Chronic Fatigue

Chronic Fatigue patients tend to get referred around to allergists, immunologists, endocrinologists and psychiatrists. Psychiatry referrals come about because of the possibility that an underlying depression is contributing to the fatigue problem.

The causes of chronic fatigue are numerous and include:

  • post viral illness  notably Glandular Fever; Ross River Fever; and Q Fever; Epstein-Barr Virus; Coxiella Burnetti Virus
  • traumatic head injury  or stroke
  • sleep disorders notably Sleep Apnoea
  • fibromyalgia
  • chemical sensitivity syndrome
  • chronic pain
  • post-amphetamine abuse (for up to 12 months after cessation)
  • depression

There are also some important medical diagnoses to exclude:

  • Systemic Lupus Erythematosis
  • Hypothyroidism
  • Multiple Sclerosis
  • Lyme Disease

Certain drugs such as alcohol,  benzodiazepines, and antihistamines  can mimic chronic fatigue.

There is also a stage of life thing. There are not many mothers with three children under 5 in the house who are not chronically sleep deprived and tired.

The key features of chronic fatigue are:

  1. Persistent Fatigue lasting longer than six months and not responding to bed rest
  2. Unrefreshing sleep
  3. Mild exercise causes debilitating symptoms
  4. Frequent headaches
  5. Frequent sore throat and tender lymph nodes
  6. Diffuse muscle pain

Management

  1.  High protein  intake.  Reduced processed and fast foods. No soft drinks. Plenty of fruit juices
  2. A gentle graded exercise programme supervised by a physiotherapist.
  3. Cognitive Behaviour Therapy – shifting focus away from the things the person cant do onto the things they can do
  4. Low dose Prednisone
  5. L-Carnitine 500mg twice a day
  6. Moclobemide  600mg three times a day

Generally people with chronic fatigue are very sensitive to medication side effects so medications need to be introduced sparingly and gradually.

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