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URLhttps://en.wikipedia.org/wiki/Fatigue
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Fatigue Other names Exhaustion, weariness, tiredness, lethargy, listlessness Artistic representation of ME/CFS Specialty General practice , primary care   Treatment Avoid known stressors and unhealthy habits ( drug use , excessive alcohol consumption , smoking), healthy diet, exercise regularly, medication , hydration , and vitamins Fatigue is a state of being without energy for a prolonged period of time. [ 1 ] [ 2 ] The word fatigue is used in two contexts: in the medical sense, and in the sense of normal tiredness. In the medical sense, fatigue is seen as a symptom, and is sometimes associated with medical conditions including autoimmune disease , organ failure , mood disorders , heart disease , infectious diseases , and post-infectious-disease states. [ 3 ] However, fatigue is complex and in up to a third of primary care cases no medical or psychiatric diagnosis is found. [ 4 ] [ 5 ] [ 6 ] In the sense of tiredness, fatigue often follows prolonged physical or mental activity. Physical fatigue results from muscle fatigue brought about by intense physical activity . [ 7 ] [ 8 ] [ 9 ] Mental fatigue results from prolonged periods of cognitive activity which impairs cognitive ability, can manifest as sleepiness , lethargy , or directed attention fatigue , [ 10 ] and can also impair physical performance. [ 11 ] Fatigue in a medical context is used to cover experiences of low energy that are not caused by normal life. [ 1 ] [ 2 ] A 2021 review proposed a definition for fatigue as a starting point for discussion: "A multi-dimensional phenomenon in which the biophysiological, cognitive, motivational and emotional state of the body is affected resulting in significant impairment of the individual's ability to function in their normal capacity" . [ 12 ] Another definition is that fatigue is "a significant subjective sensation of weariness, increasing sense of effort, mismatch between effort expended and actual performance, or exhaustion independent from medications, chronic pain, physical deconditioning, anaemia , respiratory dysfunction, depression , and sleep disorders" . [ 13 ] The use of the term fatigue in medical contexts may carry inaccurate connotations from the more general usage of the same word. More accurate terminology may also be needed for variants within the umbrella term of fatigue. [ 14 ] Comparison with other terms [ edit ] Tiredness which is a normal result of work , mental stress , anxiety , overstimulation and understimulation, jet lag , active recreation , boredom , or lack of sleep is not considered medical fatigue. This is the tiredness described in MeSH Descriptor Data. [ 15 ] Exhaustion is a state of extreme tiredness. [ 16 ] Sleepiness refers to a tendency to fall asleep, whereas fatigue refers to an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion. Sleepiness and fatigue often coexist as a consequence of sleep deprivation. [ 17 ] However sleepiness and fatigue may not correlate. [ 18 ] Fatigue is generally considered a longer-term condition than sleepiness (somnolence). [ 19 ] "Fatigue" is categorised as ICD-11 code MG22. [ 20 ] Distinguishing features of medical fatigue include: unpredictability, variability in severity, fatigue being relatively profound/overwhelming, and having extensive impact on daily living, lack of improvement with rest, where an underlying disease is present, the amount of fatigue is often not commensurate with the severity of the underlying disease. [ 12 ] [ 21 ] [ 22 ] [ 23 ] Differentiating features [ edit ] Differentiating characteristics of fatigue that may help identify the possible cause of fatigue include: Post-exertional malaise ; a common feature of ME/CFS , [ 24 ] and experienced by a significant proportion of people with Long Covid , [ 25 ] but not a feature of other fatigues. Increased by heat or cold; MS fatigue is in many cases affected in this way. [ 26 ] [ 27 ] Flare-ups and Remissions; Some fatigue diseases have flareups of a few weeks ( lupus , [ 28 ] [ 29 ] fibromyalgia [ 30 ] ). Other fatigue diseases may have longer patterns of activity and remission, or no remissions at all (MS [ 31 ] [ 32 ] [ 33 ] ). Variability within a day; Some fatigues ( rheumatoid arthritis (RA) , [ 34 ] cancer-related fatigue [ 35 ] ) seem to often be continual (24/7), whilst others (MS, Sjögren's, lupus, brain injury [ 36 ] [ 37 ] ) often vary in intensity at different times within a day. [ 34 ] A 2010 study found that Sjögren's patients reported fatigue after rising, an improvement in mid-morning, and worsening later in the day, whereas lupus (SLE) patients reported lower fatigue after rising followed by increasing fatigue through the day. [ 38 ] ME/CFS symptoms can be continual, or can fluctuate during the day, from day to day, and over longer periods. [ 33 ] Fibromyalgia fatigue can be continual or variable. [ 39 ] The pace of onset may be a related differentiating factor; MS fatigue can have abrupt onset. [ 40 ] Feeling of weight; some fatigues, including that caused by MS, create a sense of weight or gravity; "I feel like I have lead weights attached to my limbs ... or I am being pulled down by gravity." [ 41 ] Some people may have multiple causes of fatigue. Fatigue is complex and can be driven and maintained by a potentially wide range of biopsychosocial factors . [ 42 ] Tiredness is a common medically unexplained symptom . [ 5 ] In up to a third of fatigue primary care cases, no medical or psychiatric diagnosis is found. [ 4 ] [ 5 ] [ 6 ] Adverse life events [ edit ] Adverse life events have been associated with fatigue. [ 12 ] A 2021 study in a Korean city found that alcohol consumption was the variable with the most correlation with overall fatigue. [ 43 ] A 2020 Norway study found that 69% of substance use disorder patients had severe fatigue symptoms, and particularly those with extensive use of benzodiazepines . [ 44 ] Causality, as opposed to correlation, were not proven in these studies. [ citation needed ] The protracted use of digital screens—such as those associated with computers, laptops and smartphones—can cause eye fatigue, and induce a general state of mental and physical exhaustion. [ 45 ] Specific symptoms may include sore eyes, blurred vision, headaches and associated orthopedic issues such as a sore neck and back. These symptoms collectively are known as computer vision syndrome (CVS) or in colloquial parlance as screen fatigue . [ 46 ] Fatigue can often be traced to poor sleep habits. [ 47 ] Sleep deprivation and disruption is associated with subsequent fatigue. [ 48 ] [ 49 ] Sleep disturbances due to disease may impact fatigue. [ 50 ] [ 51 ] Caffeine and alcohol can disrupt sleep, causing fatigue. [ 52 ] Fatigue may be a side effect of certain medications (e.g., lithium salts , ciprofloxacin ); beta blockers , which can induce exercise intolerance , medicines used to treat allergies or coughs, [ 47 ] and many cancer treatments, particularly chemotherapy and radiotherapy . Use of benzodiazepines has been found to correlate with higher fatigue. [ 44 ] Association with diseases and illnesses [ edit ] Fatigue is often associated with diseases and conditions. Some major categories of conditions that often list fatigue as a symptom include physical diseases, substance use illness, mental illnesses, and other diseases and conditions. [ citation needed ] autoimmune diseases , [ 53 ] such as celiac disease , lupus , multiple sclerosis , myasthenia gravis , NMOSD , Sjögren's syndrome , [ 38 ] rheumatoid arthritis , [ 54 ] [ 55 ] [ 56 ] [ 12 ] spondyloarthropathy and UCTD ; [ 57 ] this population's primary concern is fatigue; [ 53 ] [ 58 ] blood disorders , such as anemia and hemochromatosis ; [ 59 ] [ 60 ] brain injury ; [ 61 ] [ 62 ] cancer , in which case it is called cancer fatigue ; [ 63 ] COVID-19 and long COVID ; [ 64 ] endocrine diseases or metabolic disorders : diabetes mellitus , hypothyroidism and Addison's disease ; [ 65 ] fibromyalgia ; [ 66 ] heart failure and heart attack ; [ 67 ] HIV [ 68 ] inborn errors of metabolism such as fructose malabsorption ; [ 69 ] [ 70 ] infectious diseases such as infectious mononucleosis or tuberculosis ; [ 65 ] irritable bowel syndrome ; [ 71 ] kidney diseases , e.g., acute renal failure , chronic renal failure ; [ 65 ] leukemia or lymphoma ; [ medical citation needed ] liver failure or liver diseases, e.g., hepatitis ; [ 65 ] [ 22 ] Low blood pressure Lyme disease ; [ medical citation needed ] neurological disorders such as narcolepsy , Parkinson's disease , postural orthostatic tachycardia syndrome (POTS) and post-concussion syndrome ; [ medical citation needed ] nutritional deficiencies, such as, sodium , iron , vitamin B 12 , and folate deficiencies physical trauma and other pain -causing conditions, such as arthritis ; [ medical citation needed ] sleep deprivation or sleep disorders , e.g. sleep apnea ; [ 65 ] stroke [ medical citation needed ] thyroid disease such as hypothyroidism ; [ medical citation needed ] sarcoidosis mast cell activation syndrome [ 72 ] [ 73 ] [ 74 ] anxiety disorders , such as generalized anxiety disorder ; [ 75 ] developmental disorders such as autism spectrum disorder ; [ 76 ] depression ; [ 77 ] [ 12 ] eating disorders , which can produce fatigue due to inadequate nutrition; [ medical citation needed ] myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [ 78 ] idiopathic chronic fatigue , a term used to describe chronic fatigue which does not have symptoms of ME/CFS. [ 79 ] [ 80 ] However ICF does not have a dedicated diagnostic code in the World Health Organization 's ICD-11 classification. [ 81 ] Gulf War syndrome ; [ 82 ] Primary vs. secondary [ edit ] In some areas, it has been proposed that fatigue be separated into primary fatigue, caused directly by a disease process, and ordinary or secondary fatigue, caused by a range of causes including exertion and also secondary impacts on a person of having a disease (such as disrupted sleep). [ 83 ] [ 84 ] [ 85 ] [ 86 ] [ 87 ] [ 88 ] The ICD-11 MG22 definition of fatigue [ 89 ] captures both types of fatigue; it includes fatigue that "occur[s] in the absence of... exertion... as a symptom of health conditions." [ medical citation needed ] Obesity correlates with higher fatigue levels and incidence. [ 90 ] [ 91 ] [ 92 ] Somatic symptom disorder [ edit ] In somatic symptom disorder [ 93 ] the patient is overfocused on a physical symptom, such as fatigue, that may or may not be explained by a medical condition. [ 94 ] [ 95 ] [ 96 ] Scientifically unsupported causes [ edit ] The concept of adrenal fatigue is often raised in media but no scientific basis has been found for it. [ 97 ] [ 98 ] [ 99 ] The mechanisms that cause fatigue are not well understood. [ 53 ] Several mechanisms may be in operation within a patient, [ 100 ] with the relative contribution of each mechanism differing over time. [ 12 ] Proposed fatigue explanations due to permanent changes in the brain may have difficulty in explaining the "unpredictability" and "variability" (i.e. appearing intermittently during the day, and not on all days) of the fatigue associated with inflammatory rheumatic diseases and autoimmune diseases (such as multiple sclerosis ). [ 12 ] Inflammation distorts neural chemistry, brain function and functional connectivity across a broad range of brain networks, [ 101 ] and has been linked to many types of fatigue. [ 53 ] [ 102 ] Findings implicate neuroinflammation in the etiology of fatigue in autoimmune and related disorders. [ 12 ] [ 53 ] Low-grade inflammation may cause an imbalance between energy availability and expenditure. [ 103 ] Cytokines are small protein molecules that modulate immune responses and inflammation (as well as other functions) and may have causal roles in fatigue. [ 104 ] [ 105 ] However a 2019 review was inconclusive as to whether cytokines play any definitive role in ME/CFS . [ 106 ] Reduced brain connectivity [ edit ] Fatigue has been correlated with reductions in structural and functional connectivity in the brain. [ 107 ] This has included in post-stroke, [ 108 ] MS, [ 109 ] NMOSD and MOG, [ 13 ] and ME/CFS. [ 110 ] This was also found for fatigue after brain injury, [ 111 ] including a significant linear correlation between self-reported fatigue and brain functional connectivity. [ 112 ] Areas of the brain for which there is evidence of relation to fatigue are the thalamus and middle frontal cortex, [ 112 ] fronto-parietal and cingulo-opercular, [ 111 ] and default mode network, salience network, and thalamocortical loop areas. [ 107 ] [ 113 ] A 2024 review found that structural connectivity changes may underlie fatigue in pwRRMS but that the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies. [ 114 ] A small 2023 study found that infratentorial lesion volume (cerebellar and brainstem) was a relatively good predictor of RRMS fatigue severity. [ 115 ] Damage to brain white matter [ edit ] Studies have found MS fatigue correlates with damage to NAWM (normal appearing white matter ) (which will not show on normal MRI but will show on DTI (diffusion tensor imaging) ). [ 116 ] [ 13 ] [ 117 ] [ 118 ] [ 119 ] [ 120 ] The correlation becomes unreliable in patients aged over 65 due to damage due to ageing. [ 121 ] Heat shock proteins [ edit ] A small 2016 study found that primary Sjögren's syndrome patients with high fatigue, when compared with those with low fatigue, had significantly higher plasma concentrations of HSP90α , and a tendency to higher concentrations of HSP72. [ 122 ] A small 2020 study of Crohn's disease patients found that higher fatigue visual analogue scale (fVAS) scores correlated with higher HSP90α levels. [ 123 ] A related small 2012 trial investigating if application of an IL-1 receptor antagonist ( anakinra ) would reduce fatigue in primary Sjögren's syndrome patients was inconclusive. [ 124 ] [ 125 ] [ 126 ] Fatigue is currently measured by many different self-measurement surveys. [ 127 ] Examples are the Fatigue Symptom Inventory (FSI) [ 128 ] [ 129 ] [ 130 ] and the Fatigue Severity