Fatigue

==Treatment and Management==

Management may include review of existing medications, and other factors and methods explained below.

===Review of existing medications===
Medications may be evaluated for side effects that contribute to fatigue<ref>{{cite journal | vauthors = Siniscalchi A, Gallelli L, Russo E, De Sarro G | title = A review on antiepileptic drugs-dependent fatigue: pathophysiological mechanisms and incidence | journal = European Journal of Pharmacology | volume = 718 | issue = 1–3 | pages = 10–16 | date = October 2013 | pmid = 24051268 | doi = 10.1016/j.ejphar.2013.09.013 }}</ref>
<ref name="Mayo-Clinic-Fatigue-Causes-2023"/><ref>{{Cite web|url=https://www.health.harvard.edu/drugs-and-medications/what-to-do-when-medication-makes-you-sleepy|title=What to do when medication makes you sleepy|date=8 March 2016|access-date=9 November 2021|archive-date=9 November 2021|archive-url=https://web.archive.org/web/20211109140913/https://www.health.harvard.edu/drugs-and-medications/what-to-do-when-medication-makes-you-sleepy|url-status=live}}</ref>{{better source needed|date=November 2021}} and the interactions of medications are complex.{{primary source inline|date=November 2021}}<ref>{{cite journal | vauthors = Phansalkar S, van der Sijs H, Tucker AD, Desai AA, Bell DS, Teich JM, Middleton B, Bates DW | display-authors = 6 | title = Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records | journal = Journal of the American Medical Informatics Association | volume = 20 | issue = 3 | pages = 489–493 | date = May 2013 | pmid = 23011124 | pmc = 3628052 | doi = 10.1136/amiajnl-2012-001089 }}</ref>

