I usually see a couple of patients a day who complain of chronic tiredness, fatigue, and loss of libido. The lethargy can be overwhelming and people are often frustrated by the persistence of their symptoms. Although few turn out to have any serious underlying health problem, each case needs to be carefully assessed.
The non-specific nature of the symptoms is the main challenge for the doctor. It is true that psychological factors can cause lethargy, tiredness, and reduced sexual activity. However, it is better to assume there is a physical explanation and exclude that first. Some of the more common causes are: post-viral/post-flu tiredness; other infections like glandular fever; anemia; other medical conditions like diabetes, heart disease or underactive thyroid gland; side-effects of certain medications like some blood pressure tablets and antihistamines; some chronic or ongoing illnesses like rheumatoid disease.
Very uncommonly, the fatigue may be shown to be due to an underlying condition like cancer or lymphoma. We are then left with a “cause not clear” group. Anxiety and depression may be major factors in this group. Chronic fatigue syndrome, CFS, or “yuppie flu”, deserves a special mention. It is characterized by debilitating long-term fatigue and may follow a flu-like illness.
Today there are specific diagnostic criteria that must be fulfilled–like symptoms lasting at least six months, presence of a mild fever, palpable lymph-nodes and the exclusion of other medical conditions. CFS has gained clearer recognition in recent years. It is real, not imaginary, and one day we will know a lot more about it.
When a patient complains of chronic tiredness the doctor follows certain steps to sort out the problem. A clear history is so important. What are the main symptoms and how long have they been present? Have there been any other symptoms, like fever, muscle weakness or loss of appetite? A careful physical examination is next, looking for signs of weight loss, anemia or any other abnormalities. The urine is also checked for sugar. Tests and investigations may or may not be required initially. Sometimes a basic blood test and chest x-ray are organized.
A review of the patient a week or two after the first consultation is helpful. If things are not improving, further investigations or referral to a specialist may be necessary. The treatment of chronic tiredness depends on the cause; any underlying condition will require treatment. If no obvious cause is found, explanation and reassurance often helps a great deal–always with the option for a further review.
Attention to lifestyle factors is also worthwhile, with emphasis on rest, diet, and a graded exercise program. If stress appears to be a factor, counselling and relaxation therapy can help. Occasionally a standard multi-vitamin preparation can help but large doses of vitamins and other supplements are not of any proven benefit. Alternative approaches like acupuncture can also be tried. However, it is best to start with a careful medical assessment, to rule out any underlying health problems.