Scale. [ 131 ] [ 132 ] [ 133 ] There is no consensus on best practice, [ 134 ] and the existing surveys do not capture the intermittent nature of some forms of fatigue. Heart rate variability cannot currently distinguish between physical fatigue and mental fatigue. [ 135 ] Many studies have shown that salivary cortisol can measure mental fatigue. [ 135 ] A 2023 guidance indicates the following [ 4 ] in the primary care setting, a medical or psychiatric diagnosis is found in at least two-thirds of patients; the most common diagnoses are viral illness , upper respiratory infection, iron-deficiency anaemia, acute bronchitis, adverse effects of a medical agent in the proper dose, and depression or other mental disorder, such as panic disorder, and somatisation disorder ; the origin of fatigue may be central, brain-derived, or peripheral, usually of a neuromuscular origin—it may be attributed to physical illness, psychological (e.g., psychiatric disorder), social (e.g., family problems), and physiological factors (e.g., old age), occupational illness (e.g., workplace stress); when unexplained, clinically evaluated chronic fatigue can be separated into ME/CFS and idiopathic chronic fatigue . [ 4 ] A 2016 German review found that about 20% of people complaining of tiredness to a GP (general practitioner) suffered from a depressive disorder. anaemia , malignancies and other serious somatic diseases were only very rarely found in fatigued primary care patients, with prevalence rates hardly differing from non-fatigued patients. if fatigue occurred in primary care patients as an isolated symptom without additional abnormalities in the medical history and in the clinical examination, then extensive diagnostic testing rarely helped detect serious diseases. Such testing might also lead to false-positive tests. [ 136 ] A 2014 Australian review recommended that a period of watchful waiting may be appropriate if there are no major warning signs. [ 137 ] A 2009 study found that about 50% of people who had fatigue received a diagnosis that could explain the fatigue after a year with the condition. In those people who had a possible diagnosis, musculoskeletal (19.4%) and psychological problems (16.5%) were the most common. Definitive physical conditions were only found in 8.2% of cases. [ 138 ] Uni- or multi-dimensional [ edit ] Fatigue can be seen as a uni-dimensional phenomenon that influences different aspects of human life. [ 139 ] [ 140 ] It can be multi-faceted and broadly defined, making understanding the causes of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases. [ 53 ] A 2021 review considered that different "types/subsets" of fatigue may exist and that patients normally present with more than one such "type/subset". These different "types/subsets" of fatigue may be different dimensions of the same symptom, and the relative manifestations of each may depend on the relative contribution of different mechanisms. Inflammation may be the root causal mechanism in many cases. [ 12 ] Physical fatigue, or muscle fatigue , is the temporary physical inability of muscles to perform optimally. The onset of muscle fatigue during physical activity is gradual, and depends upon an individual's level of physical fitness – other factors include sleep deprivation and overall health. [ 141 ] Physical fatigue can be caused by a lack of energy in the muscle, by a decrease of the efficiency of the neuromuscular junction or by a reduction of the drive originating from the central nervous system , and can be reversed by rest. [ 142 ] The central component of fatigue is triggered by an increase of the level of serotonin in the central nervous system. [ 143 ] During motor activity, serotonin released in synapses that contact motor neurons promotes muscle contraction . [ 144 ] During high level of motor activity, the amount of serotonin released increases and a spillover occurs. Serotonin binds to extrasynaptic receptors located on the axonal initial segment of motor neurons with the result that nerve impulse initiation and thereby muscle contraction are inhibited. [ 145 ] Muscle strength testing can be used to determine the presence of a neuromuscular disease , but cannot determine its cause. Additional testing, such as electromyography , can provide diagnostic information, but information gained from muscle strength testing alone is not enough to diagnose most neuromuscular disorders. [ 146 ] Mental fatigue is a temporary inability to maintain optimal cognitive performance. The onset of mental fatigue during any cognitive activity is gradual, and depends upon an individual's cognitive ability, and also upon other factors, such as sleep deprivation and overall health. Mental fatigue has also been shown to decrease physical performance. [ 10 ] It can manifest as somnolence , lethargy , directed attention fatigue , or disengagement. Research also suggests that mental fatigue is closely linked to the concept of ego depletion , though the validity of the concept is disputed. For example, one pre-registered study of 686 participants found that after exerting mental effort, people are likely to disengage and become less interested in exerting further effort. [ 147 ] Decreased attention can also be described as a more or less decreased level of consciousness . [ 148 ] In any case, this can be dangerous when performing tasks that require constant concentration, such as operating large vehicles. For instance, a person who is sufficiently somnolent may experience microsleep . However, objective cognitive testing can be used to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness. [ 149 ] [ 150 ] [ 151 ] The perception of mental fatigue is believed to be modulated by the brain's reticular activating system (RAS). [ 152 ] [ 153 ] [ 154 ] [ 155 ] [ 156 ] Fatigue impacts a driver's reaction time, awareness of hazards around them and their attention. Drowsy drivers are three times more likely to be involved in a car crash, and being awake over 20 hours is the equivalent of driving with a blood-alcohol concentration level of 0.08%. [ 157 ] Neurological fatigue [ edit ] People with multiple sclerosis experience a form of overwhelming tiredness that can occur at any time of the day, for any duration, and that does not necessarily recur in a recognizable pattern for any given patient, referred to as "neurological fatigue", and often as "multiple sclerosis fatigue" or "lassitude". [ 158 ] [ 159 ] [ 160 ] People with autoimmune diseases including inflammatory rheumatic diseases such as rheumatoid arthritis , psoriatic arthritis and primary Sjögren's syndrome , experience similar fatigue. [ 12 ] [ 53 ] Attempts have been made to isolate causes of central nervous system fatigue . Acute Acute fatigue is that which is temporary and self-limited. Acute fatigue is most often caused by an infection such as the common cold and can be cognized as one part of the sickness behavior response occurring when the immune system fights an infection . [ 161 ] Other common causes of acute fatigue include depression and chemical causes, such as dehydration , poisoning , low blood sugar , or mineral or vitamin deficiencies. Prolonged Prolonged fatigue is a self-reported, persistent (constant) fatigue lasting at least one month. [ 162 ] [ 163 ] Chronic Chronic fatigue is a self-reported fatigue lasting at least 6 consecutive months. Chronic fatigue may be either persistent or relapsing. [ 164 ] Chronic fatigue is a symptom of many chronic illnesses and of idiopathic chronic fatigue . [ 165 ] Fatigue can have significant negative impacts on quality of life. [ 166 ] Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, Myalgic Encephalomyelitis/chronic fatigue syndrome , and rheumatoid arthritis. [ 12 ] Fatigue has been described by sufferers as 'incomprehensible' due to its unpredictable occurrence, lack of relationship to physical effort and different character as compared to tiredness. [ 167 ] The World Health Organization 's ICD-11 classification [ 168 ] includes a category MG22 Fatigue (typically fatigue following exertion but sometimes may occur in the absence of such exertion as a symptom of health conditions), and many other categories where fatigue is mentioned as a secondary result of other factors. [ 169 ] It does not include any fatigue-based psychiatric illness (unless it is accompanied by related psychiatric symptoms). [ 170 ] [ 171 ] DSM-5 lists 'fatigue or loss of energy nearly every day' as one factor in diagnosing depression. [ 172 ] Treatment and management [ edit ] Management may include review of factors and methods as explained below. [ citation needed ] Cessation of medications causing fatigue [ edit ] Taking of medications with side effects of contributing to fatigue may be ceased. [ 173 ] [ 47 ] [ 174 ] [ better source needed ] [ 175 ] Medications to treat fatigue [ edit ] The UK NICE recommends consideration of amantadine , modafinil , and selective serotonin reuptake inhibitors (SSRIs) for MS fatigue. [ 176 ] A PCORI review, however, found amantadine, methylphenidate, and modafinil no more effective than placebo in reducing fatigue, with side effects reported. [ 177 ] Psychostimulants such as methylphenidate , amphetamines , and modafinil have been used in the treatment of fatigue related to depression , [ 178 ] [ 179 ] [ 180 ] [ 181 ] and medical illness such as chronic fatigue syndrome [ 182 ] [ 183 ] and cancer . [ 179 ] [ 184 ] [ 185 ] [ 186 ] [ 187 ] [ 188 ] [ 189 ] They have also been used to counteract fatigue in sleep loss [ 190 ] and in aviation . [ 191 ] Mental health tools [ edit ] CBT can be useful for fatigue, [ 192 ] [ 193 ] including ME/CFS [ 194 ] [ 195 ] but is not included in NICE guidelines for ME/CFS treatment. [ 196 ] [ 197 ] Avoidance of body heat [ edit ] Fatigue in MS often correlates with relatively high endogenous body temperature. [ 198 ] [ 26 ] [ 199 ] [ 200 ] [ 201 ] [ 202 ] [ 203 ] [ 204 ] [ 205 ] [ 206 ] [ 207 ] [ excessive citations ] Improving sleep has been associated with reduced fatigue but only in small studies. [ 208 ] [ 209 ] [ 193 ] Intermittent fasting [ edit ] A very small 2022 study found 40% reductions in fatigue categorisations after three months of 16:8 intermittent fasting . [ 210 ] Vagus nerve stimulation [ edit ] A very small 2023 study of Sjogren's patients showed reductions in self-reported fatigue after 56 days of vagus nerve stimulation . [ 105 ] Qigong and Tai chi have been postulated as helpful to reduce fatigue, but the evidence is of low quality. [ 211 ] [ 212 ] [ 213 ] Approaches to managing fatigue [ edit ] Some health systems help people manage their fatigue better through attitude changes and skills transference. [ 193 ] [ 214 ] [ 215 ] [ 216 ] [ 217 ] [ 218 ] 2023 guidance stated fatigue prevalence is between 4.3% and 21.9%. Prevalence is higher in women than men. [ 4 ] [ 219 ] A 2021 German study found that fatigue was the main or secondary reason for 10–20% of all consultations with a primary care physician. [ 220 ] A large study based on the 2004 Health and Retirement Study (HRS), a biennial longitudinal survey of US adults aged 51 and above, with mean age 65, found that 33% of women and 29% of men self-reported fatigue. [ 221 ] Fatigue represents a large health economic burden and unmet need to patients and to society. [ 12 ] Possible purposes of fatigue [ edit ] Body resource management purposes [ edit ] Fatigue has been posited as a bio-psycho-physiological state reflecting the body's overall strategy in resource (energy) management. Fatigue may occur when the body wants to limit resource utilisation ("rationing") in order to use resources for healing (part of sickness behaviour ) [ 123 ] or conserve energy for a particular current or future anticipated need, including a threat. 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Retrieved 2025-01-06 . ^ "Energy & Fatigue" . Harvard Health . April 12, 2023. Archived from the original on January 18, 2025 . Retrieved January 6, 2025 . ^ "Managing MS Fatigue - Help & Support | MS Society" . www.mssociety.org.uk . Archived from the original on 2025-01-06 . Retrieved 2025-01-06 . ^ "Fatigue" . Cleveland Clinic . Archived from the original on 2025-01-06 . Retrieved 2025-01-06 . ^ "Cancer fatigue: Why it occurs and how to cope" . Mayo Clinic . Archived from the original on 2025-01-06 . Retrieved 2025-01-06 . ^ Loge JH, Ekeberg Ø, Kaasa S (July 1998). "Fatigue in the general norwegian population". Journal of Psychosomatic Research . 45 (1): 53– 65. doi : 10.1016/s0022-3999(97)00291-2 . PMID   9720855 . ^ Maisel P, Baum E, Donner-Banzhoff N (August 30, 2021). "Fatigue as the Chief Complaint" . Deutsches Ärzteblatt International . 118 ( 33– 34): 566– 576. doi : 10.3238/arztebl.m2021.0192 . PMC   8579431 . PMID   34196270 . ^ Meng H, Hale L, Friedberg F (October 2010). "Prevalence and Predictors of Fatigue in Middle-Aged and Older Adults: Evidence from the Health and Retirement Study" . Journal of the American Geriatrics Society . 58 (10): 2033– 2034. doi : 10.1111/j.1532-5415.2010.03088.x . PMC   2981161 . PMID   20929479 . Byung-Chul Han : MĂŒdigkeitsgesellschaft . Matthes & Seitz, Berlin 2010, ISBN   978-3-88221-616-5 . (Philosophical essay about fatigue as a sociological problem and symptom). Danish edition: TrĂŠthedssamfundet. MĂžller, 2012, ISBN   978-87-994043-7-7 . Dutch edition: De vermoeide samenleving. van gennep, 2012, ISBN   978-94-6164-071-0 . Italian editions: La societĂ  della stanchezza. nottetempo, 2012, ISBN   978-88-7452-345-0 . Korean edition: 한병ìČ  지음 | êč€íƒœí™˜ ì˜źêč€. Moonji, 2011, ISBN   978-89-320-2396-0 . Spanish edition: La sociedad del cansancio. Herder Editorial, 2012, ISBN   978-84-254-2868-5 . South, David (1993). Professor puts chronic fatigue into historical perspective . Hannah Institute for the History of Medicine Number 18 Summer 1993, p. 1 Wikiquote has quotations related to Fatigue . Wikimedia Commons has media related to Fatigue . Fatigue – Information for Patients , U.S. National Cancer Institute
