Fatigue and depression often go hand in hand. “The most treatable, overlooked cause of fatigue is mental health problems, like depression, anxiety or posttraumatic stress,” says Dr. Capaldini. “Patients need a good mental health screening.”
Depression has many symptoms—sleeping a lot, losing interest in life—but getting evaluated by a doc is critical. It’s not always clear whether depression is the cause of fatigue or vice versa. “If depression is caused by fatigue, treatment of fatigue could improve depression—and the opposite is also true,” says Dr. DeJesus. For blues-based fatigue, antidepressants can turn things around. Well-known options include Prozac, Zoloft and Wellbutrin, but your doc should guide you.
Another mental health issue involved in fatigue is posttraumatic stress—related to anything from sexual abuse to an HIV diagnosis. “You’re in ‘fight or flight’ mode all the time,” says Capaldini, “the body and mind are always on.” Antidepressants—with therapy—can help you start to deal.
Power Puzzle Treating fatigue without a clear cause
Sometimes the source of serious weariness remains mysterious. It’s called “idiopathic” fatigue, and one new approach to dealing with it is a prescription psychostimulant called Provigil. Judith Rabkin, PhD, of Columbia University is doing a study in New York of Provigil for HIV positive people with persistent fatigue, no depression and no identifiable underlying medical cause (to enroll call 212.543.5762). “It’s a terrific medication for chronic disruptive fatigue,” Rabkin says, but she emphasizes that it’s “not for the occasional tired day.”
Even though researchers are studying psychostimulants, don’t run out and self-medicate with recreational drugs—they deplete the same energizing hormones they stimulate to give you a high.
Jersey Girl Despite fatigue, Daphne Cooper does her thing
During the day, Daphne Cooper, 44 teaches women with HIV about self-esteem at a ministry in Jersey City, New Jersey. At night, she takes care of her two kids. Then she crashes. “I cook early in the morning because I’m too tired at night,” she says. Why Cooper, diagnosed in 2001, is so weary isn’t clear. Her hemoglobin fell to a dangerous level before she started Procrit last year, but her doc still doesn’t know why. Cooper also battles depression. Paxil has increased her energy somewhat, and her outlook is positive again. “I get up every morning and see green grass and blue sky,” she says. “It’s an opportunity to do my thing.”
Screen It and Treat It
Screen It… •If you think you might be depressed or have posttraumatic stress, the first step is talking with your health care provider. Telltale signs that you’ve got issues: losing interest in work or relationships, feeling worthless, lack of appetite, problems sleeping, inability to concentrate and suicidal thoughts. •Your doc may be able to diagnose your mental health issues on the spot or use some simple screening questionnaires to be sure.
...and Treat It Antidepressants, generally in pill form, are an extremely effective tool for alleviating depression or post-traumatic stress. It may take some trial and error to find the right one.