While recently writing about adrenal fatigue, depression, and anxiety, I’ve been doing a lot of reading on chronic fatigue syndrome, fibromyalgia (also known as myalgic encephalomyelitis), and hormonal imbalances that are also commonly associated with severe fatigue, chronic pain, and insomnia that last months or years. Patients with symptoms associated with these conditions usually have a very difficult time figuring out what is going on with their bodies. Partly this is due to the confusing array of symptoms. Partly it is because their doctors often have little understanding of many of the conditions that can cause chronic fatigue symptoms. But possibly the biggest single reason is that there are literally dozens of possible culprits that can all create very similar sets of chronic symptoms. Trying to weed out the strong possible causes can require months or years of testing, observations, and trials of various drugs and supplements. It’s overwhelming enough in both time and financial impact that it compounds these patients’ exhaustion and dismal feelings.
I ran across this primary care diagnostic manual written by a multitude of doctors affiliated with Harvard Medical School  that includes a chapter 8 entitled “Evaluation of Chronic Fatigue”. It’s from the 4th Edition (August 2000) of a classic medical text book called Primary Care Medicine: Office Evaluation and Management of the Adult Patient (Primary Care Medicine ( Goroll )) . The latest version of the text, the 6th edition, was published in August 2009 so it contains many updates from this decade-old version plus instructions on how to access even more current content online. The book is highly regarded by many family medicine and general practitioners.
Chapter 8 is worth reading for anybody trying to cope with months or years of symptoms indicative of low energy, fatigue, depression, weakness, pain, and anxiety. Many such people have tried getting help from their MD GP or psychiatrist but have had little success because they instantly gravitate to whatever the latest and greatest blockbuster drug they’ve been told about by their friendly big pharma rep or advised to try first by their HMO and insurance industry provided prescription drug guides.
Many find that these typical doctors dole out a string of antidepressants and sleep drugs that help them little or even make matters worse and then finally give up and act like the problems are all in the patient’s head and advise them to see a psychologist when in fact they have not even scratched the surface considering the physiological explanations for the symptoms. I’d strongly encourage these people to read chapter 8 of this diagnostic manual to get a sense of the wide range of conditions that could be contributing to their symptoms. It’s by no means a comprehensive discussion of every possible culprit, but is a good introduction to the challenge of trying to pin a diagnosis on chronic fatigue symptoms.
The list of possible explanations the write-up outlines includes a host of explanations, some of which are really more symptom sets and others which are more helpful as they point to tests and treatments that can be tried. Here’s a partial list of possible explanations the writers cover for chronic fatigue symptoms that may give you an idea as to why it is often difficult to pin down the root causes for these symptoms.
- Side-effects from antidepressants
- Side-effects from anxiolytics (anti-anxiety medications)
- Side-effects from antihypertensives (high blood pressure medicines)
- Endocrine distubances
- Adrenal gland malfunctions such as Addison’s disease and adrenal insufficiency
- Diabetes mellitus
- Metabolic disturbances
- Hepatic (liver) dysfunction
- Renal (kidney) dysfunction
- Certain cancers (particularly pancreatic carcinoma)
- Cardiopulmonary diseases including congestive heart failure and chronic lung diseases
- Sleep apnea
- Chronic infections such as Lyme disease, HIV, mononucleosis, viral hepatitis, cytomegalovirus, and candida
- Recent dental work causing blood-borne bacterial infections
- Rheumatoid arthritis
One major explanation for chronic fatigue that I find to be sorely lacking in this old version of the text is mitochrondrial dysfunction. Research in the last ten years has pointed out that many chronic fatigue conditions and neurodegenerative diseases such as Parkinson’s and Alzheimer’s are probably caused in part by poorly functioning mitochondria that leave the body with inadequate energy supplies for proper operations. Please see my article Low Cortisol, Low CoQ10, and Mitochondrial Dysfunction Often Found in Adrenal Fatigue, Chronic Fatigue Syndrome, Fibromyalgia, and Myalgic Encephalomyelitis Patients  for more information on the involvement of mitochondrial dysfunction in chronic fatigue and chronic pain conditions.
If you’d like to take charge of health care for you and your family rather than just relying on whatever your GP says, books such as this primary care manual could give you a leg up on working with your medical care providers. They are probably familiar with such texts and if you point out something in them as a possible explanation, they may be more willing to consider what you have to say. While the medical jargon may be too difficult for some, in this era of Wikipedia and the internet, it is relatively easy to look up terms that you don’t understand to attain a good understanding of general purpose medical texts like this one. At the very least, they can help you understand many common medical conditions better as well as to narrow down your focus to a smaller number of promising targets for investigation when the symptoms could be from a wide variety of causes.
Finally, while you are trying to figure out the cause of your fatigue and suspect you need some help to let you sleep better, please read about the supplement L-Theanine derived from tea. It is inexpensive and has been found to work similarly to many common anti-anxiety and sleep medications but without the risk of their common side effects and potential for addiction. If your fatigue and anxiety are mild and/or short-term, L-Theanine used for anxiety and insomnia  may be enough to help you cope.
For severe and long-duration symptoms, you will need to do some reading and testing to determine the cause of your condition. Please do not simply depend upon your doctor to blindly “solve” your problem by doling out psychiatric medications without doing any testing if your condition lasts months or years.
A common culprit for long-term fatigue in people who have been subjected to intense psychological stress from job loss, divorce, child custody, and other trials and tragedies is cortisol imbalances caused by adrenal gland overproduction or underproduction of necessary hormones. Please read my article Cortisol Imbalances May Cause Weight Gain, Depression, Anxiety, and Insomnia  for more information that may help you determine if that is the case for you.
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