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[Jump to content](https://en.wikipedia.org/wiki/Fatigue#bodyContent) Main menu Main menu move to sidebar hide Navigation - [Main page](https://en.wikipedia.org/wiki/Main_Page "Visit the main page [z]") - [Contents](https://en.wikipedia.org/wiki/Wikipedia:Contents "Guides to browsing Wikipedia") - [Current events](https://en.wikipedia.org/wiki/Portal:Current_events "Articles related to current events") - [Random article](https://en.wikipedia.org/wiki/Special:Random "Visit a randomly selected article [x]") - [About Wikipedia](https://en.wikipedia.org/wiki/Wikipedia:About "Learn about Wikipedia and how it works") - [Contact us](https://en.wikipedia.org/wiki/Wikipedia:Contact_us "How to contact Wikipedia") Contribute - [Help](https://en.wikipedia.org/wiki/Help:Contents "Guidance on how to use and edit Wikipedia") - [Learn to edit](https://en.wikipedia.org/wiki/Help:Introduction "Learn how to edit Wikipedia") - [Community portal](https://en.wikipedia.org/wiki/Wikipedia:Community_portal "The hub for editors") - [Recent changes](https://en.wikipedia.org/wiki/Special:RecentChanges "A list of recent changes to Wikipedia [r]") - [Upload file](https://en.wikipedia.org/wiki/Wikipedia:File_upload_wizard "Add images or other media for use on Wikipedia") - [Special pages](https://en.wikipedia.org/wiki/Special:SpecialPages "A list of all special pages [q]") [![](https://en.wikipedia.org/static/images/icons/enwiki-25.svg) ![Wikipedia](https://en.wikipedia.org/static/images/mobile/copyright/wikipedia-wordmark-en-25.svg) ![The Free Encyclopedia](https://en.wikipedia.org/static/images/mobile/copyright/wikipedia-tagline-en-25.svg)](https://en.wikipedia.org/wiki/Main_Page) [Search](https://en.wikipedia.org/wiki/Special:Search "Search Wikipedia [f]") Appearance - [Donate](https://donate.wikimedia.org/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en) - [Create account](https://en.wikipedia.org/w/index.php?title=Special:CreateAccount&returnto=Fatigue "You are encouraged to create an account and log in; however, it is not mandatory") - [Log in](https://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Fatigue "You're encouraged to log in; however, it's not mandatory. [o]") Personal tools - [Donate](https://donate.wikimedia.org/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en) - [Create account](https://en.wikipedia.org/w/index.php?title=Special:CreateAccount&returnto=Fatigue "You are encouraged to create an account and log in; however, it is not mandatory") - [Log in](https://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Fatigue "You're encouraged to log in; however, it's not mandatory. [o]") ## Contents move to sidebar hide - [(Top)](https://en.wikipedia.org/wiki/Fatigue) - [1 Definition](https://en.wikipedia.org/wiki/Fatigue#Definition) Toggle Definition subsection - [1\.1 Terminology](https://en.wikipedia.org/wiki/Fatigue#Terminology) - [1\.2 Comparison with other terms](https://en.wikipedia.org/wiki/Fatigue#Comparison_with_other_terms) - [1\.2.1 Tiredness](https://en.wikipedia.org/wiki/Fatigue#Tiredness) - [1\.2.2 Exhaustion](https://en.wikipedia.org/wiki/Fatigue#Exhaustion) - [1\.2.3 Sleepiness](https://en.wikipedia.org/wiki/Fatigue#Sleepiness) - [2 Classification](https://en.wikipedia.org/wiki/Fatigue#Classification) Toggle Classification subsection - [2\.1 ICD-11](https://en.wikipedia.org/wiki/Fatigue#ICD-11) - [3 Presentation](https://en.wikipedia.org/wiki/Fatigue#Presentation) Toggle Presentation subsection - [3\.1 Common features](https://en.wikipedia.org/wiki/Fatigue#Common_features) - [3\.2 Differentiating features](https://en.wikipedia.org/wiki/Fatigue#Differentiating_features) - [4 Causes](https://en.wikipedia.org/wiki/Fatigue#Causes) Toggle Causes subsection - [4\.1 Adverse life events](https://en.wikipedia.org/wiki/Fatigue#Adverse_life_events) - [4\.2 Drug use](https://en.wikipedia.org/wiki/Fatigue#Drug_use) - [4\.3 Digital screen use](https://en.wikipedia.org/wiki/Fatigue#Digital_screen_use) - [4\.4 Sleep disturbance](https://en.wikipedia.org/wiki/Fatigue#Sleep_disturbance) - [4\.5 Medications](https://en.wikipedia.org/wiki/Fatigue#Medications) - [4\.6 Association with diseases and illnesses](https://en.wikipedia.org/wiki/Fatigue#Association_with_diseases_and_illnesses) - [4\.6.1 Physical diseases](https://en.wikipedia.org/wiki/Fatigue#Physical_diseases) - [4\.6.2 Mental illnesses](https://en.wikipedia.org/wiki/Fatigue#Mental_illnesses) - [4\.6.3 Other](https://en.wikipedia.org/wiki/Fatigue#Other) - [4\.6.4 Primary vs. secondary](https://en.wikipedia.org/wiki/Fatigue#Primary_vs._secondary) - [4\.7 Obesity](https://en.wikipedia.org/wiki/Fatigue#Obesity) - [4\.8 Somatic symptom disorder](https://en.wikipedia.org/wiki/Fatigue#Somatic_symptom_disorder) - [4\.9 Scientifically unsupported causes](https://en.wikipedia.org/wiki/Fatigue#Scientifically_unsupported_causes) - [5 Mechanisms](https://en.wikipedia.org/wiki/Fatigue#Mechanisms) Toggle Mechanisms subsection - [5\.1 Inflammation](https://en.wikipedia.org/wiki/Fatigue#Inflammation) - [5\.2 Reduced brain connectivity](https://en.wikipedia.org/wiki/Fatigue#Reduced_brain_connectivity) - [5\.3 Damage to brain white matter](https://en.wikipedia.org/wiki/Fatigue#Damage_to_brain_white_matter) - [5\.4 Heat shock proteins](https://en.wikipedia.org/wiki/Fatigue#Heat_shock_proteins) - [6 Measurement](https://en.wikipedia.org/wiki/Fatigue#Measurement) - [7 Diagnosis](https://en.wikipedia.org/wiki/Fatigue#Diagnosis) Toggle Diagnosis subsection - [7\.1 Diagnosis guidance](https://en.wikipedia.org/wiki/Fatigue#Diagnosis_guidance) - [7\.2 Classification](https://en.wikipedia.org/wiki/Fatigue#Classification_2) - [7\.2.1 By type](https://en.wikipedia.org/wiki/Fatigue#By_type) - [7\.2.1.1 Uni- or multi-dimensional](https://en.wikipedia.org/wiki/Fatigue#Uni-_or_multi-dimensional) - [7\.2.1.2 Physical](https://en.wikipedia.org/wiki/Fatigue#Physical) - [7\.2.1.3 Mental](https://en.wikipedia.org/wiki/Fatigue#Mental) - [7\.2.1.4 Neurological fatigue](https://en.wikipedia.org/wiki/Fatigue#Neurological_fatigue) - [7\.2.2 By timescale](https://en.wikipedia.org/wiki/Fatigue#By_timescale) - [7\.2.3 By effect](https://en.wikipedia.org/wiki/Fatigue#By_effect) - [7\.2.4 WHO classification](https://en.wikipedia.org/wiki/Fatigue#WHO_classification) - [8 Treatment and management](https://en.wikipedia.org/wiki/Fatigue#Treatment_and_management) Toggle Treatment and management subsection - [8\.1 Cessation of medications causing fatigue](https://en.wikipedia.org/wiki/Fatigue#Cessation_of_medications_causing_fatigue) - [8\.2 Medications to treat fatigue](https://en.wikipedia.org/wiki/Fatigue#Medications_to_treat_fatigue) - [8\.3 Mental health tools](https://en.wikipedia.org/wiki/Fatigue#Mental_health_tools) - [8\.4 Other approaches](https://en.wikipedia.org/wiki/Fatigue#Other_approaches) - [8\.4.1 Avoidance of body heat](https://en.wikipedia.org/wiki/Fatigue#Avoidance_of_body_heat) - [8\.4.2 Improved sleep](https://en.wikipedia.org/wiki/Fatigue#Improved_sleep) - [8\.4.3 Intermittent fasting](https://en.wikipedia.org/wiki/Fatigue#Intermittent_fasting) - [8\.4.4 Vagus nerve stimulation](https://en.wikipedia.org/wiki/Fatigue#Vagus_nerve_stimulation) - [8\.4.5 Qigong and Tai Chi](https://en.wikipedia.org/wiki/Fatigue#Qigong_and_Tai_Chi) - [8\.5 Approaches to managing fatigue](https://en.wikipedia.org/wiki/Fatigue#Approaches_to_managing_fatigue) - [9 Prevalence](https://en.wikipedia.org/wiki/Fatigue#Prevalence) - [10 Possible purposes of fatigue](https://en.wikipedia.org/wiki/Fatigue#Possible_purposes_of_fatigue) Toggle Possible purposes of fatigue subsection - [10\.1 Body resource management purposes](https://en.wikipedia.org/wiki/Fatigue#Body_resource_management_purposes) - [10\.2 Evolutionary purposes](https://en.wikipedia.org/wiki/Fatigue#Evolutionary_purposes) - [11 See also](https://en.wikipedia.org/wiki/Fatigue#See_also) - [12 References](https://en.wikipedia.org/wiki/Fatigue#References) - [13 Further reading](https://en.wikipedia.org/wiki/Fatigue#Further_reading) - [14 External links](https://en.wikipedia.org/wiki/Fatigue#External_links) Toggle the table of contents # Fatigue 63 languages - [à€…à€‚à€—à€żà€•à€Ÿ](https://anp.wikipedia.org/wiki/%E0%A4%A5%E0%A4%95%E0%A4%BE%E0%A4%A8 "à€„à€•à€Ÿà€š – Angika") - [Ű§Ù„ŰčŰ±ŰšÙŠŰ©](https://ar.wikipedia.org/wiki/%D8%A5%D8%B9%D9%8A%D8%A7%D8%A1 "Ű„ŰčÙŠŰ§ŰĄ – Arabic") - [Ű§Ù„ŰŻŰ§Ű±ŰŹŰ©](https://ary.wikipedia.org/wiki/%D8%B9%D9%8A%D8%A7 "ŰčÙŠŰ§ – Moroccan Arabic") - [БългарсĐșĐž](https://bg.wikipedia.org/wiki/%D0%A3%D0%BC%D0%BE%D1%80%D0%B0 "ĐŁĐŒĐŸŃ€Đ° – Bulgarian") - [Bosanski](https://bs.wikipedia.org/wiki/Umor "Umor – Bosnian") - [CatalĂ ](https://ca.wikipedia.org/wiki/Fatiga_muscular "Fatiga muscular – Catalan") - [閩東èȘž / MĂŹng-dÄ•Ì€ng-ngáčłÌ„](https://cdo.wikipedia.org/wiki/I%C3%B3k "IĂłk – Mindong") - [Ú©ÙˆŰ±ŰŻÛŒ](https://ckb.wikipedia.org/wiki/%D9%85%D8%A7%D9%86%D8%AF%D9%88%D9%88%DB%8C%DB%8C "Ù…Ű§Ù†ŰŻÙˆÙˆÛŒÛŒ – Central Kurdish") - [ČeĆĄtina](https://cs.wikipedia.org/wiki/%C3%9Anava "Únava – Czech") - [Cymraeg](https://cy.wikipedia.org/wiki/Blinder_meddwl "Blinder meddwl – Welsh") - [Dansk](https://da.wikipedia.org/wiki/Tr%C3%A6thed "TrĂŠthed – Danish") - [Dagbanli](https://dag.wikipedia.org/wiki/Wumsim "Wumsim – Dagbani") - [Deutsch](https://de.wikipedia.org/wiki/Fatigue "Fatigue – German") - [Esperanto](https://eo.wikipedia.org/wiki/Laceco "Laceco – Esperanto") - [Español](https://es.wikipedia.org/wiki/Cansancio "Cansancio – Spanish") - [Eesti](https://et.wikipedia.org/wiki/V%C3%A4simus "VĂ€simus – Estonian") - [Euskara](https://eu.wikipedia.org/wiki/Neke "Neke – Basque") - [ÙŰ§Ű±ŰłÛŒ](https://fa.wikipedia.org/wiki/%D8%AE%D8%B3%D8%AA%DA%AF%DB%8C "۟۳ŰȘÚŻÛŒ – Persian") - [Suomi](https://fi.wikipedia.org/wiki/V%C3%A4symys "VĂ€symys – Finnish") - [Français](https://fr.wikipedia.org/wiki/Fatigue_\(physiologie\) "Fatigue (physiologie) – French") - [Gaeilge](https://ga.wikipedia.org/wiki/Tuirse "Tuirse – Irish") - [Galego](https://gl.wikipedia.org/wiki/Cansazo "Cansazo – Galician") - [Hausa](https://ha.wikipedia.org/wiki/Rashin_karfi "Rashin karfi – Hausa") - [柹柶èȘž / Hak-kĂą-ngĂź](https://hak.wikipedia.org/wiki/Khioi "Khioi – Hakka Chinese") - [ŚąŚ‘ŚšŚ™ŚȘ](https://he.wikipedia.org/wiki/%D7%A2%D7%99%D7%99%D7%A4%D7%95%D7%AA "ŚąŚ™Ś™Ś€Ś•ŚȘ – Hebrew") - [à€čà€żà€šà„à€Šà„€](https://hi.wikipedia.org/wiki/%E0%A4%A5%E0%A4%95%E0%A4%BE%E0%A4%A8_\(%E0%A4%9A%E0%A4%BF%E0%A4%95%E0%A4%BF%E0%A4%A4%E0%A5%8D%E0%A4%B8%E0%A4%BE\) "à€„à€•à€Ÿà€š (à€šà€żà€•à€żà€€à„à€žà€Ÿ) – Hindi") - [Ő€ŐĄŐ”Ő„Ö€Ő„Ő¶](https://hy.wikipedia.org/wiki/%D4%B3%D5%A5%D6%80%D5%B0%D5%B8%D5%A3%D5%B6%D5%A1%D5%AE%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6 "ÔłŐ„Ö€Ő°ŐžŐŁŐ¶ŐĄŐźŐžÖ‚Ő©Ő”ŐžÖ‚Ő¶ – Armenian") - [Bahasa Indonesia](https://id.wikipedia.org/wiki/Kelelahan "Kelelahan – Indonesian") - [Italiano](https://it.wikipedia.org/wiki/Fatica "Fatica – Italian") - [æ—„æœŹèȘž](https://ja.wikipedia.org/wiki/%E7%96%B2%E5%8A%B4 "ç–Č抮 – Japanese") - [Taqbaylit](https://kab.wikipedia.org/wiki/Atmelli "Atmelli – Kabyle") - [ÒšĐ°Đ·Đ°Ò›ŃˆĐ°](https://kk.wikipedia.org/wiki/%D0%A8%D0%B0%D1%80%D1%88%D0%B0%D1%83 "йаршау – Kazakh") - [àȕàČšàłàČšàČĄ](https://kn.wikipedia.org/wiki/%E0%B2%86%E0%B2%AF%E0%B2%BE%E0%B2%B8 "àȆàČŻàČŸàČž – Kannada") - [한ꔭ얎](https://ko.wikipedia.org/wiki/%ED%94%BC%EB%A1%9C "í”ŒëĄœ – Korean") - [Latina](https://la.wikipedia.org/wiki/Fatigatio_\(symptoma\) "Fatigatio (symptoma) – Latin") - [LietuviĆł](https://lt.wikipedia.org/wiki/Nuovargis "Nuovargis – Lithuanian") - [Bahasa Melayu](https://ms.wikipedia.org/wiki/Keletihan "Keletihan – Malay") - [Nederlands](https://nl.wikipedia.org/wiki/Fatigue "Fatigue – Dutch") - [Livvinkarjala](https://olo.wikipedia.org/wiki/V%C3%A4zymys "VĂ€zymys – Livvi-Karelian") - [Polski](https://pl.wikipedia.org/wiki/Zm%C4%99czenie "Zmęczenie – Polish") - [PortuguĂȘs](https://pt.wikipedia.org/wiki/Fadiga "Fadiga – Portuguese") - [РуссĐșĐžĐč](https://ru.wikipedia.org/wiki/%D0%9F%D0%B5%D1%80%D0%B5%D1%83%D1%82%D0%BE%D0%BC%D0%BB%D0%B5%D0%BD%D0%B8%D0%B5 "ĐŸĐ”Ń€Đ”ŃƒŃ‚ĐŸĐŒĐ»Đ”ĐœĐžĐ” – Russian") - [Srpskohrvatski / српсĐșĐŸŃ…Ń€ĐČатсĐșĐž](https://sh.wikipedia.org/wiki/Umor "Umor – Serbo-Croatian") - [Simple English](https://simple.wikipedia.org/wiki/Fatigue "Fatigue – Simple English") - [Slovenčina](https://sk.wikipedia.org/wiki/%C3%9Anava_organizmu "Únava organizmu – Slovak") - [Slovenơčina](https://sl.wikipedia.org/wiki/Utrujenost "Utrujenost – Slovenian") - [Soomaaliga](https://so.wikipedia.org/wiki/Weyd "Weyd – Somali") - [Shqip](https://sq.wikipedia.org/wiki/Lodhja_\(trupore\) "Lodhja (trupore) – Albanian") - [СрпсĐșĐž / srpski](https://sr.wikipedia.org/wiki/%D0%A3%D0%BC%D0%BE%D1%80 "ĐŁĐŒĐŸŃ€ – Serbian") - [Svenska](https://sv.wikipedia.org/wiki/Tr%C3%B6tthet "Trötthet – Swedish") - [àź€àźźàźżàźŽàŻ](https://ta.wikipedia.org/wiki/%E0%AE%95%E0%AE%B3%E0%AF%88%E0%AE%AA%E0%AF%8D%E0%AE%AA%E0%AF%81 "àź•àźłàŻˆàźȘàŻàźȘàŻ – Tamil") - [ఀెà°Čుగు](https://te.wikipedia.org/wiki/%E0%B0%A8%E0%B1%80%E0%B0%B0%E0%B0%B8%E0%B0%82 "చీరఞం – Telugu") - [àč„àž—àžą](https://th.wikipedia.org/wiki/%E0%B8%84%E0%B8%A7%E0%B8%B2%E0%B8%A1%E0%B8%A5%E0%B9%89%E0%B8%B2 "àž„àž§àžČàžĄàž„àč‰àžČ – Thai") - [TĂŒrkçe](https://tr.wikipedia.org/wiki/H%C3%A2lsizlik "HĂąlsizlik – Turkish") - 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[Wikidata item](https://www.wikidata.org/wiki/Special:EntityPage/Q9690 "Structured data on this page hosted by Wikidata [g]") Appearance move to sidebar hide From Wikipedia, the free encyclopedia State of tiredness, exhaustion or loss of energy This article is about the medical term. For other uses, see [Fatigue (disambiguation)](https://en.wikipedia.org/wiki/Fatigue_\(disambiguation\) "Fatigue (disambiguation)"). Not to be confused with [Muscle weakness](https://en.wikipedia.org/wiki/Muscle_weakness "Muscle weakness") or [Lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"). Medical condition | Fatigue | | |---|---| | Other names | Exhaustion, weariness, tiredness, lethargy, listlessness | | [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/06/Cfs_woman_sketch.jpg/250px-Cfs_woman_sketch.jpg)](https://en.wikipedia.org/wiki/File:Cfs_woman_sketch.jpg) | | | Artistic representation of [ME/CFS](https://en.wikipedia.org/wiki/ME/CFS "ME/CFS") | | | [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [General practice](https://en.wikipedia.org/wiki/General_practice "General practice"), [primary care](https://en.wikipedia.org/wiki/Primary_care "Primary care") [![Edit this on Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q9690?uselang=en#P1995 "Edit this on Wikidata") | | Treatment | Avoid known stressors and unhealthy habits ([drug use](https://en.wikipedia.org/wiki/Substance_abuse "Substance abuse"), [excessive alcohol consumption](https://en.wikipedia.org/wiki/Excessive_alcohol_consumption "Excessive alcohol consumption"), smoking), healthy diet, exercise regularly, [medication](https://en.wikipedia.org/wiki/Medication "Medication"), [hydration](https://en.wikipedia.org/wiki/Drinking "Drinking"), and [vitamins](https://en.wikipedia.org/wiki/Vitamins "Vitamins") | **Fatigue** is a state of being without energy for a prolonged period of time.