What are the treatment options for fatigue?

From the Guidelines

Treatment for fatigue should begin with identifying and addressing the underlying cause, and may include a combination of lifestyle modifications, such as improving sleep hygiene, regular physical activity, and stress management techniques, as well as medical treatments like iron supplements, thyroid medication, or antidepressants, and cognitive behavioral therapy for fatigue associated with psychological factors. When considering treatment options for fatigue, it's essential to prioritize interventions that have been shown to be effective in reducing fatigue and improving quality of life. According to the most recent and highest quality study 1, primary care clinicians should assess for fatigue and treat any causative factors, including anemia, thyroid dysfunction, and cardiac dysfunction. Some key points to consider when treating fatigue include:

• Improving sleep hygiene by maintaining a consistent sleep schedule, creating a comfortable sleep environment, and limiting screen time before bed
• Engaging in regular physical activity, even starting with just 10-15 minutes daily of walking or gentle exercise, to improve cardiovascular function and release endorphins
• Eating regular balanced meals with complex carbohydrates, lean proteins, and healthy fats while staying well-hydrated
• Using stress management techniques such as meditation, deep breathing exercises, or yoga to reduce fatigue caused by chronic stress
• Considering medical treatments like iron supplements (typically ferrous sulfate 325mg daily) for anemia, thyroid medication for hypothyroidism, or antidepressants for depression-related fatigue
• Referring patients for cognitive behavioral therapy as appropriate, as it has shown effectiveness for fatigue associated with psychological factors 1. It's also important to note that some nonpharmacologic interventions, such as mind-body interventions like mindfulness-based approaches, yoga, and acupuncture, may offer some benefit in reducing fatigue, although additional research is needed to confirm their effectiveness 1. Ultimately, the most effective treatment plan for fatigue will depend on the individual patient's needs and circumstances, and may involve a combination of these approaches.

From the FDA Drug Label

Parenteral vitamin B12 is the recommended treatment and will be required for the remainder of the patient's life. A dose of 100 mcg daily for 6 or 7 days should be administered by intramuscular or deep subcutaneous injection.

The treatment options for fatigue due to vitamin B12 deficiency include parenteral vitamin B12 administration, with an initial dose of 100 mcg daily for 6 or 7 days, followed by alternate day injections and then monthly injections for life 2.

• Folic acid should be administered concomitantly if needed.
• For patients with normal intestinal absorption, oral B12 preparations may be used for chronic treatment.
• Iron supplements may also be considered for treating fatigue due to iron deficiency anemia, under the advice and supervision of a physician 3 3.

From the Research

Treatment Options for Fatigue

• Vitamin and mineral supplements: Vitamins and minerals, such as B vitamins, vitamin C, iron, magnesium, and zinc, play essential roles in energy-yielding metabolism and can help alleviate fatigue 4.
• Physical activity: Regular physical activity has been shown to reduce the risk of experiencing feelings of low energy and fatigue, with a strong, consistent, temporally appropriate dose-response relationship between physical activity and feelings of energy and fatigue 5.
• Iron replacement therapy: Iron deficiency is a common cause of fatigue, and iron replacement therapy can help improve functional performance and reduce fatigue in older hospitalized patients 6.
• Vitamin B12 replacement therapy: Vitamin B12 deficiency can cause fatigue, and replacement therapy can help improve symptoms, with oral administration of high-dose vitamin B12 being as effective as intramuscular administration for correcting anemia and neurologic symptoms 7, 8.

Dietary Considerations

• Consuming foods fortified with vitamin B12 or taking vitamin B12 supplements can help improve absorption rates, particularly in patients older than 50 years and vegans or strict vegetarians 8.
• A diet deficient in iron can contribute to fatigue, and iron supplementation can help improve functional performance and reduce fatigue in older hospitalized patients 6.

Medical Considerations

• Screening for vitamin B12 deficiency may be warranted in patients with one or more risk factors, such as gastric or small intestine resections, inflammatory bowel disease, or use of certain medications 8.
• Measurement of serum methylmalonic acid can be used to confirm vitamin B12 deficiency in asymptomatic high-risk patients with low-normal levels of vitamin B12 8.