Fa­tigue and con­stant ex­haus­tion: Why do I al­ways feel tired? Why am I tired all day long? What are the med­ical caus­es? Many med­ical and psy­chi­atric dis­or­ders are ac­com­pa­nied by symp­toms of fa­tigue or re­duced ac­tiv­i­ty. It is there­fore very im­por­tant to con­duct a thor­ough clin­i­cal ex­am­i­na­tion be­fore at­tribut­ing such symp­toms to chron­ic fa­tigue syn­drome (CFS). Per­haps the most rel­e­vant clin­i­cal di­ag­noses that ex­clude CFS are:

• Sleep ap­noea: This is rather com­mon for pa­tients with se­vere obe­si­ty. All oth­er sleep dis­or­ders can cause fa­tigue the next morn­ing.

• Hy­pothy­roidism (re­duced func­tion of the thy­roid gland)

• Chron­ic heart prob­lems (low out­put, car­diomy­opa­thy)

• Side ef­fects of med­ica­tion (some med­ica­tion for high blood pres­sure, sleep­ing pills, pills for mus­cle re­lax­ation and many more!)

• Chron­ic al­co­hol abuse/ad­dic­tion to drugs or med­ica­tion: Even some months af­ter ex­ces­sive al­co­hol ex­po­sure, symp­toms of fa­tigue and/or a lack of mo­ti­va­tion can in­ter­fere with the qual­i­ty of life.

• Some chron­ic in­fec­tions (eg, He­pati­tis B or C) or ma­lig­nan­cies such as Hodgkin's lym­phoma can al­so cause fa­tigue.

• Use and de­pri­va­tion of caf­feine (cof­fee, tea, choco­late)

• For women, heavy men­stru­a­tion that leads to iron de­fi­cien­cy

Many psy­chi­atric dis­or­ders and/or med­ical treat­ments can cause symp­toms of fa­tigue. Fa­tigue and som­no­lence are com­mon symp­toms of de­pres­sion, dys­thymia and bipo­lar dis­or­ders. Any sub­type of schiz­o­phre­nia or delu­sion­al dis­or­ders can cause fa­tigue. The same is true of eat­ing dis­or­ders such as anorex­ia or bu­lim­ia ner­vosa. Med­ical ex­am­i­na­tion be per­formed to rule out these dis­or­ders and con­di­tions be­fore mak­ing a di­ag­no­sis of CFS.

Symp­toms of chron­ic fa­tigue (CFS)

De­f­i­n­i­tion

A state of chron­ic fa­tigue, ex­haus­tion and tired­ness dur­ing the day that lasts more than six months and that can­not be ex­plained by a phys­i­cal path­o­gen­ic cause.

Symp­toms of CFS

Ex­haus­tion, tired­ness dur­ing the day and a lack of en­er­gy and pro­duc­tiv­i­ty are very un­spe­cif­ic symp­toms and are very com­mon among pa­tients. Typ­i­cal ac­ces­so­ry symp­toms of a fa­tigue syn­drome (ie, chron­ic fa­tigue syn­drome) are:

• Con­cen­tra­tion dis­or­ders (al­so see oth­er pos­si­ble caus­es)

• Sleep dis­or­ders and an ex­ces­sive need to sleep

•Sub­febrile tem­per­a­tures (i.e., a slight fever with no ex­plic­a­ble cause of in­fec­tion)

• Swollen lymph nodes (most­ly painful, es­pe­cial­ly in the shoul­der area and the neck)

• Mus­cle pain

• Pain on one or both sides of the neck and in­flam­ma­tion of the phar­ynx

It is com­mon to see de­pres­sion symp­toms and anx­i­ety dis­or­ders. Due to the num­ber and non-spe­cif­ic na­ture of these symp­toms, it can be dif­fi­cult to de­vel­op a dif­fer­en­tial di­ag­no­sis.

Some re­search­es have found that a virus, XM­RV, is very com­mon in peo­ple with chron­ic tired­ness syn­drome. Oth­er re­searchers have found sim­i­lar re­sults, while sev­er­al oth­er re­searchers have not been able to re­peat this re­sult. Sci­ence has not yet come to a firm con­clu­sion of whether a virus can be a cause of chron­ic tired­ness or not.

Burn out

It is im­por­tant to be aware that all tired­ness is not caused by chron­ic fa­tigue. There can al­so be non-psy­cho­log­i­cal caus­es of tired­ness. More in­for­ma­tion.

Many re­searchers are scep­ti­cal about the term "burn out" be­cause it sug­gests that peo­ple can­not re­cov­er from this con­di­tion, which is wrong. Ex­perts pre­fer call­ing this dis­or­der ex­haus­tion/fa­tigue syn­drome. More than half of the pa­tients suf­fer­ing from this dis­ease suf­fer al­so from de­pres­sion. The dif­fer­ence be­tween those who are ex­haust­ed and those who al­so suf­fer from de­pres­sion is that the ex­haust­ed ones sel­dom show symp­toms such as self-ac­cu­sa­tion, thoughts about sui­cide and de­creased ap­petite. Peo­ple who are ex­haust­ed feel frus­trat­ed about their sit­u­a­tion.