Chronic Fatique

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Been so tired recently. Be it sleeping or exercising (yoga) does not solve the problem. What should I do with my chronic fatigue? Which includes dizziness, cold like syndrome, excessive perspiration and feeling under the weather during weekends. I am currently on treatment for MDD.

Thank you for your question. I see a range of fatigue in my practice from mild, moderate to severe. I am going to do my best to cover more of the common causes with some even less common reasons why you can feel tired to exhausted.

In your case, knowing you are being treated for MDD (major depressive disorder) there is already a deficiency. When I see people with depression, we target the physiological causes for depression but also the psychological causes for depression. At times, it can be either one or the other. I find it has been more physiological than psychological

First off, I want to look at what ‘fatigue’ or ‘chronic fatigue’ means. Being tired can mean something completely different from one person to another. So it is important to know where you see yourself in these following descriptions: 

  • Sensation of exhaustion

  • Not enough energy

  • Boredom

  • Hates work

  • Dyspnea with exertion

  • Lack of energy

  • Lassitude

  • Listlessness

  • Reduced output or performance

  • Sleepiness

  • Tiredness

  • Weakness

  • Weariness

  • Unwillingness to work

Now lets dive into the areas that can cause fatigue or the diseases that are associated with fatigue as there are many

Psychogenic fatigue

  • Present all the time

  • Present on wakening

  • Often improves later in the day

  • Fluctuates with changes in mood or stress

  • Symptoms of depression, anxiety, somatization disorder

Fatal illnesses: most fatal illnesses produce fatigue

Other areas

  • Digestive: Malabsorption and break down of foods: hypochlorhydria, enzyme deficiency

  • Anemia

     – Iron deficiency anemia or microcytic anemia (caused by heavy bleeding, lack of iron in diet or decreased absorption, internal bleeding, pregnancy). Other signs and symptoms

       – B12/Folate deficiency (macrocyctic anemia)

       – Pernicious anemia

  • Congestive heart failure

  • Chronic fatigue syndrome (CSF)Other names of this condition include:

    – Chronic (Post) Viral Fatigue Syndrome

    – Chronic Fatigue Immune Dysfunction Syndrome (CFIDS)

    – Chronic Epstein-Barr Virus Infection (CEBV)

    – Chronic Mononucleosis Syndrome

    – Epidemic Neuromyasthenia

    – Benign Myalgic Encephalomyelitis (U.K.)

    – Icelandic Disease; Akureyri Disease

    *Note other overlapping conditions associated with CSF

           -Fibromyalgia

           – Chronic Candidiasis; Intestinal Dysbiosis

           – Adrenal Fatigue/Exhaustion

           – Reactive Hypoglycemia; Metabolic Syndrome

           – Hypothyroidism

           – Wilson’s Temperature/T3 Syndrome

           – Multiple Environmental Sensitivities

  • Chronic liver disease/cirrhosis.

  • COPD

  • Chronic renal failure

  • Connective tissue diseases: RA, SLE

Endocrine

  • – *Adrenal insufficiency – I see this a lot in practice and confirmed with a four point cortisol salivary test

  • – Diabetes mellitus

  • – Electrolyte disorders

  • – Hyperthyroidism

  • – Hypoglycemia

  • – Hypothyroidism

  • – Obesity

  • – Starvation or dieting

Infection

  • Brucellosis

  • Endocarditis

  • EBV, CMV

  • Hepatitis

  • Hiv

  • Mononucleosis

  • Osteomyelitis

  • Pharyngitis

  • Toxoplasmosis

  • Tuberculosis

  • UTI

  • Viral illness

  • Chronic liver disease/cirrhosis. 

  • COPD

  • Chronic renal failure

  • Connective tissue diseases: RA, SLE

Endocrine

  • – *Adrenal insufficiency – I see this a lot in practice and confirmed with a four point cortisol salivary test

  • – Diabetes mellitus

  • – Electrolyte disorders

  • – Hyperthyroidism

  • – Hypoglycemia

  • – Hypothyroidism

  • – Obesity

  • – Starvation or dieting

Psychosocial conditions

– Adjustment reaction

– Anxiety disorders

– Depression

– Occupational stress

– Situation life stresses

Heavy Metal Toxicity – each of these present with a number of other symptoms beyond fatigue 

– Mercury                

– Arsenic

– Lead

Going through all of these possible diagnosis’s, I would say based on the little information I have from your case, is that you have Chronic Fatigue Syndrome. CFS other more common symptoms include:

  • – GI: IBS, nausea, bloating, diarrhea, etc.

  • – Emotions: depression, anxiety, mood swings, irritability, panic attacks

  • – Chills, night sweats, fevers

  • –  Recurrent or chronic infections: respiratory, urinary tract, vaginitis.  

  • – Visual disturbances: blurring, light sensitivity, dry eyes, changes in vision

The pathophysiology of CFS can include:

  • – Intestinal dysbiosis (bacterial, fungal): increased gut permeability, microbial toxin absorption

  • – Exhausted/ill/traumatized individuals force themselves to work harder to keep up with responsibilities

  • – Endocrine dysfunction: blunted hypothalamic-pit-adrenal axis function (severe “adrenal exhaustion”); sex hormone and possible thyroid dysregulation

  • – Reactive hypoglycemia; Metabolic Syndrome

  • – Chronic immune activation; decreased ability to respond to infections; multiple environmental sensitivities; up-regulation of genes regulating immune function; may be genetic predisposition

  • – Decreased mitochondrial function

  • – Altered neurotransmitter activity (eg decreased serum and increased tissue levels of serotonin) à note: having depression means there is low production of serotonin

  • – Accumulation of cellular and tissue toxins

  • – Chronic low level inflammation

Testing to consider

  • – Screening: CBC, ESR, Chemistry Screen

  • – Autoantibodies

  • – Post-infection onset and/or ongoing fever, sore throat, enlarged nodes, etc: consider antibody titers against EBV, CMV, viral hepatitis, Toxoplasmosis, etc.

  • – Special blood tests for infectious diseases based on history, geography, presentation: Lyme Disease, Brucellosis, Tularemia, Syphilis,

  • – Thyroid

  • – Adrenal hormones

  • – Sex hormones

  • – GI Tests: candida (culture, antibodies), bacterial cultures, protozoan

The biggest hurdle then is to discover why  you have chronic fatigue as there are many possibilities. But know that there is an answer

Hope this helps you in your journey and may you find the right people to help you with the most appropriate treatment.

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