[\[1\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-2023-1)[\[2\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Cancer-terms-2023-2) The word *fatigue* is used in two contexts: in the medical sense, and in the sense of normal tiredness. In the medical sense, fatigue is seen as a symptom, and is sometimes associated with medical conditions including [autoimmune disease](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease"), [organ failure](https://en.wikipedia.org/wiki/Organ_failure "Organ failure"), [mood disorders](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), [heart disease](https://en.wikipedia.org/wiki/Heart_disease "Heart disease"), [infectious diseases](https://en.wikipedia.org/wiki/Infectious_disease "Infectious disease"), and post-infectious-disease states.[\[3\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid23892338-3) However, fatigue is complex and in up to a third of primary care cases no medical or psychiatric diagnosis is found.[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4)[\[5\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Medically_unexplained_symptoms-2017-5)[\[6\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31574939-6) In the sense of tiredness, fatigue often follows prolonged physical or mental activity. Physical fatigue results from [muscle fatigue](https://en.wikipedia.org/wiki/Muscle_fatigue "Muscle fatigue") brought about by intense [physical activity](https://en.wikipedia.org/wiki/Physical_activity "Physical activity").[\[7\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-7)[\[8\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-8)[\[9\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-9) Mental fatigue results from prolonged periods of [cognitive](https://en.wikipedia.org/wiki/Cognition "Cognition") activity which impairs cognitive ability, can manifest as [sleepiness](https://en.wikipedia.org/wiki/Sleepiness "Sleepiness"), [lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"), or [directed attention fatigue](https://en.wikipedia.org/wiki/Directed_attention_fatigue "Directed attention fatigue"),[\[10\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Marcora_2009_857%E2%80%93864-10) and can also impair physical performance.[\[11\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Martin-11) ## Definition \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=1 "Edit section: Definition")\] Fatigue in a medical context is used to cover experiences of low energy that are not caused by normal life.[\[1\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-2023-1)[\[2\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Cancer-terms-2023-2) A 2021 review proposed a definition for fatigue as a starting point for discussion: *"A multi-dimensional phenomenon in which the biophysiological, cognitive, motivational and emotional state of the body is affected resulting in significant impairment of the individual's ability to function in their normal capacity"*.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Another definition is that fatigue is *"a significant subjective sensation of weariness, increasing sense of effort, mismatch between effort expended and actual performance, or exhaustion independent from medications, chronic pain, physical deconditioning, [anaemia](https://en.wikipedia.org/wiki/Anemia "Anemia"), respiratory dysfunction, [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)"), and sleep disorders"*.[\[13\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37180990-13) ### Terminology \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=2 "Edit section: Terminology")\] The use of the term *fatigue* in medical contexts may carry inaccurate connotations from the more general usage of the same word. More accurate terminology may also be needed for variants within the umbrella term of fatigue.[\[14\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-14) ### Comparison with other terms \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=3 "Edit section: Comparison with other terms")\] #### Tiredness \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=4 "Edit section: Tiredness")\] Tiredness which is a normal result of [work](https://en.wikipedia.org/wiki/Work_\(human_activity\) "Work (human activity)"), mental [stress](https://en.wikipedia.org/wiki/Stress_\(medicine\) "Stress (medicine)"), [anxiety](https://en.wikipedia.org/wiki/Anxiety "Anxiety"), overstimulation and understimulation, [jet lag](https://en.wikipedia.org/wiki/Jet_lag "Jet lag"), active [recreation](https://en.wikipedia.org/wiki/Recreation "Recreation"), [boredom](https://en.wikipedia.org/wiki/Boredom "Boredom"), or [lack of sleep](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") is not considered medical fatigue. This is the tiredness described in MeSH Descriptor Data.[\[15\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-15) #### Exhaustion \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=5 "Edit section: Exhaustion")\] Exhaustion is a state of extreme tiredness.[\[16\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-16) #### Sleepiness \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=6 "Edit section: Sleepiness")\] Sleepiness refers to a tendency to fall asleep, whereas fatigue refers to an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion. Sleepiness and fatigue often coexist as a consequence of sleep deprivation.[\[17\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-17) However sleepiness and fatigue may not correlate.[\[18\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-18) Fatigue is generally considered a longer-term condition than sleepiness (somnolence).[\[19\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid16376590-19) ## Classification \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=7 "Edit section: Classification")\] ### ICD-11 \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=8 "Edit section: ICD-11")\] "Fatigue" is categorised as [ICD-11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11") code MG22.[\[20\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-20) ## Presentation \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=9 "Edit section: Presentation")\] ### Common features \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=10 "Edit section: Common features")\] Distinguishing features of medical fatigue include: - unpredictability, - variability in severity, - fatigue being relatively profound/overwhelming, and having extensive impact on daily living, - lack of improvement with rest, - where an underlying disease is present, the amount of fatigue is often not commensurate with the severity of the underlying disease.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12)[\[21\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-21)[\[22\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Swain2006-22)[\[23\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-23) ### Differentiating features \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=11 "Edit section: Differentiating features")\] Differentiating characteristics of fatigue that may help identify the possible cause of fatigue include: - [Post-exertional malaise](https://en.wikipedia.org/wiki/Post-exertional_malaise "Post-exertional malaise"); a common feature of [ME/CFS](https://en.wikipedia.org/wiki/ME/CFS "ME/CFS"),[\[24\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-24) and experienced by a significant proportion of people with [Long Covid](https://en.wikipedia.org/wiki/Long_Covid "Long Covid"),[\[25\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-25) but not a feature of other fatigues. - Increased by heat or cold; [MS fatigue](https://en.wikipedia.org/wiki/Signs_and_symptoms_of_multiple_sclerosis#Fatigue "Signs and symptoms of multiple sclerosis") is in many cases affected in this way.[\[26\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto5-26)[\[27\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-27) - Flare-ups and Remissions; Some fatigue diseases have flareups of a few weeks ([lupus](https://en.wikipedia.org/wiki/Lupus "Lupus"),[\[28\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-28)[\[29\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-29) [fibromyalgia](https://en.wikipedia.org/wiki/Fibromyalgia "Fibromyalgia")[\[30\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-30)). Other fatigue diseases may have longer patterns of activity and remission, or no remissions at all (MS[\[31\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-32)[\[33\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto3-33)). - Variability within a day; Some fatigues ([rheumatoid arthritis (RA)](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis"),[\[34\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto-34) [cancer-related fatigue](https://en.wikipedia.org/wiki/Cancer-related_fatigue "Cancer-related fatigue")[\[35\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-35)) seem to often be continual (24/7), whilst others (MS, Sjögren's, lupus, brain injury[\[36\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-36)[\[37\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-37)) often vary in intensity at different times within a day.[\[34\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto-34) A 2010 study found that Sjögren's patients reported fatigue after rising, an improvement in mid-morning, and worsening later in the day, whereas lupus (SLE) patients reported lower fatigue after rising followed by increasing fatigue through the day.[\[38\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto1-38) ME/CFS symptoms can be continual, or can fluctuate during the day, from day to day, and over longer periods.[\[33\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto3-33) Fibromyalgia fatigue can be continual or variable.[\[39\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-39) - The pace of onset may be a related differentiating factor; MS fatigue can have abrupt onset.[\[40\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-40) - Feeling of weight; some fatigues, including that caused by MS, create a sense of weight or gravity; *"I feel like I have lead weights attached to my limbs ... or I am being pulled down by gravity."*[\[41\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-41) Some people may have multiple causes of fatigue. ## Causes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=12 "Edit section: Causes")\] Fatigue is complex and can be driven and maintained by a potentially wide range of [biopsychosocial factors](https://en.wikipedia.org/wiki/Biopsychosocial_model "Biopsychosocial model").[\[42\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-w053-42) Tiredness is a common [medically unexplained symptom](https://en.wikipedia.org/wiki/Medically_unexplained_physical_symptoms "Medically unexplained physical symptoms").[\[5\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Medically_unexplained_symptoms-2017-5) In up to a third of fatigue primary care cases, no medical or psychiatric diagnosis is found.[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4)[\[5\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Medically_unexplained_symptoms-2017-5)[\[6\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31574939-6) ### Adverse life events \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=13 "Edit section: Adverse life events")\] Adverse life events have been associated with fatigue.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ### Drug use \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=14 "Edit section: Drug use")\] A 2021 study in a Korean city found that alcohol consumption was the variable with the most correlation with overall fatigue.[\[43\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-43) A 2020 Norway study found that 69% of substance use disorder patients had severe fatigue symptoms, and particularly those with extensive use of [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepines "Benzodiazepines").[\[44\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto4-44) Causality, as opposed to correlation, were not proven in these studies.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] ### Digital screen use \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=15 "Edit section: Digital screen use")\] The protracted use of digital screens—such as those associated with computers, laptops and smartphones—can cause eye fatigue, and induce a general state of mental and physical exhaustion.[\[45\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-45) Specific symptoms may include sore eyes, blurred vision, headaches and associated orthopedic issues such as a sore neck and back. These symptoms collectively are known as [computer vision syndrome](https://en.wikipedia.org/wiki/Computer_vision_syndrome "Computer vision syndrome") (CVS) or in colloquial parlance as *screen fatigue*.[\[46\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-46) ### Sleep disturbance \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=16 "Edit section: Sleep disturbance")\] Fatigue can often be traced to poor sleep habits.[\[47\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-Causes-2023-47) [Sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") and disruption is associated with subsequent fatigue.