Loss of vitality or subacute general decline

Specialty: General.

• subacute psychophysical decline
• progressive lack of vigor over weeks of evolution
• progressive body languor

Why it occurs

• Major depressive disorder of subacute onset (a drop in the levels of serotonin, norepinephrine and dopamine in the nervous system that is manifested by severe asthenia, anhedonia and loss of vital impulse)
• Late-onset hypogonadism decompensated by stressors of weeks of evolution (marked decrease in testosterone in men that affects metabolic, muscular and psychological dynamism)
• Subacute deficiency of essential micronutrients due to extreme restrictive diets or prolonged periods of fasting (low tissue iron, borderline vitamin B12 levels, acute vitamin D deficiency)
• Burnout syndrome in the acute decompensation phase (total depletion of catecholamine and cortisol reserves that produces profound languor)
• Chronic infections in the latency phase or subclinical reactivation (such as herpes virus or hepatitis C virus).

Initial workup

Dosage of morning free and total testosterone, serum ferritin, vitamin B12 and folic acid, complete thyroid profile with antibodies, morning serum cortisol levels, complete blood count, ESR and CRP, and psychometric depression rating scale.

Standard management

• Avoid empirical initiation of stimulants without an adequate prior psychiatric and metabolic evaluation
• Sertraline — 50 mg orally daily in the morning if underlying major depressive disorder is confirmed, monitoring the appearance of initial adverse effects
• Vitamin D3 (1000 to 2000 IU per day orally if a deficiency is detected to support vitality and peripheral muscle strength).