a person may have is to speak with your doctor or a trained mental health professional.
What causes long term depression?
Persistent Depressive Disorder describes a form of long-term depression that can be linked to a number of symptoms and causes. People living with long term depression can lose interest in their daily activities, struggle with productivity, experience low self-esteem, and eventually develop additional symptoms relevant to common anxiety disorders. The American Psychiatric Association states that one in 15 adults experience depression within any given year, and one in five have it at least once in their lifetime. Because of the common nature of people’s experience with depressive disorders, it is difficult to isolate specific causes.
The hopelessness and feelings of inadequacy associated with long-term depression may stem from childhood abuse, relationship issues, body image challenges, or mood disorders resulting from a hormonal change or situational trauma. Women who have recently given birth can develop postpartum depression that cannot be explained by any of the usually suggested causes of depression, which proves that some causes remain unknown.
Long Term Depression can be the result of years of substance abuse, genetic disposition, delayed treatment, or trouble receiving an accurate diagnosis, since many symptoms remain unnoticed or unreported until the depression becomes severe. People with persistent depression may have trouble with feeling happy or upbeat, but that may be mistaken as a cultural norm or a casual personality trait.
This is why it’s important to study current mental health information and speak to a professional for support. Long term depression is a chronic mental challenge, but symptoms are regularly classified as mild, coming and going over time. Some people may live years without experiencing the symptoms of depression the signs reemerge. This makes it difficult to determine which triggers lead to its resurgence, what caused the onset of the depression, and why it remains long-term.
During those intervals, participants in clinical trials report experiencing symptoms that align with more than one type of depression at once, often classified as “double depression.” With dual diagnosis and the numerous potential triggers a person may encounter throughout their experience with long term depression, it is advised to speak with a doctor as soon as possible, if you are concerned.
Does depression count as a disability?
Many depressive disorders make it hard for people living with depression to manage through daily activities like working to support themselves and their families. Because of the debilitating nature of certain depression symptoms, the disorder is considered a psychiatric disability under the Americans with Disabilities Act (ADA). The ADA guarantees the right to receive connection to mental health services and support, but it does not automatically qualify everyone with depression for disability compensation or insurance.
If your primary care doctor or another mental health professional has diagnosed you with depression, you have exhibited relevant signs and symptoms for at least two weeks. Based on health information gathered from the Anxiety and Depression Association of America, even with treatment, severe forms of depression can make it near impossible to work, which is why the disorder remains the leading cause of disability for people 15-44.
Although the symptoms of the disability can present at any stage in life, the median age for people with severely depressed mood begins at 32. Between the time symptoms are reported and when treatment begins, many people are in the first stages of establishing a job or career. If you are diagnosed with a type of depression that is considered treatment-resistant, then it is considered a disability, though qualification for financial assistance and health insurance is still not guaranteed.
The ADA requires a person’s depression to “substantially limit” one or more daily activities before assistance can be offered by the Social Security Administration (SSA). Since the National Institute of Mental Health explains compounded effects of depression, such as the development of medical illnesses like heart problems, diabetes, Alzheimer’s, and Parkinson’s disease, many people experience multiple defects that prevent them from working, which would qualify them for financial assistance and health insurance from the SSA. If you have been unable to work for at least 12 months, live in a low income neighborhood, and/or have contributed to Social Security funds through payroll deductions for 5 out of the last 10 years, you may qualify for benefits like Medicaid, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).
How can you help someone who is mentally ill?
Mental illness affects everyone differently, creating various opportunities to offer help. Everyone experiences tough times and almost everyone will have some experience with depression, anxiety, or another form of mental health disorder throughout their life. If the symptoms of a person’s condition begins to impact their daily responsibilities and affect their relationships, they can benefit from having a support person available who’s willing to help.
The first step to offering support is to understand the type of illness the person may have. You can find a wide variety of mental health information online, listing certain signs and symptoms that may explain the presence of a mental health challenge. Resources like the National Institute of Mental Health are a great starting point to reference, if you are concerned. However, the best way to accurately diagnose your friend or loved one is to have them evaluated by a professional.
Sometimes, determining the person’s diagnosis isn’t as important as helping them cope with the symptoms they are experiencing. When illnesses like depression and anxiety remain untreated, people can struggle with performing daily tasks that sustain their quality of life. Things like eating, exercise, cleaning, and going to work or school are important to maintaining your mental health. If a person’s health, grades, or work performance declines, the consequences can worsen their mental condition. Pay attention to their behavior patterns, although certain signs and symptoms of mental disorders may affect some more severely than others. Try to open the floor to talk about their mental health, rather than wait for them to bring the topic up. Sometimes, having a listening ear and the undivided attention of a person you trust can help people open up about their problems. Don’t probe or dismiss any of their concerns, even if they may seem irrational or easily solved. Instead, allow them space to talk as much (or as little) as they please. Listen to what they say, and show that you are being supportive.
Aside from therapy, some people may benefit from other coping strategies like taking them on a short trip or arranging for them to participate in their favorite hobby. You may decide to help a friend with depression organize their house or cook their favorite meal. A small gift or token of your friendship may be more than enough to help them counter feelings of grief, sadness, or hopelessness.