===Medications to treat fatigue===
The UK [[National Institute for Health and Care Excellence|NICE]] recommends consideration of amantadine, modafinil and SSRIs for MS fatigue.<ref>{{Cite web|url=https://www.nice.org.uk/guidance/ng220/chapter/Recommendations#ms-symptom-management-and-rehabilitation|title=Recommendations &#124; Multiple sclerosis in adults: management &#124; Guidance &#124; NICE|date=June 22, 2022|website=www.nice.org.uk|access-date=January 7, 2023|archive-date=January 7, 2023|archive-url=https://web.archive.org/web/20230107085547/https://www.nice.org.uk/guidance/ng220/chapter/Recommendations#ms-symptom-management-and-rehabilitation|url-status=live}}</ref> [[Psychostimulant]]s such as [[methylphenidate]], [[amphetamine-type stimulant|amphetamine]]s, and [[modafinil]] have been used in the treatment of fatigue related to [[depression (mood)|depression]],<ref name="pmid18425966">{{cite journal |vauthors=Candy M, Jones L, Williams R, Tookman A, King M |title=Psychostimulants for depression |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD006722 |date=April 2008 |pmid=18425966 |doi=10.1002/14651858.CD006722.pub2 |url= }}</ref><ref name="pmid19281939">{{cite journal |vauthors=Hardy SE |title=Methylphenidate for the treatment of depressive symptoms, including fatigue and apathy, in medically ill older adults and terminally ill adults |journal=Am J Geriatr Pharmacother |volume=7 |issue=1 |pages=34–59 |date=February 2009 |pmid=19281939 |pmc=2738590 |doi=10.1016/j.amjopharm.2009.02.006 |url= }}</ref><ref name="pmid26906078">{{cite journal |vauthors=Malhi GS, Byrow Y, Bassett D, Boyce P, Hopwood M, Lyndon W, Mulder R, Porter R, Singh A, Murray G |title=Stimulants for depression: On the up and up? |journal=Aust N Z J Psychiatry |volume=50 |issue=3 |pages=203–207 |date=March 2016 |pmid=26906078 |doi=10.1177/0004867416634208 |s2cid=45341424 |url= }}</ref><ref name="pmid34144366">{{cite journal |vauthors=Bahji A, Mesbah-Oskui L |title=Comparative efficacy and safety of stimulant-type medications for depression: A systematic review and network meta-analysis |journal=J Affect Disord |volume=292 |issue= |pages=416–423 |date=September 2021 |pmid=34144366 |doi=10.1016/j.jad.2021.05.119 |url= }}</ref> and [[medical illness]] such as [[chronic fatigue syndrome]]<ref name="pmid20088743">{{cite journal |vauthors=Van Houdenhove B, Pae CU, Luyten P |title=Chronic fatigue syndrome: is there a role for non-antidepressant pharmacotherapy? |journal=Expert Opin Pharmacother |volume=11 |issue=2 |pages=215–223 |date=February 2010 |pmid=20088743 |doi=10.1517/14656560903487744 |s2cid=34827174 |url= }}</ref><ref name="pmid18505357">{{cite journal |vauthors=Valdizán Usón JR, Idiazábal Alecha MA |title=Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate |journal=Expert Rev Neurother |volume=8 |issue=6 |pages=917–927 |date=June 2008 |pmid=18505357 |doi=10.1586/14737175.8.6.917 |s2cid=37482754 |url= }}</ref> and [[cancer]].<ref name="pmid19281939" /><ref name="pmid8856815">{{cite journal |vauthors=Masand PS, Tesar GE |title=Use of stimulants in the medically ill |journal=Psychiatr Clin North Am |volume=19 |issue=3 |pages=515–547 |date=September 1996 |pmid=8856815 |doi=10.1016/s0193-953x(05)70304-x |url= }}</ref><ref name="pmid20870637">{{cite journal |vauthors=Breitbart W, Alici Y |title=Psychostimulants for cancer-related fatigue |journal=J Natl Compr Canc Netw |volume=8 |issue=8 |pages=933–942 |date=August 2010 |pmid=20870637 |doi=10.6004/jnccn.2010.0068 |url= |doi-access=free}}</ref><ref name="pmid21251796">{{cite journal |vauthors=Minton O, Richardson A, Sharpe M, Hotopf M, Stone PC |title=Psychostimulants for the management of cancer-related fatigue: a systematic review and meta-analysis |journal=J Pain Symptom Manage |volume=41 |issue=4 |pages=761–767 |date=April 2011 |pmid=21251796 |doi=10.1016/j.jpainsymman.2010.06.020 |url= |doi-access=free}}</ref><ref name="pmid24416225">{{cite journal |vauthors=Gong S, Sheng P, Jin H, He H, Qi E, Chen W, Dong Y, Hou L |title=Effect of methylphenidate in patients with cancer-related fatigue: a systematic review and meta-analysis |journal=PLOS ONE |volume=9 |issue=1 |pages=e84391 |date=2014 |pmid=24416225 |pmc=3885551 |doi=10.1371/journal.pone.0084391 |bibcode=2014PLoSO...984391G |url= |doi-access=free}}</ref><ref name="pmid25299141">{{cite journal |vauthors=Yennurajalingam S, Bruera E |title=Review of clinical trials of pharmacologic interventions for cancer-related fatigue: focus on psychostimulants and steroids |journal=Cancer J |volume=20 |issue=5 |pages=319–324 |date=2014 |pmid=25299141 |doi=10.1097/PPO.0000000000000069 |s2cid=29351114 |url= }}</ref><ref name="pmid25814977">{{cite journal |vauthors=Dobryakova E, Genova HM, DeLuca J, Wylie GR |title=The dopamine imbalance hypothesis of fatigue in multiple sclerosis and other neurological disorders |journal=Front Neurol |volume=6 |issue= |page=52 |date=2015 |pmid=25814977 |pmc=4357260 |doi=10.3389/fneur.2015.00052 |url= |doi-access=free}}</ref> They have also been used to counteract fatigue in [[sleep loss]]<ref name="pmid16268386">{{cite journal |vauthors=Bonnet MH, Balkin TJ, Dinges DF, Roehrs T, Rogers NL, Wesensten NJ |title=The use of stimulants to modify performance during sleep loss: a review by the sleep deprivation and Stimulant Task Force of the American Academy of Sleep Medicine |journal=Sleep |volume=28 |issue=9 |pages=1163–1187 |date=September 2005 |pmid=16268386 |doi=10.1093/sleep/28.9.1163 |url= |doi-access=free}}</ref> and in [[aviation]].<ref name="pmid33754977">{{cite journal |vauthors=Ehlert AM, Wilson PB |title=Stimulant Use as a Fatigue Countermeasure in Aviation |journal=Aerosp Med Hum Perform |volume=92 |issue=3 |pages=190–200 |date=March 2021 |pmid=33754977 |doi=10.3357/AMHP.5716.2021 |s2cid=232325161 |url= }}</ref>

