Loss of vitality or general decay

Specialty: General.

• lack of vigor
• physical decay
• loss of general dynamism
• physical and mental languor

Why it occurs

• Depressive disorders of moderate to severe intensity (reduction of dopaminergic and noradrenergic transmission that generates anhedonia, asthenia and lack of vital drive)
• Late-onset hypogonadism or testosterone deficiency in men (decreased muscle anabolism, lower erythropoiesis and mood disturbance due to low androgen levels)
• Subclinical or marginal deficiency of key nutrients (iron without established anemia, vitamin B12 in lower range or extremely low vitamin D)
• Persistent chronic stress with burnout syndrome in the late phase (which presents with flattening of the cortisol rhythm and depletion of neurotransmitters)
• Degenerative joint or systemic diseases in the indolent initial phase but with high systemic impact.

Initial workup

Dosage of free and total testosterone (in men, sample taken first thing in the morning), serum ferritin, vitamin B12, folates, 25-hydroxyvitamin D, complete thyroid profile, lipid profile, and Hamilton or Beck depression rating scale.

Standard management

• Cholecalciferol — Vitamin D3, 1000 to 2000 IU daily orally if insufficiency is detected to improve muscle strength and general vitality
• Ferrous Sulfate — 200 mg orally daily, administered with vitamin C on an empty stomach, if iron deficiency without anemia is confirmed for mitochondrial support
• Multivitamin with minerals (one dose per day to correct marginal nutritional deficiencies if dietary intake is inadequate).