Characteristics Of The Selected Articles
Sixteen of the 21 articles were published in the past 5 years. More than half were cross-sectional studies,,,,,,,,,,,,,,,,, while two were longitudinal prospective cohort studies,. Two articles used both cross-sectional and longitudinal study designs,,,. There was one within-subject experimental study design and three randomized placebo-controlled trials,,,.
Across the 21 studies, 9 were conducted in Europe,,,,,,,,,, and 10 were conducted in the United States,,,,,,,,,. One study took place in Australia, and another study was a multi-continental venture involving 12 different countries. Out of the 9175 participants enrolled across these studies , 45.7% of the participants enrolled were male. One study analyzed medical records from a veteran database that enlisted close to a million veterans in the United States, 91% of whom were male. Three studies enrolled in-patient participants,,, and seven studies enrolled outpatient populations,,,,,,. The rest enrolled healthy or primary care patients.
Two studies collected data via online assessments,, and four studies either retrospectively analyzed data or utilized previously collected datasets,,,. Two studies utilized healthy controls,, and six studies used the control groups or placebo groups for comparison,,,,,.
Dont Ignore The Signs Of Mental Fatigue
Its easy to overlook mental fatigue symptoms when they become a common daily occurrence.
Thats why its important to check in with yourself once in a while and see how youre doing physically, emotionally, and mentally. Mental exhaustion is a condition that can be managed and overcome by making healthy changes in your life. These include prioritizing self-care or fixing your sleep schedule.
If you dont want to do it alone, BetterUp can help. Our coaches will create a personalized plan thats proven to increase your mental well-being and resilience.
Treating Depression And Fatigue
Therapy or counseling can help treat depression. It can also be treated with certain medications. These include antidepressants, antipsychotics, and mood stabilizers.
Taking antidepressants can sometimes make symptoms of chronic fatigue syndrome worse. Thats why your doctor should screen you for depression and chronic fatigue syndrome before prescribing any medication.
Several treatments can help people with chronic fatigue syndrome, depression, or both. These include:
People with depression and chronic fatigue syndrome should also try to develop good sleeping habits. Taking the following steps can help you sleep longer and more deeply:
- go to bed at the same time every night
- create an environment that promotes sleep
- avoid taking long naps
- avoid foods and drinks that can prevent you from sleeping well
- avoid exercising at least 4 hours before bedtime
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Depression Affects Neurotransmitters That Regulate Sleep
Depression is a complex condition that can develop for many reasons. One known contributing factor to depression is an imbalance of certain neurotransmitters. Neurotransmitters are chemicals that allow nerve cells to communicate with each other and help regulate numerous functions in the body, including sleep.
Dopamine and serotonin are two neurotransmitters that regulate the bodys sleep/wake cycle and are affected by depression. Dopamine is responsible for feelings of wakefulness and serotonin induces sleep. Low serotonin levels in the brain are linked to less restful sleep.
Imbalances in these hormones may explain why some people with depression tend to sleep too much , while others have trouble sleeping.
Immune Response And Depression And Fatigue
Previous meta-analyses have shown an increase in proinflammatory cytokines, such as TNF and IL-6 , in people suffering from depression . In a more recent, larger scale meta-analysis a greater range of changes have been described in people with depression, including higher levels of TNF, IL-6, IL-13, IL-18, IL-12, IL-1RA, and sTNFR2, along with a decrease in the proinflammatory cytokine IFN . A wide variety of chemokine levels have also been demonstrated to be significantly affected, including increased CCL2 , CXCL4, and CXCL7, with CCL4 having significantly lower levels in serum . Studies found increased levels of serum IL-1RA, IL-6, TNF, and IP-10 in cancer patients with fatigue . There is also evidence that these changes may be predictive of future depression. A longitudinal study showed that people with higher IL-6 at age nine are more likely to have depression at age 18 in a dose dependent manner, even adjusting for a variety of factors . Gimeno et al. conducted a study in adults that showed similar results, with CRP and IL-6 levels at baseline predicting cognitive symptoms of depression 12 years later.
