What are the common causes and management strategies for fatigue?

From the Guidelines

Fatigue is commonly caused by inadequate sleep, poor nutrition, physical inactivity, stress, depression, anxiety, medical conditions, and medication side effects, and management strategies should prioritize addressing these lifestyle factors. According to the most recent and highest quality study 1, management strategies should begin with addressing lifestyle factors, such as aiming for 7-9 hours of quality sleep nightly, maintaining a consistent sleep schedule, and practicing good sleep hygiene by limiting screen time before bed. Nutritional improvements include eating regular balanced meals with adequate protein, complex carbohydrates, and staying well-hydrated with 2-3 liters of water daily. Regular moderate exercise, starting with just 10-15 minutes daily and gradually increasing to 150 minutes weekly, can paradoxically improve energy levels by enhancing cardiovascular function and sleep quality.

Some key points to consider in managing fatigue include:

• Assessing for fatigue and treating any causative factors, such as anemia, thyroid dysfunction, and cardiac dysfunction 1
• Offering treatment or referral for factors that may impact fatigue, such as mood disorders, sleep disturbance, pain, and so on 1
• Counseling patients to engage in regular physical activity and referring for cognitive behavioral therapy as appropriate 1
• Using energy conservation techniques, such as prioritizing important activities during peak energy times and taking short 10-20 minute rest breaks throughout the day 1
• Considering referral to an appropriate specialist or supportive care provider for further evaluation and management of fatigue 1

For persistent fatigue, medical evaluation is essential to identify underlying conditions that may require specific treatments, such as iron supplements for anemia or levothyroxine for hypothyroidism. Caffeine consumption should be limited to mornings and early afternoon to avoid sleep disruption. By addressing lifestyle factors and using evidence-based management strategies, patients can effectively manage their fatigue and improve their overall quality of life.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Fatigue and Common Causes

Fatigue is a symptom reported by patients with a variety of chronic conditions, characterized by persistent overwhelming tiredness, severe lack of energy, and physical weakness that worsens over time 2. The common causes of fatigue can be attributed to various factors, including:

• Chronic conditions such as heart failure, multiple sclerosis, rheumatoid arthritis, chronic kidney disease, and chronic obstructive pulmonary disease 2
• Neurological diseases such as multiple sclerosis, Parkinson disease, and stroke 3, 4
• Benign paroxysmal positional vertigo (BPPV) 3
• Chronic heart failure (CHF) 5

Management Strategies for Fatigue

Management strategies for fatigue may include:

• Comprehensive assessment and a broad approach in interventions aimed at alleviating fatigue 5
• Treatment with fatigue-relieving drugs such as amantadine, methylphenidate, or modafinil 3
• Addressing associated symptoms such as sleep disturbance, impaired cognition, and depression 2
• Recognizing the importance of distinguishing between subjective complaint and objective signs of fatigue 4

Factors Influencing Fatigue

Factors that may influence fatigue include:

• Uncertainty and sense of coherence in patients with chronic heart failure 5
• Age, with older patients experiencing reduced motivation and ability to concentrate 5
• The type and severity of the underlying condition, with some conditions causing more severe fatigue than others 2, 4