Hello,
Thanks for your query.

From your detail history, it is clear that you have following symptoms:
•     Low mood, lack of motivation in life, feeling of worthlessness, always feeling down
•     Tiredness
•     Poor sleep, sleeplessness
•     Loss of concentration

You case is interesting and but difficult too. Even your attending physician is facing problem to solve it and reports are normal. I will try to give my best effort to help you in this problem.

I would like to consider multiple possibilities in following hierarchy:
•     Anxiety and Depression: If associated with anxiety and low mood. need to be rule out by
detailed interview by psychiatrist
•     Poor sleep pattern: For that follow steps of sleep hygiene.
•     Vitamin deficiency: Get serum B12 level. Start multi vitamins as they are easily available.
•     Side effect of substance use: stop use if present.
•     Thyroid related problem: It is good that, thyroid reports are normal in your case.

Apart from above advice following simple measures will help you:
-Healthy diet: Milk and fruits in diet.
-Daily morning walk

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

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Hello again,
Thanks for follow up.

You can get serum B12 level from any good lab. It is done on morning blood sample. Regarding psychiatrist: They will ask questions to help you to give required information.

Irrespective of cause of problem, below principles of sleep hygiene which will help you in long term:
•     Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
•     Avoid napping during the day
•     Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
•     Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime
•     Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep.
•     Use comfortable bedding.
•     Find a comfortable temperature setting for sleeping and keep the room well ventilated.
•     Block out all distracting noise, and eliminate as much light as possible.
•     Reserve the bed for sleep. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.
•     Practice relaxation techniques before bed. Relaxation techniques such as yoga, XXXXXXX breathing and others may help relieve anxiety and reduce muscle tension.
•     Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.
•     Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
•     Getting Up in the Middle of the Night :Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.
•     A Word About Television: Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.


Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful.

Wish you good health.
Regards.

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