===Mental health tools===
[[Cognitive behavioral therapy|CBT]] has been found useful for fatigue.<ref>{{Cite web|url=https://www.nhs.uk/live-well/sleep-and-tiredness/self-help-tips-to-fight-fatigue/|title=Self-help tips to fight tiredness|date=January 27, 2022|website=nhs.uk|access-date=January 31, 2024|archive-date=January 31, 2024|archive-url=https://web.archive.org/web/20240131103430/https://www.nhs.uk/live-well/sleep-and-tiredness/self-help-tips-to-fight-fatigue/|url-status=live}}</ref>

===Improved sleep===
Improving sleep can reduce fatigue.<ref>{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/23090368/|title=Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia|first1=Aline Cristina|last1=Orlandi|first2=Camila|last2=Ventura|first3=Andrea Lopes|last3=Gallinaro|first4=Renata Alqualo|last4=Costa|first5=Laís Verderame|last5=Lage|date=October 11, 2012|journal=Revista Brasileira de Reumatologia|volume=52|issue=5|pages=666–678|via=PubMed|pmid=23090368}}</ref><ref name="auto2">{{Cite web|url=https://www.nhs.uk/live-well/sleep-and-tiredness/self-help-tips-to-fight-fatigue/|title=Self-help tips to fight tiredness|date=January 27, 2022|website=nhs.uk}}</ref>

===Lifestyle changes===
Fatigue may be reduced by reducing obesity, caffeine and alcohol intake,{{fact|date=April 2024}} pain and sleep disturbance, and by improving mental well-being.<ref>{{cite journal |last1=Geenen |first1=Rinie |last2=Dures |first2=Emma |title=A biopsychosocial network model of fatigue in rheumatoid arthritis: a systematic review |journal=Rheumatology |date=November 2019 |volume=58 |issue=Supplement_5 |pages=v10–v21 |doi=10.1093/rheumatology/kez403 |pmid=31682275 |pmc=6827269 }}</ref><ref name="pmid34599320" /> Aerobic exercise may reduce fatigue.<ref>{{cite journal |last1=Strombeck |first1=B. E. |last2=Theander |first2=E. |last3=Jacobsson |first3=L. T. H. |title=Effects of exercise on aerobic capacity and fatigue in women with primary Sjogren's syndrome |journal=Rheumatology |date=31 March 2007 |volume=46 |issue=5 |pages=868–871 |doi=10.1093/rheumatology/kem004 |pmid=17308315 }}</ref> Caffeine is used by many people to manage fatigue, but may have complex effects including later tiredness.<ref>{{Cite web|url=https://www.health.harvard.edu/blog/exercise-versus-caffeine-which-is-your-best-ally-to-fight-fatigue-2017060811843|title=Exercise versus caffeine: Which is your best ally to fight fatigue?|date=June 8, 2017|website=Harvard Health}}</ref><ref name="auto2"/><ref>https://www.nytimes.com/2021/09/07/well/eat/coffee-caffeine-sleep-pressure.html</ref><ref>{{Cite journal|url=https://www.sciencedirect.com/science/article/pii/S0149763416300690|title=A review of caffeine's effects on cognitive, physical and occupational performance|first1=Tom M.|last1=McLellan|first2=John A.|last2=Caldwell|first3=Harris R.|last3=Lieberman|date=December 1, 2016|journal=Neuroscience & Biobehavioral Reviews|volume=71|pages=294–312|via=ScienceDirect|doi=10.1016/j.neubiorev.2016.09.001|pmid=27612937 |doi-access=free}}</ref>