[\[48\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-48)[\[49\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-49) Sleep disturbances due to disease may impact fatigue.[\[50\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-50)[\[51\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-51) Caffeine and alcohol can disrupt sleep, causing fatigue.[\[52\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Tiredness-and_fatigue-2018-52) ### Medications \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=17 "Edit section: Medications")\] Fatigue may be a side effect of certain [medications](https://en.wikipedia.org/wiki/Medication "Medication") (e.g., [lithium salts](https://en.wikipedia.org/wiki/Lithium_salt "Lithium salt"), [ciprofloxacin](https://en.wikipedia.org/wiki/Ciprofloxacin "Ciprofloxacin")); [beta blockers](https://en.wikipedia.org/wiki/Beta_blocker "Beta blocker"), which can induce [exercise intolerance](https://en.wikipedia.org/wiki/Exercise_intolerance "Exercise intolerance"), medicines used to treat allergies or coughs,[\[47\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-Causes-2023-47) and many cancer treatments, particularly [chemotherapy](https://en.wikipedia.org/wiki/Chemotherapy "Chemotherapy") and [radiotherapy](https://en.wikipedia.org/wiki/Radiotherapy "Radiotherapy"). Use of [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepines "Benzodiazepines") has been found to correlate with higher fatigue.[\[44\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto4-44) ### Association with diseases and illnesses \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=18 "Edit section: Association with diseases and illnesses")\] Fatigue is often associated with diseases and conditions. Some major categories of conditions that often list fatigue as a symptom include physical diseases, substance use illness, mental illnesses, and other diseases and conditions.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] #### Physical diseases \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=19 "Edit section: Physical diseases")\] - [autoimmune diseases](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease"),[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) such as [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease"), [lupus](https://en.wikipedia.org/wiki/Lupus "Lupus"), [multiple sclerosis](https://en.wikipedia.org/wiki/Signs_and_symptoms_of_multiple_sclerosis#fatigue "Signs and symptoms of multiple sclerosis"), [myasthenia gravis](https://en.wikipedia.org/wiki/Myasthenia_gravis "Myasthenia gravis"), [NMOSD](https://en.wikipedia.org/wiki/NMOSD "NMOSD"), [Sjögren's syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_syndrome "Sjögren's syndrome"),[\[38\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto1-38) [rheumatoid arthritis](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis"),[\[54\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-54)[\[55\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-55)[\[56\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-56)[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) [spondyloarthropathy](https://en.wikipedia.org/wiki/Spondyloarthropathy "Spondyloarthropathy") and [UCTD](https://en.wikipedia.org/wiki/UCTD "UCTD");[\[57\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-57) this population's primary concern is fatigue;[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53)[\[58\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-58) - [blood disorders](https://en.wikipedia.org/wiki/Blood_disorders "Blood disorders"), such as [anemia](https://en.wikipedia.org/wiki/Anemia "Anemia") and [hemochromatosis](https://en.wikipedia.org/wiki/Hemochromatosis "Hemochromatosis");[\[59\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Cleveland_Clinic_medical_professional_2022_z395-59)[\[60\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Hamilton_2022_g129-60) - [brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury");[\[61\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-61)[\[62\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-62) - [cancer](https://en.wikipedia.org/wiki/Cancer "Cancer"), in which case it is called [cancer fatigue](https://en.wikipedia.org/wiki/Cancer_fatigue "Cancer fatigue");[\[63\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-63) - [COVID-19](https://en.wikipedia.org/wiki/COVID-19 "COVID-19") and [long COVID](https://en.wikipedia.org/wiki/Long_COVID "Long COVID");[\[64\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-64) - [endocrine diseases](https://en.wikipedia.org/wiki/Endocrine_disease "Endocrine disease") or [metabolic disorders](https://en.wikipedia.org/wiki/Metabolic_disorder "Metabolic disorder"): [diabetes mellitus](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism") and [Addison's disease](https://en.wikipedia.org/wiki/Addison%27s_disease "Addison's disease");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [fibromyalgia](https://en.wikipedia.org/wiki/Fibromyalgia "Fibromyalgia");[\[66\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Beyond_pain-66) - [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") and [heart attack](https://en.wikipedia.org/wiki/Heart_attack "Heart attack");[\[67\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-67) - [HIV](https://en.wikipedia.org/wiki/HIV "HIV")[\[68\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Fatigue_Symptom_Management-68) - [inborn errors of metabolism](https://en.wikipedia.org/wiki/Inborn_error_of_metabolism "Inborn error of metabolism") such as [fructose malabsorption](https://en.wikipedia.org/wiki/Fructose_malabsorption "Fructose malabsorption");[\[69\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-69)[\[70\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-70) - [infectious diseases](https://en.wikipedia.org/wiki/Infectious_diseases "Infectious diseases") such as [infectious mononucleosis](https://en.wikipedia.org/wiki/Infectious_mononucleosis "Infectious mononucleosis") or [tuberculosis](https://en.wikipedia.org/wiki/Tuberculosis "Tuberculosis");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome");[\[71\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Fatigue_in_irritable_bowel_syndrome-71) - [kidney diseases](https://en.wikipedia.org/wiki/Kidney_disease "Kidney disease"), e.g., [acute renal failure](https://en.wikipedia.org/wiki/Acute_renal_failure "Acute renal failure"), [chronic renal failure](https://en.wikipedia.org/wiki/Chronic_renal_failure "Chronic renal failure");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [leukemia](https://en.wikipedia.org/wiki/Leukemia "Leukemia") or [lymphoma](https://en.wikipedia.org/wiki/Lymphoma "Lymphoma");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [liver failure](https://en.wikipedia.org/wiki/Liver_failure "Liver failure") or liver diseases, e.g., [hepatitis](https://en.wikipedia.org/wiki/Hepatitis "Hepatitis");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65)[\[22\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Swain2006-22) - [Low blood pressure](https://en.wikipedia.org/wiki/Hypotension "Hypotension") - [Lyme disease](https://en.wikipedia.org/wiki/Lyme_disease "Lyme disease");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [neurological disorders](https://en.wikipedia.org/wiki/Neurological_disorder "Neurological disorder") such as [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy"), [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease"), [postural orthostatic tachycardia syndrome](https://en.wikipedia.org/wiki/Postural_Orthostatic_Tachycardia_Syndrome "Postural Orthostatic Tachycardia Syndrome") (POTS) and [post-concussion syndrome](https://en.wikipedia.org/wiki/Post-concussion_syndrome "Post-concussion syndrome");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - nutritional deficiencies, such as, [sodium](https://en.wikipedia.org/wiki/Hyponatremia "Hyponatremia"), [iron](https://en.wikipedia.org/wiki/Iron-deficiency_anemia "Iron-deficiency anemia"), [vitamin B12](https://en.wikipedia.org/wiki/Vitamin_B12_deficiency "Vitamin B12 deficiency"), and [folate](https://en.wikipedia.org/wiki/Folate_deficiency "Folate deficiency") deficiencies - [physical trauma](https://en.wikipedia.org/wiki/Physical_trauma "Physical trauma") and other [pain](https://en.wikipedia.org/wiki/Pain "Pain")\-causing conditions, such as [arthritis](https://en.wikipedia.org/wiki/Arthritis "Arthritis");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") or [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder"), e.g. [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [stroke](https://en.wikipedia.org/wiki/Stroke "Stroke")\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [thyroid disease](https://en.wikipedia.org/wiki/Thyroid_disease "Thyroid disease") such as [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - sarcoidosis - [mast cell activation syndrome](https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome "Mast cell activation syndrome")[\[72\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMID33261124-72)[\[73\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMID28262205-73)[\[74\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMID38948000-74) #### Mental illnesses \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=20 "Edit section: Mental illnesses")\] - [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder"), such as [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder");[\[75\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-DSM5-75) - [developmental disorders](https://en.wikipedia.org/wiki/Developmental_disorder "Developmental disorder") such as [autism spectrum disorder](https://en.wikipedia.org/wiki/Autism_spectrum "Autism spectrum");[\[76\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Williams_Gotham_p.-76) - [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder");[\[77\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-77)[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) - [eating disorders](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder"), which can produce fatigue due to inadequate nutrition;\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] #### Other \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=21 "Edit section: Other")\] - [myalgic encephalomyelitis/chronic fatigue syndrome](https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome "Myalgic encephalomyelitis/chronic fatigue syndrome") (ME/CFS)[\[78\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-78) - [idiopathic chronic fatigue](https://en.wikipedia.org/wiki/Idiopathic_chronic_fatigue "Idiopathic chronic fatigue"), a term used to describe chronic fatigue which does not have symptoms of ME/CFS.[\[79\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMC6522773-79)[\[80\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-80) However ICF does not have a dedicated diagnostic code in the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization")'s [ICD-11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11") classification.[\[81\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-81) - [Gulf War syndrome](https://en.wikipedia.org/wiki/Gulf_War_syndrome "Gulf War syndrome");[\[82\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-82) #### Primary vs. secondary \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=22 "Edit section: Primary vs. secondary")\] In some areas, it has been proposed that fatigue be separated into - primary fatigue, caused directly by a disease process, and - ordinary or secondary fatigue, caused by a range of causes including exertion and also secondary impacts on a person of having a disease (such as disrupted sleep).[\[83\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-83)[\[84\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-84)[\[85\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Gerber_et_al_2019-85)[\[86\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-86)[\[87\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-87)[\[88\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-88) The ICD-11 MG22 definition of fatigue[\[89\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-89) captures both types of fatigue; it includes fatigue that "occur\[s\] in the absence of... exertion... as a symptom of health conditions."\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] ### Obesity \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=23 "Edit section: Obesity")\] Obesity correlates with higher fatigue levels and incidence.[\[90\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-90)[\[91\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid15851643-91)[\[92\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-92) ### Somatic symptom disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=24 "Edit section: Somatic symptom disorder")\] In [somatic symptom disorder](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder")[\[93\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-93) the patient is overfocused on a physical symptom, such as fatigue, that may or may not be explained by a medical condition.[\[94\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-94)[\[95\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-95)[\[96\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-96) ### Scientifically unsupported causes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=25 "Edit section: Scientifically unsupported causes")\] The concept of [adrenal fatigue](https://en.wikipedia.org/wiki/Adrenal_fatigue "Adrenal fatigue") is often raised in media but no scientific basis has been found for it.[\[97\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-97)[\[98\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-webmd-98)[\[99\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-99) ## Mechanisms \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=26 "Edit section: Mechanisms")\] The mechanisms that cause fatigue are not well understood.[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) Several mechanisms may be in operation within a patient,[\[100\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31682277-100) with the relative contribution of each mechanism differing over time.