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Immunomodulatory Effects Of Antidepressant And Anti
Changes in the levels of immune markers have also been associated with the response to antidepressant therapies and found helpful in predicting treatment efficacy . In mice treated with LPS, serotonin reuptake inhibitor and serotoninnorepinephrine reuptake inhibitor administration lead to decreased serum levels of TNF and increased levels of IL-10 . In the repeated social stress model, treatment with tricyclic antidepressant decreased microglial expression of IL-6 mRNA both in vivo and following ex vivo stimulation, where TNF and IL-1 mRNA levels were also reduced . In vitro studies using animal macrophages have also confirmed similar immunosuppressive effects where the decrease in IL-6 and increase in IL-10 that follows treatment with amitriptyline, fluoxetine, and mianserin, suggests that such effects may be mediated by an inhibition of the nuclear factor kappa-light-chain-enhancer of activated B cells pathway . On the other hand, Munzer et al. found that treatment in vitro of whole blood cultures with SSRIs and mirtazapine, a tetracyclic antidepressant , had the opposite effect on the stimulated production of cytokines, with an increase in inflammatory markers including IL-1, IL-6, and TNF.
Table 1. Efficacy prediction and immunomodulatory effect of therapies.
How To Cope With Depression Fatigue
- Exercise: Exercise may seem like a counterintuitive answer to sleeping well, but one analysis of various studies found that doing over 20 minutes of low to moderate-intensity exercise can increase energy and reduce fatigue.
- Establish a sleep routine: A routine can help train your body for bedtime. For example, stick to a schedule and have a special bedtime ritual that can help you relax before trying to sleep.
- Consider TMS: If youre currently taking antidepressants and have noticed a decline in sleep quality, talk to your doctor about trying an alternative depression treatment, like transcranial magnetic stimulation . TMS is a non-medication depression treatment that may actually improve sleep.
Insomnia and fatigue can be destructive to your daily life and your health. If youve been diagnosed with depression and are struggling with fatigue, talk to your doctor. If youre currently taking antidepressants and are interested in learning about alternative depression treatments, like TMS and how it can help patients with depression, visit our website.
Resources:
1. Ghanean H, Ceniti AK, and Kennedy SH. Fatigue in Patients With Major Depressive Disorder: Prevalence, Burden and Pharmacological Approaches to Management. CNS Drugs. 2018 32:65-74. https://pubmed.ncbi.nlm.nih.gov/29383573/. Accessed July 09, 2020.
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How To Tell If You Are Depressed Or Just Tired
With both depression and fatigue, symptoms include low energy, low motivation, and anhedonia, or a loss of interest in pleasurable activities, Dimitriu says.
One distinguishing factor can be the desire to engage in activities people who have fatigue wish to do things, but lack energy, whereas people with depression have lower interest in activities, he says.
“Another important consideration is the duration of the low mood and if it improves with sleep,” Dimitriu says. A single good night’s sleep can improve a tired person’s mood, he notes.
But depression-related fatigue permeates every facet of a person’s life, says Ricke. The effect is felt:
- Physically: Everyday tasks eating, showering, getting dressed, and so on may become difficult. “The body can feel heavy, slow, and stiff due to depression,” Ricke says.
- Cognitively: Due to depression, you may experience “difficulty sustaining focus, concentrating, and processing information,” Ricke says. Of course, lack of sleep can have a similar cognitive impact, making it challenging to concentrate.
- Emotionally: Here is where the effects may be most profound. “Fatigue makes it more difficult to weed through the already confusing thoughts and feelings that are part of depression,” Ricke says. Forming emotional connections with friends, family, and the people around you may be more challenging when you’re fatigued, she says. And that, in turn, “can perpetuate feelings of aloneness and hopelessness,” Ricke says.
Prioritize Getting Good Sleep
Since depression may be causing you to have disordered sleeping habits, it can be helpful to develop better sleep habits.
Sleep hygiene pretty much just means good sleeping habits. Here are some ways of implementing sleep hygiene:
- Be consistent with sleep and wake times. Try going to bed at roughly the same time each night and getting up at the same time each morning. This way, your body becomes accustomed to a certain routine that optimizes healthy sleeping.
- Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature. You can experiment with different room temperatures or try out a white noise machine. With patience, you might discover the best room environment to promote sleep.
- Remove TVs, computers, and smartphones from the bedroom. This may seem like an impossible task sometimes, but avoiding harsh blue light will help you fall asleep faster.
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What Is On The Horizon For The Treatment Of Residual Fatigue
Dr. Fava: Ongoing studies are currently evaluating some antidepressant medications that, in theory, may be much less likely to cause fatigue as a side effect, such as the triple uptake inhibitors and SNRIs with more prominent noradrenergic effects, as well as adjunctive treatments to minimize residual fatigue, such as norepinephrine reuptake inhibitors .
It is important to note that residual fatigue is not limited to patients with depression and that many drugs we use to treat other mental and medical conditions can induce fatigue well. For instance, we often see fatigue affect patients with schizophrenia that further compounds the apathy and negative symptoms that are core to that illness. Many of the medications we use for neurological conditions can cause symptoms of fatigue as well and that also exacerbates the existing condition for these patients. So, I would say that the topic of fatigue extends beyond depression and will become an important focus of assessment, treatment, and drug development in the next few years.
Why Depression Makes You Tired And How To Deal With Fatigue
- Fatigue is one of the most common symptoms of depression.
- If you are depressed, it’s likely that you will lack energy and feel tired physically, emotionally, and cognitively.
- Depression can also make sleep less restful and restorative here’s how to get better sleep and feel less tired.
- This article was medically reviewed by David A. Merrill, MD, PhD, psychiatrist and director of the Pacific Brain Health Center at Pacific Neuroscience Institute at Providence Saint John’s Health Center.
- This story is part of Insider’s guide to Depression.
For people with depression, feeling tired is an all-too-common symptom. “Tiredness or fatigue is one of the hallmarks of depression,” says Amy Ricke, MD, of Your Doctors Online.
With depression, energy levels dip, and many of the symptoms, such as profound sadness and loneliness, can further exacerbate fatigue. Here’s why depression makes you tired, how to tell if it’s the cause of your fatigue, and how you can feel more refreshed and well-rested.
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Keep Time With Your Body Clock
Some people get a burst of energy first thing in the morning. They’re often called morning larks. Night owls are people who are at their best at the end of the day.
These individual differences in daily energy patterns are determined by brain structure and genetics, so they can be tough to change. Instead, become aware of your own circadian rhythms. Then schedule demanding activities when your energy levels are typically at their peak.
How To Treat Mental Fatigue
In today’s modern world, it’s common for the average person to be busy for most of their waking hours. In addition to a forty-hour workweek, there’s also commuting, shopping, taking care of household chores, and making time for friends and family. This often means individuals forget to take care of themselves and taking breaks may be left by the wayside. But failing to take care of oneself can lead to mental fatigue, which occurs when individuals go through periods of prolonged cognitive activity without giving their brain a rest. This can cause individuals to feel mentally and emotionally drained, not to mention overwhelmed. The typical symptoms of mental fatigue include stress eating, loss of appetite, insomnia, lack of motivation, and a feeling of being mentally blocked.
Get familiar with how to treat mental fatigue now.
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How Do You Assess The Symptoms Of Fatigue In Mdd
Dr. Fava: First, I want to confirm that the patient actually has a diagnosis of MDD. There may be some patients who complain of many symptoms of fatigue but do not have MDD, or there may be some patients with comorbid illnesses that include some depressive symptoms and fatigue, but are not truly MDD. Second, it is really important to differentiate between symptoms of fatigue that have been caused by the drugs we are using to treat the MDD in contrast to symptoms that are present as residual symptoms of MDD.