===Avoidance of body heat===
Fatigue in [[Multiple sclerosis|MS]] has been linked to relatively high [[Endogeny|endogenous]] body temperature.<ref>{{Cite web|url=https://www.msaustralia.org.au/symptom/heat-sensitivity/|title=Heat Sensitivity|access-date=2024-03-15|archive-date=2024-01-17|archive-url=https://web.archive.org/web/20240117003926/https://www.msaustralia.org.au/symptom/heat-sensitivity/|url-status=live}}</ref><ref>{{Cite web|url=https://mstrust.org.uk/a-z/temperature-sensitivity|title=Temperature sensitivity &#124; MS Trust|first=M. S.|last=Trust|website=mstrust.org.uk|access-date=2024-03-15|archive-date=2024-01-17|archive-url=https://web.archive.org/web/20240117003924/https://mstrust.org.uk/a-z/temperature-sensitivity|url-status=live}}</ref><ref>{{Cite web|url=https://multiplesclerosisnewstoday.com/multiple-sclerosis-news/2014/08/11/higher-body-temperature-in-rrms-patients-could-cause-increased-fatigue/|title=Higher Body Temperature in RRMS Patients Could Cause Increased Fatigue|first=BioNews|last=Staff|date=August 11, 2014|website=multiplesclerosisnewstoday.com|access-date=March 15, 2024|archive-date=March 15, 2024|archive-url=https://web.archive.org/web/20240315125742/https://multiplesclerosisnewstoday.com/multiple-sclerosis-news/2014/08/11/higher-body-temperature-in-rrms-patients-could-cause-increased-fatigue/|url-status=live}}</ref><ref>{{Cite journal|title=Body temperature is elevated and linked to fatigue in relapsing-remitting multiple sclerosis, even without heat exposure|first1=James F.|last1=Sumowski|first2=Victoria M.|last2=Leavitt|date=July 15, 2014|journal=Archives of Physical Medicine and Rehabilitation|volume=95|issue=7|pages=1298–1302|doi=10.1016/j.apmr.2014.02.004|pmid=24561056|pmc=4071126}}</ref><ref>{{cite journal |last1=Leavitt |first1=V. M. |last2=De Meo |first2=E. |last3=Riccitelli |first3=G. |last4=Rocca |first4=M. A. |last5=Comi |first5=G. |last6=Filippi |first6=M. |last7=Sumowski |first7=J. F. |title=Elevated body temperature is linked to fatigue in an Italian sample of relapsing–remitting multiple sclerosis patients |journal=Journal of Neurology |date=November 2015 |volume=262 |issue=11 |pages=2440–2442 |doi=10.1007/s00415-015-7863-8 |pmid=26223805 }}</ref><ref>{{cite journal | vauthors = Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G, Wenderoth N, Lutterotti A, Müller A, Stephan KE | display-authors = 6 | title = Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 90 | issue = 6 | pages = 642–651 | date = June 2019 | pmid = 30683707 | pmc = 6581095 | doi = 10.1136/jnnp-2018-320050 }}</ref><ref>{{cite journal | vauthors = Ellison PM, Goodall S, Kennedy N, Dawes H, Clark A, Pomeroy V, Duddy M, Baker MR, Saxton JM | display-authors = 6 | title = Neurostructural and Neurophysiological Correlates of Multiple Sclerosis Physical Fatigue: Systematic Review and Meta-Analysis of Cross-Sectional Studies | journal = Neuropsychology Review | volume = 32 | issue = 3 | pages = 506–519 | date = September 2022 | pmid = 33961198 | pmc = 9381450 | doi = 10.1007/s11065-021-09508-1 }}</ref><ref>{{cite journal | pmc=5102292 | date=2016 | title=Central fatigue in multiple sclerosis: A review of the literature | journal=The Journal of Spinal Cord Medicine | volume=39 | issue=4 | pages=386–399 | doi=10.1080/10790268.2016.1168587 | pmid=27146427 | vauthors = Newland P, Starkweather A, Sorenson M }}</ref><ref name="pmid35963205">{{cite journal |last1=Christogianni |first1=Aikaterini |last2=O'Garro |first2=Jasmine |last3=Bibb |first3=Richard |last4=Filtness |first4=Ashleigh |last5=Filingeri |first5=Davide |title=Heat and cold sensitivity in multiple sclerosis: A patient-centred perspective on triggers, symptoms, and thermal resilience practices |journal=Multiple Sclerosis and Related Disorders |date=November 2022 |volume=67 |pages=104075 |doi=10.1016/j.msard.2022.104075 |pmid=35963205 |url=https://eprints.soton.ac.uk/469558/1/2022_MS_survey_heat_cold_MSARD.pdf }}</ref><ref>{{Cite journal|title=Thermoregulation in multiple sclerosis|first1=Scott L.|last1=Davis|first2=Thad E.|last2=Wilson|first3=Andrea T.|last3=White|first4=Elliot M.|last4=Frohman|date=November 15, 2010|journal=Journal of Applied Physiology|volume=109|issue=5|pages=1531–1537|doi=10.1152/japplphysiol.00460.2010|pmid=20671034|pmc=2980380}}</ref><ref>{{cite book |doi=10.1016/B978-0-444-64074-1.00042-2 |chapter=Thermoregulatory dysfunction in multiple sclerosis |title=Thermoregulation: From Basic Neuroscience to Clinical Neurology, Part II |series=Handbook of Clinical Neurology |date=2018 |volume=157 |pages=701–714 |pmid=30459034 |isbn=978-0-444-64074-1 | vauthors = Davis SL, Jay O, Wilson TE }}</ref>