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Proposed fatigue explanations due to permanent changes in the brain may have difficulty in explaining the "unpredictability" and "variability" (i.e. appearing intermittently during the day, and not on all days) of the fatigue associated with inflammatory rheumatic diseases and autoimmune diseases (such as [multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis")).[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ### Inflammation \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=27 "Edit section: Inflammation")\] Inflammation distorts neural chemistry, brain function and functional connectivity across a broad range of brain networks,[\[101\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-101) and has been linked to many types of fatigue.[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53)[\[102\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-102) Findings implicate [neuroinflammation](https://en.wikipedia.org/wiki/Neuroinflammation "Neuroinflammation") in the [etiology](https://en.wikipedia.org/wiki/Etiology "Etiology") of fatigue in [autoimmune](https://en.wikipedia.org/wiki/Autoimmunity "Autoimmunity") and related disorders.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12)[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) Low-grade [inflammation](https://en.wikipedia.org/wiki/Inflammation "Inflammation") may cause an imbalance between energy availability and expenditure.[\[103\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-103) [Cytokines](https://en.wikipedia.org/wiki/Cytokines "Cytokines") are small protein molecules that modulate immune responses and inflammation (as well as other functions) and may have causal roles in fatigue.[\[104\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-104)[\[105\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Tarn_Evans_Traianos_et_al_2023-105) However a 2019 review was inconclusive as to whether cytokines play any definitive role in [ME/CFS](https://en.wikipedia.org/wiki/ME/CFS "ME/CFS").[\[106\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-106) ### Reduced brain connectivity \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=28 "Edit section: Reduced brain connectivity")\] Fatigue has been correlated with reductions in structural and functional connectivity in the brain.[\[107\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Qi-2019-107) This has included in post-stroke,[\[108\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-108) MS,[\[109\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-109) NMOSD and MOG,[\[13\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37180990-13) and ME/CFS.[\[110\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-110) This was also found for fatigue after brain injury,[\[111\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid35221951-111) including a significant linear correlation between self-reported fatigue and brain functional connectivity.[\[112\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid26878885-112) Areas of the brain for which there is evidence of relation to fatigue are the [thalamus](https://en.wikipedia.org/wiki/Thalamus "Thalamus") and middle frontal cortex,[\[112\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid26878885-112) fronto-parietal and cingulo-opercular,[\[111\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid35221951-111) and default mode network, salience network, and thalamocortical loop areas.[\[107\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Qi-2019-107)[\[113\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-113) A 2024 review found that structural connectivity changes may underlie fatigue in pwRRMS but that the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies.[\[114\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-114) A small 2023 study found that infratentorial lesion volume (cerebellar and brainstem) was a relatively good predictor of RRMS fatigue severity.[\[115\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-115) ### Damage to brain white matter \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=29 "Edit section: Damage to brain white matter")\] Studies have found [MS fatigue](https://en.wikipedia.org/wiki/Signs_and_symptoms_of_multiple_sclerosis#Fatigue "Signs and symptoms of multiple sclerosis") correlates with damage to NAWM (normal appearing [white matter](https://en.wikipedia.org/wiki/White_matter "White matter")) (which will not show on normal [MRI](https://en.wikipedia.org/wiki/Magnetic_resonance_imaging "Magnetic resonance imaging") but will show on [DTI (diffusion tensor imaging)](https://en.wikipedia.org/wiki/Diffusion_MRI "Diffusion MRI")).[\[116\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-116)[\[13\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37180990-13)[\[117\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-117)[\[118\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-118)[\[119\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-119)[\[120\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-120) The correlation becomes unreliable in patients aged over 65 due to damage due to ageing.[\[121\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-121) ### Heat shock proteins \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=30 "Edit section: Heat shock proteins")\] A small 2016 study found that primary [Sjögren's syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_syndrome "Sjögren's syndrome") patients with high fatigue, when compared with those with low fatigue, had significantly higher plasma concentrations of [HSP90α](https://en.wikipedia.org/wiki/Hsp90 "Hsp90"), and a tendency to higher concentrations of HSP72.[\[122\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-122) A small 2020 study of Crohn's disease patients found that higher fatigue visual analogue scale (fVAS) scores correlated with higher HSP90α levels.[\[123\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31601148-123) A related small 2012 trial investigating if application of an IL-1 receptor antagonist ([anakinra](https://en.wikipedia.org/wiki/Anakinra "Anakinra")) would reduce fatigue in primary Sjögren's syndrome patients was inconclusive.[\[124\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-124)[\[125\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-125)[\[126\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-126) ## Measurement \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=31 "Edit section: Measurement")\] Fatigue is currently measured by many different self-measurement surveys.[\[127\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-127) Examples are the Fatigue Symptom Inventory (FSI)[\[128\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-128)[\[129\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-129)[\[130\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-130) and the Fatigue Severity Scale.[\[131\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-131)[\[132\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-132)[\[133\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-133) There is no consensus on best practice,[\[134\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-134) and the existing surveys do not capture the intermittent nature of some forms of fatigue. [Heart rate variability](https://en.wikipedia.org/wiki/Heart_rate_variability "Heart rate variability") cannot currently distinguish between physical fatigue and mental fatigue.[\[135\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37637168-135) Many studies have shown that [salivary](https://en.wikipedia.org/wiki/Saliva "Saliva") [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol") can measure mental fatigue.[\[135\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37637168-135) ## Diagnosis \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=32 "Edit section: Diagnosis")\] ### Diagnosis guidance \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=33 "Edit section: Diagnosis guidance")\] A 2023 guidance indicates the following[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4) - in the primary care setting, a medical or psychiatric diagnosis is found in at least two-thirds of patients; - the most common diagnoses are [viral illness](https://en.wikipedia.org/wiki/Viral_disease "Viral disease"), upper respiratory infection, iron-deficiency anaemia, acute bronchitis, adverse effects of a medical agent in the proper dose, and depression or other mental disorder, such as panic disorder, and [somatisation disorder](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder"); - the origin of fatigue may be central, brain-derived, or peripheral, usually of a neuromuscular origin—it may be attributed to physical illness, psychological (e.g., psychiatric disorder), social (e.g., family problems), and physiological factors (e.g., old age), occupational illness (e.g., workplace stress); - when unexplained, clinically evaluated chronic fatigue can be separated into [ME/CFS](https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome "Myalgic encephalomyelitis/chronic fatigue syndrome") and [idiopathic chronic fatigue](https://en.wikipedia.org/wiki/Idiopathic_chronic_fatigue "Idiopathic chronic fatigue").[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4) A 2016 German review found that - about 20% of people complaining of tiredness to a GP (general practitioner) suffered from a depressive disorder. - [anaemia](https://en.wikipedia.org/wiki/Anemia "Anemia"), malignancies and other serious somatic diseases were only very rarely found in fatigued primary care patients, with prevalence rates hardly differing from non-fatigued patients. - if fatigue occurred in primary care patients as an isolated symptom without additional abnormalities in the medical history and in the clinical examination, then extensive diagnostic testing rarely helped detect serious diseases. Such testing might also lead to false-positive tests.[\[136\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-136) A 2014 Australian review recommended that a period of watchful waiting may be appropriate if there are no major warning signs.[\[137\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-137) A 2009 study found that about 50% of people who had fatigue received a diagnosis that could explain the fatigue after a year with the condition. In those people who had a possible diagnosis, musculoskeletal (19.4%) and psychological problems (16.5%) were the most common. Definitive physical conditions were only found in 8.2% of cases.[\[138\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid19858240-138) ### Classification \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=34 "Edit section: Classification")\] #### By type \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=35 "Edit section: By type")\] ##### Uni- or multi-dimensional \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=36 "Edit section: Uni- or multi-dimensional")\] Fatigue can be seen as a uni-dimensional phenomenon that influences different aspects of human life.[\[139\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-139)[\[140\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-140) It can be multi-faceted and broadly defined, making understanding the causes of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases.[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) A 2021 review considered that different "types/subsets" of fatigue may exist and that patients normally present with more than one such "type/subset". These different "types/subsets" of fatigue may be different dimensions of the same symptom, and the relative manifestations of each may depend on the relative contribution of different mechanisms. Inflammation may be the root causal mechanism in many cases.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ##### Physical \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=37 "Edit section: Physical")\] Physical fatigue, or [muscle fatigue](https://en.wikipedia.org/wiki/Muscle_fatigue "Muscle fatigue"), is the temporary physical inability of muscles to perform optimally. The onset of muscle fatigue during physical activity is gradual, and depends upon an individual's level of physical fitness – other factors include [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") and overall health.[\[141\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-WebMD-141) Physical fatigue can be caused by a lack of energy in the muscle, by a decrease of the efficiency of the [neuromuscular junction](https://en.wikipedia.org/wiki/Neuromuscular_junction "Neuromuscular junction") or by a reduction of the drive originating from the [central nervous system](https://en.wikipedia.org/wiki/Central_nervous_system "Central nervous system"), and can be reversed by rest.[\[142\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-142) The central component of fatigue is triggered by an increase of the level of [serotonin](https://en.wikipedia.org/wiki/Serotonin "Serotonin") in the central nervous system.[\[143\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid10919962-143) During motor activity, serotonin released in synapses that contact [motor neurons](https://en.wikipedia.org/wiki/Motor_neuron "Motor neuron") promotes [muscle contraction](https://en.wikipedia.org/wiki/Muscle_contraction "Muscle contraction").[\[144\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-144) During high level of motor activity, the amount of serotonin released increases and a spillover occurs. Serotonin binds to extrasynaptic receptors located on the [axonal initial segment](https://en.wikipedia.org/wiki/Axonal_initial_segment "Axonal initial segment") of motor neurons with the result that [nerve impulse](https://en.wikipedia.org/wiki/Action_potential "Action potential") initiation and thereby muscle contraction are inhibited.