What is the management and treatment approach for a patient presenting with asthenia (weakness or lack of energy)?

Management and Treatment of Asthenia (Weakness or Lack of Energy)

The management of asthenia requires a systematic diagnostic approach to identify and treat the underlying cause, as up to 50% of cases are related to depression, while the remaining cases may be due to various medical conditions requiring specific interventions. 1

Diagnostic Evaluation

• Differentiate true asthenia (subjective feeling of weakness not necessarily related to effort) from related symptoms such as weakness, dizziness, or dyspnea, as patients often confuse these sensations 1

• Classify asthenia based on duration:

  • Prolonged fatigue: lasting more than one month
  • Chronic fatigue: persisting longer than 6 months 1

• Consider chronic fatigue syndrome (CFS) as a diagnosis of exclusion when symptoms persist for more than 6 months without identifiable cause, using the 1994 international consensus criteria 1

Common Causes of Asthenia

• Depression is the most common cause, accounting for approximately 50% of all cases 1

• Other frequent causes include:

  • Cardiovascular diseases with associated asthenic syndrome 2
  • Cerebrovascular pathology 2
  • Post-viral conditions (including post-COVID asthenia) 2, 3
  • Senile asthenia syndrome in older adults 2
  • Stress-related neurotic disorders 3
  • Somatoform disorders (panic attacks, generalized anxiety disorders) 3

Treatment Approach

• The most effective treatment strategy is to identify and address the underlying cause, though approximately 20% of patients may remain without a definitive diagnosis 1

• For depression-related asthenia:

  • Consider appropriate antidepressant therapy based on symptom profile and patient characteristics 3
  • Implement cognitive-behavioral therapy when appropriate 4

• For cardiovascular or cerebrovascular-related asthenia:

  • Optimize management of the underlying cardiovascular condition 2
  • Consider citicoline (500 mg/day for 30 days) which has shown effectiveness for asthenic syndrome in patients with cardiovascular disease 2

• For post-viral asthenia:

  • Implement a gradual return to physical activity with careful monitoring of symptoms 3
  • Consider supportive therapies to manage specific symptoms 2

• For senile asthenia syndrome:

  • Address age-related physiological reserve decreases 2
  • Consider nootropic agents with antiasthenic effects such as citicoline 2

Monitoring and Follow-Up

• Regular assessment of symptom improvement is essential, with follow-up appointments scheduled based on severity and underlying cause 5

• Monitor for development or worsening of cognitive disorders, which frequently accompany asthenia 4

• Evaluate treatment response and adjust therapy as needed, particularly for chronic cases 5

Patient Education

• Explain the nature of asthenia as a defense mechanism signaling energy resource depletion 4

• Provide realistic expectations about recovery timeframes based on the underlying cause 1

• Emphasize the importance of adequate rest, proper nutrition, and appropriate physical activity levels 6

• Discuss the significant social and economic impact of untreated asthenia to encourage adherence to treatment plans 1