===Qigong and Tai Chi===
[[Qigong]] and [[Tai chi]] have been postulated as helpful to reduce fatigue, but the evidence is of low quality.<ref>{{cite journal |last1=Xiang |first1=Yu |last2=Lu |first2=Liming |last3=Chen |first3=Xiankun |last4=Wen |first4=Zehuai |title=Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials |journal=PLOS ONE |date=5 April 2017 |volume=12 |issue=4 |pages=e0174872 |doi=10.1371/journal.pone.0174872 |doi-access=free |pmid=28380067 |pmc=5381792 |bibcode=2017PLoSO..1274872X }}</ref><ref>{{cite journal |last1=Wang |first1=Rui |last2=Huang |first2=Xueyan |last3=Wu |first3=Yeqi |last4=Sun |first4=Dai |title=Efficacy of Qigong Exercise for Treatment of Fatigue: A Systematic Review and Meta-Analysis |journal=Frontiers in Medicine |date=22 June 2021 |volume=8 |doi=10.3389/fmed.2021.684058 |doi-access=free |pmid=34239889 |pmc=8257957 }}</ref><ref>{{cite book |doi=10.1016/bs.irn.2019.08.002 |chapter=Qigong exercise for chronic fatigue syndrome |title=Exercise on Brain Health |series=International Review of Neurobiology |date=2019 |volume=147 |pages=121–153 |pmid=31607352 |isbn=978-0-12-816967-4 | vauthors = Chan JS, Ng S, Yuen L, Chan CL }}</ref>

===Intermittent fasting===
A small 2022 study found both physical and mental fatigue were significantly reduced after three months of 16:8 [[intermittent fasting]].<ref>{{Cite journal|title=Intermittent Fasting—Short- and Long-Term Quality of Life, Fatigue, and Safety in Healthy Volunteers: A Prospective, Clinical Trial|first1=Katharina|last1=Anic|first2=Mona W.|last2=Schmidt|first3=Larissa|last3=Furtado|first4=Lina|last4=Weidenbach|first5=Marco J.|last5=Battista|first6=Marcus|last6=Schmidt|first7=Roxana|last7=Schwab|first8=Walburgis|last8=Brenner|first9=Christian|last9=Ruckes|first10=Johannes|last10=Lotz|first11=Karl J.|last11=Lackner|first12=Annbalou|last12=Hasenburg|first13=Annette|last13=Hasenburg|date=October 10, 2022|journal=Nutrients|volume=14|issue=19|pages=4216|doi=10.3390/nu14194216|doi-access=free |pmid=36235868|pmc=9571750}}</ref>

===Vagus nerve stimulation===
A small 2023 study showed possible efficacy of [[vagus nerve stimulation]] for fatigue reduction in [[Sjogren's]] patients.<ref name="Tarn Evans Traianos et al 2023">{{cite journal |last1=Tarn |first1=Jessica |last2=Evans |first2=Evelyn |last3=Traianos |first3=Emmanuella |last4=Collins |first4=Alexis |last5=Stylianou |first5=Mryto |last6=Parikh |first6=Jehill |last7=Bai |first7=Yang |last8=Guan |first8=Yu |last9=Frith |first9=James |last10=Lendrem |first10=Dennis |last11=Macrae |first11=Victoria |last12=McKinnon |first12=Iain |last13=Simon |first13=Bruce S. |last14=Blake |first14=Justyna |last15=Baker |first15=Mark R. |last16=Taylor |first16=John Paul |last17=Watson |first17=Stuart |last18=Gallagher |first18=Peter |last19=Blamire |first19=Andrew |last20=Newton |first20=Julia |last21=Ng |first21=Wan-Fai |title=The Effects of Noninvasive Vagus Nerve Stimulation on Fatigue in Participants With Primary Sjögren's Syndrome |journal=Neuromodulation: Technology at the Neural Interface |date=April 2023 |volume=26 |issue=3 |pages=681–689 |doi=10.1016/j.neurom.2022.08.461 |pmid=37032583 |doi-access=free |url=https://eprints.ncl.ac.uk/file_store/production/277349/582E1D76-1B8D-4923-BDDF-44D29369B45A.pdf }}</ref>