[\[145\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-145) Muscle strength testing can be used to determine the presence of a [neuromuscular disease](https://en.wikipedia.org/wiki/Neuromuscular_disease "Neuromuscular disease"), but cannot determine its cause. Additional testing, such as [electromyography](https://en.wikipedia.org/wiki/Electromyography "Electromyography"), can provide diagnostic information, but information gained from muscle strength testing alone is not enough to diagnose most neuromuscular disorders.[\[146\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-146) ##### Mental \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=38 "Edit section: Mental")\] Mental fatigue is a temporary inability to maintain optimal cognitive performance. The onset of mental fatigue during any cognitive activity is gradual, and depends upon an individual's cognitive ability, and also upon other factors, such as sleep deprivation and overall health. Mental fatigue has also been shown to decrease physical performance.[\[10\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Marcora_2009_857%E2%80%93864-10) It can manifest as [somnolence](https://en.wikipedia.org/wiki/Somnolence "Somnolence"), [lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"), [directed attention fatigue](https://en.wikipedia.org/wiki/Directed_attention_fatigue "Directed attention fatigue"), or disengagement. Research also suggests that mental fatigue is closely linked to the concept of [ego depletion](https://en.wikipedia.org/wiki/Ego_depletion "Ego depletion"), though the validity of the concept is disputed. For example, one pre-registered study of 686 participants found that after exerting mental effort, people are likely to disengage and become less interested in exerting further effort.[\[147\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-147) Decreased attention can also be described as a more or less decreased [level of consciousness](https://en.wikipedia.org/wiki/Level_of_consciousness "Level of consciousness").[\[148\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-148) In any case, this can be dangerous when performing tasks that require constant concentration, such as operating large vehicles. For instance, a person who is sufficiently somnolent may experience [microsleep](https://en.wikipedia.org/wiki/Microsleep "Microsleep"). However, objective cognitive testing can be used to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.[\[149\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid29355911-149)[\[150\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid30884965-150)[\[151\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid38079429-151) The [perception](https://en.wikipedia.org/wiki/Perception "Perception") of mental fatigue is believed to be modulated by the brain's [reticular activating system](https://en.wikipedia.org/wiki/Reticular_activating_system "Reticular activating system") (RAS).[\[152\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid24926625-152)[\[153\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid28690375-153)[\[154\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31216564-154)[\[155\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37155119-155)[\[156\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31751025-156) Fatigue impacts a driver's reaction time, awareness of hazards around them and their attention. Drowsy drivers are three times more likely to be involved in a car crash, and being awake over 20 hours is the equivalent of driving with a blood-alcohol concentration level of 0.08%.[\[157\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-157) ##### Neurological fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=39 "Edit section: Neurological fatigue")\] People with [multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis") experience a form of overwhelming tiredness that can occur at any time of the day, for any duration, and that does not necessarily recur in a recognizable pattern for any given patient, referred to as "neurological fatigue", and often as "multiple sclerosis fatigue" or "lassitude".[\[158\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid32672087-158)[\[159\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-159)[\[160\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-160) People with [autoimmune diseases](https://en.wikipedia.org/wiki/Autoimmune_diseases "Autoimmune diseases") including inflammatory rheumatic diseases such as [rheumatoid arthritis](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis"), [psoriatic arthritis](https://en.wikipedia.org/wiki/Psoriatic_arthritis "Psoriatic arthritis") and primary [Sjögren's syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_syndrome "Sjögren's syndrome"), experience similar fatigue.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12)[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) Attempts have been made to isolate causes of [central nervous system fatigue](https://en.wikipedia.org/wiki/Central_nervous_system_fatigue "Central nervous system fatigue"). #### By timescale \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=40 "Edit section: By timescale")\] Acute Acute fatigue is that which is temporary and self-limited. Acute fatigue is most often caused by an [infection](https://en.wikipedia.org/wiki/Infection "Infection") such as the [common cold](https://en.wikipedia.org/wiki/Common_cold "Common cold") and can be cognized as one part of the [sickness behavior](https://en.wikipedia.org/wiki/Sickness_behavior "Sickness behavior") response occurring when the [immune system](https://en.wikipedia.org/wiki/Immune_system "Immune system") fights an [infection](https://en.wikipedia.org/wiki/Infection "Infection").[\[161\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Brain,_Behavior,_and_Immunity_2012_pp._552%E2%80%93558-161) Other common causes of acute fatigue include [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") and chemical causes, such as [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration"), [poisoning](https://en.wikipedia.org/wiki/Poison "Poison"), [low blood sugar](https://en.wikipedia.org/wiki/Low_blood_sugar "Low blood sugar"), or [mineral](https://en.wikipedia.org/wiki/Mineral_\(nutrient\) "Mineral (nutrient)") or [vitamin](https://en.wikipedia.org/wiki/Vitamin "Vitamin") deficiencies. Prolonged Prolonged fatigue is a self-reported, persistent (constant) fatigue lasting at least one month.[\[162\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34589772-162)[\[163\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid18458765-163) Chronic Chronic fatigue is a self-reported fatigue lasting at least 6 consecutive months. Chronic fatigue may be either persistent or relapsing.[\[164\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-CDC1994-164) Chronic fatigue is a symptom of many chronic illnesses and of [idiopathic chronic fatigue](https://en.wikipedia.org/wiki/Idiopathic_chronic_fatigue "Idiopathic chronic fatigue").[\[165\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-mitochondrial_content-165) #### By effect \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=41 "Edit section: By effect")\] Fatigue can have significant negative impacts on quality of life.[\[166\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-166) Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, [Myalgic Encephalomyelitis/chronic fatigue syndrome](https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome "Myalgic encephalomyelitis/chronic fatigue syndrome"), and rheumatoid arthritis.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Fatigue has been described by sufferers as 'incomprehensible' due to its unpredictable occurrence, lack of relationship to physical effort and different character as compared to tiredness.[\[167\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-167) #### WHO classification \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=42 "Edit section: WHO classification")\] The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization")'s [ICD-11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11") classification[\[168\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-ICD-11-168) includes a category MG22 Fatigue (typically fatigue following exertion but sometimes may occur in the absence of such exertion as a symptom of health conditions), and many other categories where fatigue is mentioned as a secondary result of other factors.[\[169\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-169) It does not include any fatigue-based psychiatric illness (unless it is accompanied by related psychiatric symptoms).[\[170\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Desai2018-170)[\[171\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid32701520-171) [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") lists 'fatigue or loss of energy nearly every day' as one factor in diagnosing depression.[\[172\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-172) ## Treatment and management \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=43 "Edit section: Treatment and management")\] Management may include review of factors and methods as explained below.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] ### Cessation of medications causing fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=44 "Edit section: Cessation of medications causing fatigue")\] Taking of medications with side effects of contributing to fatigue may be ceased.[\[173\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-173) [\[47\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-Causes-2023-47)[\[174\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-174)\[*[better source needed](https://en.wikipedia.org/wiki/Wikipedia:Verifiability#Questionable_sources "Wikipedia:Verifiability")*\][\[175\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-175) ### Medications to treat fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=45 "Edit section: Medications to treat fatigue")\] See also: [List of investigational fatigue drugs](https://en.wikipedia.org/wiki/List_of_investigational_fatigue_drugs "List of investigational fatigue drugs") The UK [NICE](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence") recommends consideration of [amantadine](https://en.wikipedia.org/wiki/Amantadine "Amantadine"), [modafinil](https://en.wikipedia.org/wiki/Modafinil "Modafinil"), and [selective serotonin reuptake inhibitors](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRIs) for MS fatigue.[\[176\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-176) A [PCORI](https://en.wikipedia.org/wiki/Patient-Centered_Outcomes_Research_Institute "Patient-Centered Outcomes Research Institute") review, however, found amantadine, methylphenidate, and modafinil no more effective than placebo in reducing fatigue, with side effects reported.[\[177\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-177) [Psychostimulants](https://en.wikipedia.org/wiki/Psychostimulant "Psychostimulant") such as [methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate"), [amphetamines](https://en.wikipedia.org/wiki/Amphetamine-type_stimulant "Amphetamine-type stimulant"), and modafinil have been used in the treatment of fatigue related to [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)"),[\[178\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid18425966-178)[\[179\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid19281939-179)[\[180\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid26906078-180)[\[181\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34144366-181) and [medical illness](https://en.wikipedia.org/wiki/Medical_illness "Medical illness") such as [chronic fatigue syndrome](https://en.wikipedia.org/wiki/Chronic_fatigue_syndrome "Chronic fatigue syndrome")[\[182\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid20088743-182)[\[183\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid18505357-183) and [cancer](https://en.wikipedia.org/wiki/Cancer "Cancer").[\[179\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid19281939-179)[\[184\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid8856815-184)[\[185\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid20870637-185)[\[186\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid21251796-186)[\[187\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid24416225-187)[\[188\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid25299141-188)[\[189\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid25814977-189) They have also been used to counteract fatigue in [sleep loss](https://en.wikipedia.org/wiki/Sleep_loss "Sleep loss")[\[190\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid16268386-190) and in [aviation](https://en.wikipedia.org/wiki/Aviation "Aviation").[\[191\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid33754977-191) ### Mental health tools \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=46 "Edit section: Mental health tools")\] [CBT](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") can be useful for fatigue,[\[192\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-192)[\[193\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto2-193) including ME/CFS[\[194\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-194)[\[195\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-195) but is not included in [NICE](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence") guidelines for ME/CFS treatment.[\[196\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-196)[\[197\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-197) ### Other approaches \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=47 "Edit section: Other approaches")\] #### Avoidance of body heat \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=48 "Edit section: Avoidance of body heat")\] Fatigue in [MS](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis") often correlates with relatively high [endogenous](https://en.wikipedia.org/wiki/Endogeny "Endogeny") body temperature.