Unexplained Fatigue: Insights from Psychiatry

Q: Unexplained Fatigue: Insights from Psychiatry

Hello： Based on your description, it is possible that you are experiencing symptoms of autonomic nervous system dysregulation, with excessive activation of the parasympathetic nervous system during the day leading to fatigue and lack of energy. <br>I would recommend making the fo

Unable to identify the cause of fatigue?

Due to feelings of low mood and stress, I had seen a psychiatrist for several years in the past.
For the past seven to eight years, I have been experiencing fatigue issues.
When severe, I suffer from hypersomnia and weakness, feeling so fatigued that even minor movements can lead to exhaustion or palpitations.
In the most severe cases, I can sleep almost all day, feeling heavy-headed and groggy.
The symptoms tend to fluctuate, but occasionally, I might suddenly feel awake and normal, with good energy.
However, I have not seen a psychiatrist for the past four years, and I do not have any significant emotional issues; my life is normal.
Yet, the fatigue persists and fluctuates, and the severity of the symptoms seems unrelated to my emotions and stress levels.
Mild symptoms include slight fatigue and a tight, uncomfortable feeling in my head.
Over the past few years, I have consulted various specialists and undergone numerous tests, but no issues have been identified.
I was even referred to traditional Chinese medicine.
Due to the lack of findings, I have been suspected of having emotional problems, but in the past two years, my work stress has been low, and I have been eating well, sleeping well, and enjoying life, with very few working hours.
Therefore, I cannot see any correlation between my physical condition and my emotions.
Recently, I visited a neurologist for further evaluation, undergoing EEG, hormone tests, and other basic examinations, all of which returned normal results.
The doctor repeatedly inquired about any low mood issues, which is quite frustrating because I am certain I do not have any emotional problems, and my social interactions are completely normal.
Currently, the doctor diagnosed my head discomfort as tension-type headaches.
The main issues with fatigue and head discomfort are that they affect my concentration and short-term memory.
The doctor has prescribed me antiarrhythmic medication and acetaminophen.
Essentially, the doctor has no other solutions and can only inform me that the head discomfort is benign headache, as all tests have shown no problems.
I have a habit of exercising and occasionally playing badminton, and the doctor suggested that aerobic exercise would be beneficial.
I would like to ask if there are any recommendations from a psychiatric perspective regarding my situation?

boo, 30~39 year old female. Ask Date: 2022/04/16

Dr. Wang Yaoting reply Psychiatry

Hello: Based on your description, it is possible that you are experiencing symptoms of autonomic nervous system dysregulation, with excessive activation of the parasympathetic nervous system during the day leading to fatigue and lack of energy.
I would recommend making the following adjustments:
1.
Maintain a regular schedule, ensure adequate sleep, and engage in moderate exercise: Sleep helps stabilize mood, so aim for at least 7 hours of sleep each night.
Incorporate regular exercise into your weekly routine to promote sweating.
Try the 333 exercise method, which involves exercising at least 3 times a week for a minimum of 30 minutes each session, ensuring your heart rate reaches at least 130 beats per minute after each workout.
Activities can include moderate aerobic exercises such as jogging, brisk walking, cycling, swimming, playing sports, or dancing.
2.
Develop effective stress-relief techniques: Regularly talk with close friends, listen to music, sing, or get a massage.
Combine these activities with diaphragmatic breathing—slowly inhale through your nose and exhale through your mouth.
Aim to do this 20 times in the morning, afternoon, evening, and before bed, totaling at least 80 times a day.
3.
Keep a daily mood journal before bedtime to reflect on and organize your emotions from the day, which can help alleviate tension and stress.
4.
Maintain a balanced diet with regular meals and limit the intake of stimulating foods.

If you have implemented these suggestions and still do not see improvement, consider visiting a psychiatrist.
Certain serotonin medications may help alleviate these symptoms.
I hope this answers your question :)

Reply Date: 2022/04/16

More Info

Your situation reflects a complex interplay between physical and psychological factors that can contribute to unexplained fatigue. It’s important to recognize that fatigue can stem from a variety of sources, including medical, psychological, and lifestyle factors. Given your history of psychiatric treatment and the ongoing fatigue despite normal medical evaluations, it’s essential to explore this further from a psychiatric perspective.

Understanding Unexplained Fatigue
Unexplained fatigue, particularly when it is chronic and not linked to identifiable medical conditions, can often be associated with psychological issues such as anxiety, depression, or stress-related disorders. Even if you feel emotionally stable now, past experiences of stress or trauma can have lingering effects on your body and mind. The brain and body are interconnected, and psychological stress can manifest physically, leading to symptoms such as fatigue, sleep disturbances, and cognitive difficulties.

Potential Psychiatric Considerations
1. Chronic Fatigue Syndrome (CFS): This condition is characterized by extreme fatigue that doesn’t improve with rest and is often worsened by physical or mental activity. While it’s not fully understood, it may involve immune system dysfunction, hormonal imbalances, or psychological factors.

2. Somatic Symptom Disorder: This is a condition where a person experiences physical symptoms that are distressing and may not have a clear medical explanation. The symptoms can be exacerbated by psychological factors, including stress and anxiety.

3. Adjustment Disorders: If you have experienced significant stressors in your life, even if they are not currently affecting you, your body may still be reacting to those past stressors. Adjustment disorders can manifest as fatigue and other physical symptoms.

4. Sleep Disorders: Even if you feel you are sleeping well, the quality of sleep matters. Conditions like sleep apnea or restless leg syndrome can lead to non-restorative sleep, resulting in daytime fatigue.

Recommendations
1. Psychiatric Evaluation: Since you have not seen a psychiatrist in four years, it may be beneficial to schedule an evaluation. A psychiatrist can help assess whether there are underlying psychological factors contributing to your fatigue.

2. Cognitive Behavioral Therapy (CBT): This form of therapy can be effective in addressing the cognitive patterns that may contribute to your fatigue. It can help you develop coping strategies and improve your overall mental health.

3. Mindfulness and Relaxation Techniques: Practices such as mindfulness meditation, yoga, or progressive muscle relaxation can help reduce stress and improve your overall sense of well-being.

4. Regular Physical Activity: You mentioned that you engage in fitness activities. Continuing with regular aerobic exercise can improve energy levels and reduce fatigue. It’s essential to find a balance that works for you without overexerting yourself.

5. Sleep Hygiene: Ensure you maintain good sleep hygiene practices. This includes having a regular sleep schedule, creating a restful environment, and avoiding stimulants before bedtime.

6. Nutritional Assessment: Sometimes, fatigue can be linked to dietary deficiencies. A consultation with a nutritionist may help identify any gaps in your diet that could be contributing to your fatigue.

7. Follow-Up with Neurology: Since you have seen a neurologist, it’s crucial to maintain communication with them regarding any changes in your symptoms. If your current treatment isn’t effective, discussing alternative medications or therapies may be necessary.

Conclusion
Your experience of unexplained fatigue is valid and deserves attention. While it may seem disconnected from emotional issues, the mind-body connection is powerful, and psychological factors can significantly impact physical health. Engaging with a mental health professional can provide you with the support and strategies needed to address your fatigue holistically. Remember, recovery is often a gradual process, and seeking help is a crucial step in understanding and managing your symptoms effectively.

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