Almost one in three people who seek medical help report fatigue as their main symptom or part of their symptoms. Studies have shown that up to 8% of the general population may experience fatigue. Some of the most common complaints doctors hear from their patients are:

  • “Even though I sleep well, in the morning I can’t get out of bed.”
  • “I just got back from vacation, but I still feel very tired.”
  • “I get tired at the slightest thing. I can no longer do things that I used to until a while ago.”
  • “I can not focus. I can barely keep my eyes open.”

And the next question is: “What should I take to feel better”?

Let it be clear from the beginning that “miracle” treatments and medicines do not exist! But each person who complains of fatigue may mean something different.

Thus, fatigue is a general and vague symptom that may include:

  • Difficulty or inability to start an activity (subjective feeling of weakness).
  • Reduced ability to maintain activity (fatigue easily).
  • Concentration and memory disorders or emotional instability (mental fatigue).
  • Drowsiness.
  • A combination of the above.

Depending on its duration, fatigue is characterized as:

  • Acute: It lasts less than 1 month and is usually due to pathological causes that are easily recognized in combination with other clinical manifestations (e.g. respiratory infection, acute stress).
  • Subacute: Duration 1 – 6 months.
  • Years: Duration longer than 6 months.

Subacute or chronic fatigue is often associated with underlying pathological or psychological conditions, drug toxicity, or substance use.

The initial assessment of all patients complaining of subacute or chronic fatigue includes:

  • Details Download History: The patient is encouraged to describe exactly what he feels in his own words, but also to give his own possible explanations for the fatigue he feels. The mode of onset of symptoms (abrupt or gradual), the course (stable, improving or worsening), possible diurnal variation, factors that help or worsen the condition and the impact of fatigue on the patients’ personal, professional and family life should be considered in detail, as they often lead to the correct diagnosis. Symptoms suggestive of depression (e.g. mood, sleep and eating disorders) or anxiety symptoms (palpitations, sweating, phobias, panic attacks) should be investigated and the corresponding diagnostic tests applied. Detailed control of medications taken and possible substance use or abuse is also necessary.
  • Clinical examination: In addition to the detailed and complete clinical examination, special signs of diseases that may manifest themselves with chronic fatigue are sought with an emphasis on the general appearance, thyroid diseases, the presence of lymph node swellings or hepatosplenomegaly and the examination of the cardiovascular, respiratory, nervous and muscular systems.
  • Laboratory Tests: Extensive laboratory and imaging testing in the absence of pathological findings from history taking and clinical examination has little diagnostic value and is not recommended. Patients should undergo selected tests. Often, depending on the age, family history and habits of the patients, the check-up also includes tests to rule out neoplasms.
  • Further diagnostic investigation determined by the presence or absence of findings from the above basic control. Patients with negative findings from the initial screening repeat the evaluation process after 1-3 months.

The cause of chronic fatigue can be determined in about 2/3 of patients.

In some cases habits and lifestyle are enough to explain the symptoms. Patients with underlying diseases often associate the fatigue they feel with activities they cannot complete.

In contrast, patients whose fatigue is due to mental disorders, drug toxicity, or substance use usually feel constantly tired, without describing worsening of their symptoms after activity or improvement after rest.

If after 6 months of follow-up no specific diagnosis has been made to justify the fatigue, we consider the patients to be suffering from “idiopathic fatigue” the “chronic fatigue syndrome”.

Chronic fatigue syndrome

Chronic fatigue syndrome is a disorder of unknown etiology, with specific diagnostic criteria and strong evidence of neurological “dysfunction”. Patients without a specific diagnosis who do not meet the criteria for the diagnosis of chronic fatigue syndrome are considered to have “idiopathic chronic fatigue”.

Treatment of patients experiencing fatigue is primarily aimed at changing the habits and lifestyle that may be responsible for the symptoms and treating possible underlying pathological or psychiatric disorders. Symptom response to the administered treatment is continuously monitored and evaluated.

For patients who have not been diagnosed and likely fall into the category of idiopathic fatigue or chronic fatigue syndrome, the following have been tried:

  • Empiric antidepressant treatment in those who present with depressive symptoms but do not meet the diagnostic criteria for depression. A period of a few weeks is required to evaluate the effect of treatment on symptoms. If there is no result within 2 months, the treatment is stopped.
  • Cognitive Behavioral Therapy (CBT).
  • Occupational therapy.
  • Nutritional and other therapeutic interventions (eg administration of vitamins or stimulant drugs), without proven efficacy.

in conclusion

Feeling tired?

  • Don’t look for “magic” solutions!
  • Consult your doctor.
  • Changing some of your habits or lifestyle, or treating some simple pathological or psychological disorder that may be underlying your symptoms, is often the solution.
  • There is a chance that nothing will be found to account for your symptoms. Even then, with proper treatment and monitoring you may be helped.

It is written by
Stergios Tassiopoulos
Pathologist
Deputy Director of the 1st Pathology Clinic, HYGEIA

tasiopoulos