Chronic and persistent fatigue

Specialty: General.

• prolonged exhaustion
• chronic fatigue
• persistent vital lethargy
• long-term lack of energy

Why it occurs

• Chronic fatigue syndrome or myalgic encephalomyelitis (associated with mitochondrial dysfunction, alteration of the hypothalamic-pituitary-adrenal axis and immune deregulation after infections)
• Major depressive disorders or other disorders in the psychiatric sphere (where the alteration of monoamine neurotransmitters mimics profound physical fatigue)
• Undiagnosed obstructive sleep apnea or severe disorders of sleep architecture (leading to chronic oxygen deprivation and interruption of deep sleep phases)
• Peripheral endocrinopathies (severe primary hypothyroidism, uncontrolled diabetes mellitus or chronic adrenal insufficiency)
• Underlying chronic infectious diseases (extrapulmonary tuberculosis, brucellosis, Lyme disease or chronic viremia due to hepatitis B or C).

Initial workup

Serum determination of ferritin, serum iron and iron binding capacity, complete thyroid profile, antinuclear antibodies (ANA), levels of vitamin B12 and folic acid, glycosylated hemoglobin (HbA1c), serology for HIV and hepatitis, and polysomnography if there is suspicion of sleep pathology.

Standard management

• Coenzyme Q10 — 100 to 200 mg per day orally as a mitochondrial cofactor to optimize cellular ATP production
• B complex with emphasis on methylcobalamin — 1000 mcg per day orally, if levels in the lower limit range are identified for the support of neurological and hematopoietic cellular metabolism
• Melatone (2 to 5 mg orally 30 minutes before bedtime to try to regulate the sleep-wake cycle if circadian rhythm dysfunction is detected).