You could always try a Dad is Dead playthrough. It adds a extra bot of tension to a playthrough. There has been threads over at another Forum I frequent that has a list of graves with names stats and time of death. Alongside other gamers and their progress. So it can get a little competitive as your always trying to beat your last run and the best of others.

Just one rule...Dead is Dead.

1) When your character falls in battle or falls from a cliff, that's it. They are dead. Game over. No reloads. Feel free to restart, ( at the cave exit ) with the ole "I or II", after their names. If you so choose.

*Exception*
...If your character falls due to a glitch, the game locks up or due to any outside action and/or distraction ( kids / pets / mother-in-law ) at no fault from the player. No shame will fall upon you to revert to a previous save.

NOTE : Difficulty has no bearing in DID. It should be set, according the comfort of the player. Pending things like character build, roleplay, limits, mods, and experience, this can easily vary among players.

I set myself goals and targets, adding loads of mods with countless additional gaming hours also helps

Creating new stuff for your characters. In my case, since I love the 50's and 60's era I've found a lot of joy introducing little memorabilia pieces to the game: a little poster here, a new dress there... I try not to play the same missions very often and content myself with just wandering around the areas. That makes easier for me to keep the love

Quest mods are how i usually keep the game intresting. I also tend to play fallout in burts between starting and finishing other games.

You can always try playing the game in a unique stlye. Maybe even role play as a different hero. Good or Evil, Ncr or Legion. But quest mods to me or the ultimate way to go, keeps my game fresh! lol

what I always end up doing is downloading more quest mods. Big or small ones, it doesn't matter to me keeps me entertained for awhile especially with awop (underground sysytem is huge). roleplaying seems to make the game a lot more interesting. I also added monster mods adds lots off new things to shoot at. turning up the difficulty to, manual reload, reloading speed, JSawyer mod, realistic weapon damage all that fun stuff makes the game feel different. everyone isn't bullet sponge and you have to think things through and plan before a fire fight.