If I had a dollar for every time I hear this from a patient I could save our economy. This is a serious and disabling complaint we hear from 22-33% of patients in our primary care offices. In this blog I want to address the potential causes of fatigue, and what workup your doctor should pursue. In a follow-up blog we will talk about approaches to the treatment of fatigue.
First, make the distinction in your mind of fatigue from somnolence, feeling winded, and muscle weakness, although these symptoms may also be associated with fatigue. People with fatigue report a lack of energy, mental exhaustion, poor muscle endurance, delayed recovery after physical exertion, and nonrestorative sleep.
There are many potential causes of fatigue including lifestyle issues, physical conditions, mental disorders, and medication side effects. Here are your initial steps toward figuring out the cause:
1) Ask yourself about the quality and quantity of your sleep. If your sleep is disrupted by getting up to use the restroom, a partners snoring, or allergic rhinitis (stuffy nose) that wakes you up chances are you are NOT getting a good restorative sleep.
2) Get a good physical exam. Physical examination findings that could suggest a worrisome cause of fatigue include enlarged lymph nodes, a heart murmur, an enlarged thyroid, lower extremity swelling (heart failure, liver disease), poor muscle tone and other neurologic abnormalities.
3) If the physical exam is unrevealing consider talking to your doctor about some basic blood tests. Laboratory studies should be considered although their results affect management in only 5 percent of cases. Many physicians will order a complete blood count, erythrocyte sedimentation rate, chemistry panel, thyroid-stimulating hormone, and urinalysis. Women of childbearing age should receive a pregnancy test.
What is chronic fatigue? Chronic Fatigue is defined as fatigue that lasts longer than six months. Chronic fatigue is not the same thing as Chronic Fatigue Syndrome which includes fatigue as well as 4-5 other associated symptoms and won't be specifically discussed in this blog. Medical or psychiatric diagnoses can explain fatigue in at least two-thirds of patients with complaints of chronic fatigue. In one study, for example, a psychiatric diagnosis was found in 74 percent of over 400 patients who presented to a chronic fatigue clinic with at least one month of fatigue. The three major psychiatric illnesses were major depression (58 percent), panic disorder (14 percent), and somatization disorder (10 percent). There is debate, however, whether depression in individual patients is the cause or consequence of symptoms of chronic fatigue.
Medical causes for chronic fatigue that deserve to be investigated if no psychiatric cause is found include:
Fatigue is frustrating and often there are no easy answers. In the next blog I will talk about steps you can take toward the treatment of fatigue.