Chronic fatigue could flag depression

Dr Jocelyn Lowinger

People with chronic fatigue states associated with depression or anxiety are more likely to seek help from a doctor than people with fatigue alone, a large Australian population study shows.

Data from more than 11,000 people showed that of the 2% of people with chronic fatigue states (neurasthenia), those most likely to seek help had concurrent affective, anxiety or physical disorders (British Journal of Psychiatry 2002;181;56-61).

Professor Ian Hickie, CEO of beyondblue: the national depression initiative and lead author of the study, said GPs should be aware "the great majority of people who come through their door with medically unexplained tiredness have unrecognised depression or anxiety."

"The drive to see a doctor isn't underpinned simply by fatigue, it's underpinned by concurrent depression and anxiety. But the patient will turn up saying 'my principle complaint is fatigue'...they don't walk in saying 'I'm depressed or anxious'."

Professor Hickie said more people who have fatigue alone actually don't go seeking healthcare and only a small proportion of people with fatigue will have chronic fatigue syndrome (six months of medically unexplained fatigue).

The more important thing is to make an accurate diagnosis of depression or anxiety, he said, adding that selective serotonin reuptake inhibitors are good treatments for fatigue associated with depression but not for fatigue alone.

Professor Hickie said chronic fatigue guidelines (Med J Aust 2002;176;517-556) were essentially for people who are tired and not depressed. He said "chronic fatigue states can be treated with a wide range of pharmacological strategies like moclobemide or non-pharmacological strategies, the most important of which are cognitive-behaviour and rehabilitation approaches, things like sleep-wake cycle management and activities".

"The treatments are out there, but they depend on accurate diagnosis at the GP end."

© Medical Observer 19 July 2002


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