I begin my assessment by obtaining a careful, detailed history of all of the symptoms that existed prior to the initiation of treatment, followed by identifying any symptoms that have persisted despite treatment, and then I ask about any new symptoms that have emerged during treatment. Treatment-emergent symptoms may or may not be caused by the medications we are using, but it is important to differentiate whether these symptom are new or were preexisting to the treatment. Obviously, it is also important to explore whether the residual symptoms are more or less severe than they were before treatment commenced.
patients with residual fatigue are more likely to get depressed again despite continued prophylactic treatment. There is a much greater likelihood that patients with MDD who have residual symptoms like fatigue will also have work, school, and/or social difficulties.
A Challenging Life Event
An event that completely turns your life upside down can put a great deal of strain on your mental health.
Oftentimes, people experience different types of grief as a result. Normal or uncomplicated grief causes short-term mental fatigue. Complicated grief, like the death of a loved one or a divorce, can bring on mental fatigue that impacts your mental health over a long period.
Other factors contributing to mental fatigue include poor nutrition, lack of sleep, or clutter. Once you identify the causes, start by taking steps to alleviate your symptoms.
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Depression Acts On Neurotransmitters To Make You Tired
Depression is likely associated with changes in brain neurotransmitters, such as dopamine, norepinephrine, and serotonin. “These neurotransmitters play important roles in regulating energy levels, sleep, appetite, motivation, and pleasure,” Ricke says.
According to Harvard Health Publishing, depression is a complex disease with many possible and interlinked causes, including genetics, medical conditions, stressful life events, and brain chemistry. And it can be challenging to tell the difference between everyday tiredness and depression-related fatigue.
“Fatigue and depression can look quite similar,” says Alex Dimitriu, MD, psychiatrist and sleep medicine expert, and founder of Menlo Park Psychiatry & Sleep Medicine.
Pain Depression And Dryness
Fatigue symptoms are important to patients with pSS and there is an association between fatigue and other symptoms such as pain and depression. Howard Tripp et al identified pain and depression scores, in association with the pro-inflammatory cytokines inducible protein 10 and interferon gamma, as the two symptoms best predicting fatigue groups.
Pain is associated with both mental and physical fatigue. The origin of pain in pSS is unclear, although research points towards neuropathic pain being the most common type of pain in pSS, followed by nociceptive pain. The relationship between pain and fatigue is reported in other conditions including rheumatoid arthritis , systemic lupus erythematosus and ankylosing spondylitis . Previous research using anti-tumour necrosis factor inhibitors in RA suggests that the reductions in reported fatigue were attributable to a reduction in pain, rather than direct effects on fatigue itself and pain may be a mediator of fatigue. Pain can be modified through medications which have an association with drowsiness such as amitriptyline and gabapentin. This contribution gives a possible explanation as to why drowsy medications do not have a major role in predicting mental fatigue.
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Some Antidepressants Can Cause Fatigue
Some antidepressants, including SSRIs and SNRIs, are considered stimulating antidepressants and can disturb sleep and cause fatigue. Your doctor may instruct you to take your medication in the morning to avoid any problems getting a good nights sleep.
Not all antidepressants affect sleep quality. If youre currently taking an antidepressant and are having trouble sleeping, talk to your doctor. They may lower your dosage, add a low-dose sedating antidepressant that may help you sleep, suggest that you try a different antidepressant, or recommend an alternative depression treatment.
Resource Of Mental Health Information And Treatment Options
The Treatment Specialist provides in depth information, statistics, and clinical study results about a wide range of mental health and behavioral health disorders. When wondering can depression cause severe fatigue, it implies that you or a loved one may be struggling with this serious mental health condition. The Treatment Specialist offers information about depression and the various treatment options available. For any questions about depression, please reach out to The Treatment Specialist today at 644-7911.
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How To Treat Chronic Fatigue Syndrome
This article was co-authored by Chris M. Matsko, MD. Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017. This article has been viewed 60,219 times.
Chronic Fatigue Syndrome, or CFS, is a debilitating condition which leaves the afflicted individual with an ongoing feeling of exhaustion. Persons with CFS may be unable to perform even mundane activities which under normal circumstances present no problem. There is no cure for CFS, and there are no medications developed specifically for the condition. Fortunately, there are a number of treatment options available which can alleviate the symptoms associated with CFS.