Overall, it’s important to let them know that they are not alone, despite the way the condition may make them feel. There are millions of people battling mental health challenges around the world, and each one of them can get stronger with the proper support. In light of a potential crisis, it’s important to remain calm and ensure that everyone involved stays safe. If they become suicidal or are experiencing an alternate reality, avoid being confrontational. Contact their doctor or get help from emergency support services like the National Suicide Prevention Lifeline, a 24-hour service that can be reached by dialing 800-273-8255.
What happens if mental illness goes untreated?
If mental disorders remain untreated, additional complications and disorders may develop over time. There are approximately 43.8 billion adults living with mental health challenges in the U.S., with 60% remaining untreated, according to a 2012 National Survey on Drug Use and Health. Some of the most severely challenging mental conditions remain untreated in 40% of adults. These high rates impact more than the people with the disorders, they also affect their children, partners, friends, families, and coworkers.
Studies show that untreated mental health problems severely impact the economy, costing about $100 billion each year in productivity losses. Unfortunately, the United States has the highest population of untreated children and adults with mental disorders in the world. This trend is closely followed by developing countries, with up to 85% of their serious cases remaining untreated as well. This creates a global phenomenon that keeps billions of people in poverty, experiencing a combination of mental, physical, and emotional illnesses. Globally, it is estimated that mental health challenges cost close to $2.5 trillion per year. This is a worldwide public health concern that warrants immediate action.
Many agencies work to advocate for increased access to treatment and mental health education. Due to the cost of treatment, people going through socioeconomic challenges cannot always receive the help they need. Cultural and societal stigma surrounding mental health also deters some people from seeking help. However, the shame and embarrassment can cause a domino effect that leads to a serious decline in a person’s health.
Continued and rapid decline in a person’s mental health is the most obvious consequence to delayed treatment. The longer a person lives with untreated mental problems, the more challenging it becomes to remedy. Certain therapy methods, like Cognitive Behavioral Therapy, are most effective when a person receives early access to treatment. People may eventually notice multiplied diagnoses or worsening symptoms of their disorder, which may require more intense treatment options.
Studies show that untreated mental health challenges can also create deteriorating effects on the body. Aches, pains, a weakened immune system, gastrointestinal distress, heart disease, stroke, high blood pressure, stroke, declined brain function, advanced aging, and premature death are just a few health concerns often attributed to long-term mental disorders. People with extended, untreated mental health problems are also more prone to unemployment, homelessness, substance abuse, alcoholism, and increased rates of incarceration.
Do mental health issues get worse with age?
According to the Centers for Disease Control and Prevention, approximately 20% of older adults in the United States have been diagnosed with a mental health disorder. Sadly, about one out of every three of those people never receive treatment. Whether treated or undiagnosed, studies prove that mental health issues do get worse with age. With added life stressors, like estrangement from family, compounding physical health challenges, changing prescriptions, and, most recently, isolation and fear stemming from the pandemic, researchers believe the elderly are more susceptible to mental health disorders than they’ve ever been.
As people age, their body’s functions begin to slow or malfunction, making it more difficult for them to heal and cope with the demands of daily life. People who received their mental health diagnosis earlier in life may experience advanced challenges as they age, due to the ineffectiveness of certain medications in older patients. For instance, lithium is often prescribed to people with bipolar, as antidepressants produce varied results. However, lithium is not an appropriate medication for people over 75, since it does not react well with their bodies.
Older people also experience neurological challenges, as the brain continues to age. One of the most common mental health issues in elderly people involve severe cognitive impairment. Disorders like Alzheimer’s and dementia make it difficult to control your mood. With more than 5 million adults over 65 having been diagnosed with Alzheimers, many of whom also have a mood disorder like depression, the compounding and overlapping signs and symptoms can make treatment a significant challenge. If mental disorders are distorting a person’s ability to understand, remember, and respond to treatment, symptoms will not only persist, they will continue to get worse.
Can a person be chronically depressed?
Yes, it is possible for a person to become chronically depressed. Some people with chronic or long-term depression develop something called persistent depressive disorder or dysthymia, a type of mood disorder that’s usually a less severe form of major depression (major depressive disorder). Dysthymia involves having a depressed mood or mild depression symptoms most of the time for at least two years or longer (or one year in children and teens). According to the American Psychiatric Association, a person with depression or dysthymia may experience the following symptoms:
- Lose interest in activities they once enjoyed
- Trouble sleeping (sleeping too little or too much)
- Difficulty thinking, trouble concentrating and making decisions
- Feelings of worthlessness and guilt
People with dysthymia can also experience bouts or episodes of severe or major depression. This is sometimes called dual depression or double depression, with episodes lasting a few weeks or months.
How long does it take for depression to be chronic?
Like any other mental illness, depression affects everyone differently. Many people live with depression for many years but are able to manage it with talk therapy, antidepressant medication, and sometimes even electroconvulsive therapy. Depression can be mild, barely interfering with a person’s everyday life, or it can be severe or treatment resistant, making it difficult for a person to carry out their daily activities. In either case, depression is considered medically chronic when it lasts for more than two years.
Is chronic depression lifelong?
Not necessarily. Depression is considered chronic when it lasts more than two years. However, millions of people with chronic or persistent depression have been able to balance their mood and recover by working with a therapist, talking medication, or a combination of both.
What does dysthymia look like?
Symptoms of dysthymia or persistent depressive disorder include:
- Depression or a depressed mood most of the time (every day or almost every day) for most of the day
- Low-self esteem
- Feelings of worthlessness, hopelessness, or guilt
- Poor concentration and decision-making
- Low energy
- Trouble falling asleep or staying asleep
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