[\[198\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-198)[\[26\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto5-26)[\[199\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-199)[\[200\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-200)[\[201\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-201)[\[202\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-202)[\[203\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-203)[\[204\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-204)[\[205\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid35963205-205)[\[206\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-206)[\[207\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-207)\[*[excessive citations](https://en.wikipedia.org/wiki/Wikipedia:Citing_sources#Bundling_citations "Wikipedia:Citing sources")*\] #### Improved sleep \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=49 "Edit section: Improved sleep")\] Improving sleep has been associated with reduced fatigue but only in small studies.[\[208\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-208)[\[209\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-209)[\[193\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto2-193) #### Intermittent fasting \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=50 "Edit section: Intermittent fasting")\] A very small 2022 study found 40% reductions in fatigue categorisations after three months of 16:8 [intermittent fasting](https://en.wikipedia.org/wiki/Intermittent_fasting "Intermittent fasting").[\[210\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-210) #### Vagus nerve stimulation \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=51 "Edit section: Vagus nerve stimulation")\] A very small 2023 study of [Sjogren's](https://en.wikipedia.org/wiki/Sjogren%27s "Sjogren's") patients showed reductions in self-reported fatigue after 56 days of [vagus nerve stimulation](https://en.wikipedia.org/wiki/Vagus_nerve_stimulation "Vagus nerve stimulation").[\[105\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Tarn_Evans_Traianos_et_al_2023-105) #### Qigong and Tai Chi \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=52 "Edit section: Qigong and Tai Chi")\] [Qigong](https://en.wikipedia.org/wiki/Qigong "Qigong") and [Tai chi](https://en.wikipedia.org/wiki/Tai_chi "Tai chi") have been postulated as helpful to reduce fatigue, but the evidence is of low quality.[\[211\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-211)[\[212\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-212)[\[213\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-213) ### Approaches to managing fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=53 "Edit section: Approaches to managing fatigue")\] Some health systems help people manage their fatigue better through attitude changes and skills transference.[\[193\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto2-193)[\[214\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-214)[\[215\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-215)[\[216\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-216)[\[217\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-217)[\[218\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-218) ## Prevalence \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=54 "Edit section: Prevalence")\] 2023 guidance stated fatigue prevalence is between 4.3% and 21.9%. Prevalence is higher in women than men.[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4)[\[219\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-219) A 2021 German study found that fatigue was the main or secondary reason for 10–20% of all consultations with a primary care physician.[\[220\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-220) A large study based on the 2004 Health and Retirement Study (HRS), a biennial longitudinal survey of US adults aged 51 and above, with mean age 65, found that 33% of women and 29% of men self-reported fatigue.[\[221\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-221) Fatigue represents a large health economic burden and unmet need to patients and to society.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ## Possible purposes of fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=55 "Edit section: Possible purposes of fatigue")\] ### Body resource management purposes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=56 "Edit section: Body resource management purposes")\] Fatigue has been posited as a bio-psycho-physiological state reflecting the body's overall strategy in resource (energy) management. Fatigue may occur when the body wants to limit resource utilisation ("rationing") in order to use resources for healing (part of [sickness behaviour](https://en.wikipedia.org/wiki/Sickness_behaviour "Sickness behaviour"))[\[123\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31601148-123) or conserve energy for a particular current or future anticipated need, including a threat.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ### Evolutionary purposes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=57 "Edit section: Evolutionary purposes")\] It has been posited that fatigue had evolutionary benefits in making more of the body's resources available for healing processes, such as immune responses, and in limiting disease spread by tending to reduce social interactions.[\[100\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31682277-100) ## See also \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=58 "Edit section: See also")\] - [Acquiescence](https://en.wikipedia.org/wiki/Acquiescence "Acquiescence") - [Affect](https://en.wikipedia.org/wiki/Affect_\(psychology\) "Affect (psychology)") - [Cancer-related fatigue](https://en.wikipedia.org/wiki/Cancer-related_fatigue "Cancer-related fatigue") - [Central governor](https://en.wikipedia.org/wiki/Central_governor "Central governor") - [Chronic stress](https://en.wikipedia.org/wiki/Chronic_stress "Chronic stress") - [Clouding of consciousness](https://en.wikipedia.org/wiki/Clouding_of_consciousness "Clouding of consciousness") - [Combat stress reaction](https://en.wikipedia.org/wiki/Combat_stress_reaction "Combat stress reaction") - [Directed attention fatigue](https://en.wikipedia.org/wiki/Directed_attention_fatigue "Directed attention fatigue") - [Disorders of diminished motivation](https://en.wikipedia.org/wiki/Disorders_of_diminished_motivation "Disorders of diminished motivation") - [Effects of fatigue on safety](https://en.wikipedia.org/wiki/Effects_of_fatigue_on_safety "Effects of fatigue on safety") - [Feeling](https://en.wikipedia.org/wiki/Feeling "Feeling") - [Gaucher's disease](https://en.wikipedia.org/wiki/Gaucher%27s_disease "Gaucher's disease") - [Heat illness](https://en.wikipedia.org/wiki/Heat_illness "Heat illness") - [Malaise](https://en.wikipedia.org/wiki/Malaise "Malaise") - [Microsleep](https://en.wikipedia.org/wiki/Microsleep "Microsleep") - [Museum fatigue](https://en.wikipedia.org/wiki/Museum_fatigue "Museum fatigue") - [Presenteeism](https://en.wikipedia.org/wiki/Presenteeism "Presenteeism") - [Sleep-deprived driving](https://en.wikipedia.org/wiki/Sleep-deprived_driving "Sleep-deprived driving") - [Pacing (activity management)](https://en.wikipedia.org/wiki/Pacing_\(activity_management\) "Pacing (activity management)") - [Zoom fatigue](https://en.wikipedia.org/wiki/Zoom_fatigue "Zoom fatigue") ## References \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=59 "Edit section: References")\] 1. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Mayo-Clinic-Fatigue-2023_1-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Mayo-Clinic-Fatigue-2023_1-1) ["Fatigue"](https://www.mayoclinic.org/symptoms/fatigue/basics/definition/sym-20050894). *[Mayo Clinic](https://en.wikipedia.org/wiki/Mayo_Clinic "Mayo Clinic")*. [Archived](https://web.archive.org/web/20230106193733/https://www.mayoclinic.org/symptoms/fatigue/basics/definition/sym-20050894) from the original on 2023-01-06. Retrieved 2023-01-06. 2. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Cancer-terms-2023_2-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Cancer-terms-2023_2-1) ["Cancer terms"](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/fatigue#:~:text=\(fuh-TEEG\),may%20be%20acute%20or%20chronic). [Archived](https://web.archive.org/web/20230106193733/https://www.cancer.gov/publications/dictionaries/cancer-terms/def/fatigue#:~:text=\(fuh-TEEG\),may%20be%20acute%20or%20chronic) from the original on 2023-01-06. Retrieved 2023-01-06. 3. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-pmid23892338_3-0)** Finsterer J, Mahjoub SZ (August 2014). "Fatigue in healthy and diseased individuals". *Am J Hosp Palliat Care*. **31** (5): 562–575\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/1049909113494748](https://doi.org/10.1177%2F1049909113494748). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23892338](https://pubmed.ncbi.nlm.nih.gov/23892338). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12582944](https://api.semanticscholar.org/CorpusID:12582944). 4. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-1) [***c***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-2) [***d***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-3) [***e***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-4) ["Evaluation of fatigue — Differential diagnosis of symptoms"](https://bestpractice.bmj.com/topics/en-us/571). *BMJ Best Practice*. [Archived](https://web.archive.org/web/20231203113928/https://bestpractice.bmj.com/topics/en-us/571) from the original on 2023-12-03. Retrieved 2024-03-25. 5. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Medically_unexplained_symptoms-2017_5-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Medically_unexplained_symptoms-2017_5-1) [***c***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Medically_unexplained_symptoms-2017_5-2) ["Medically unexplained symptoms"](https://www.nhs.uk/conditions/medically-unexplained-symptoms/). 19 October 2017. [Archived](https://web.archive.org/web/20170929113241/http://www.nhs.uk/conditions/medically-unexplained-symptoms/Pages/Somatisation.aspx) from the original on 29 September 2017. Retrieved 6 January 2023. 6. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-pmid31574939_6-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-pmid31574939_6-1) Haß U, Herpich C, Norman K (September 2019). 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[Archived](https://web.archive.org/web/20250106162801/https://www.mssociety.org.uk/about-ms/signs-and-symptoms/fatigue/managing-fatigue) from the original on 2025-01-06. Retrieved 2025-01-06. 217. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-217)** ["Fatigue"](https://my.clevelandclinic.org/health/symptoms/21206-fatigue). *Cleveland Clinic*. [Archived](https://web.archive.org/web/20250106162800/https://my.clevelandclinic.org/health/symptoms/21206-fatigue) from the original on 2025-01-06. Retrieved 2025-01-06. 218. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-218)** ["Cancer fatigue: Why it occurs and how to cope"](https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-fatigue/art-20047709). *Mayo Clinic*. [Archived](https://web.archive.org/web/20250106162800/https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-fatigue/art-20047709) from the original on 2025-01-06. Retrieved 2025-01-06. 219. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-219)** Loge JH, Ekeberg Ø, Kaasa S (July 1998). "Fatigue in the general norwegian population". *Journal of Psychosomatic Research*. **45** (1): 53–65\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/s0022-3999(97)00291-2](https://doi.org/10.1016%2Fs0022-3999%2897%2900291-2). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [9720855](https://pubmed.ncbi.nlm.nih.gov/9720855). 220. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-220)** Maisel P, Baum E, Donner-Banzhoff N (August 30, 2021). ["Fatigue as the Chief Complaint"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579431). *Deutsches Ärzteblatt International*. **118** (33–34\): 566–576\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3238/arztebl.m2021.0192](https://doi.org/10.3238%2Farztebl.m2021.0192). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8579431](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579431). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34196270](https://pubmed.ncbi.nlm.nih.gov/34196270). 221. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-221)** Meng H, Hale L, Friedberg F (October 2010). ["Prevalence and Predictors of Fatigue in Middle-Aged and Older Adults: Evidence from the Health and Retirement Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981161). *Journal of the American Geriatrics Society*. **58** (10): 2033–2034\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1532-5415.2010.03088.x](https://doi.org/10.1111%2Fj.1532-5415.2010.03088.x). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2981161](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981161). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20929479](https://pubmed.ncbi.nlm.nih.gov/20929479). ## Further reading \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=60 "Edit section: Further reading")\] - [Byung-Chul Han](https://en.wikipedia.org/wiki/Byung-Chul_Han "Byung-Chul Han"): *MĂŒdigkeitsgesellschaft*. Matthes & Seitz, Berlin 2010, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-88221-616-5](https://en.wikipedia.org/wiki/Special:BookSources/978-3-88221-616-5 "Special:BookSources/978-3-88221-616-5") . (Philosophical essay about fatigue as a sociological problem and symptom). - Danish edition: TrĂŠthedssamfundet. MĂžller, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-87-994043-7-7](https://en.wikipedia.org/wiki/Special:BookSources/978-87-994043-7-7 "Special:BookSources/978-87-994043-7-7") . - Dutch edition: De vermoeide samenleving. van gennep, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-94-6164-071-0](https://en.wikipedia.org/wiki/Special:BookSources/978-94-6164-071-0 "Special:BookSources/978-94-6164-071-0") . - Italian editions: La societĂ  della stanchezza. nottetempo, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-88-7452-345-0](https://en.wikipedia.org/wiki/Special:BookSources/978-88-7452-345-0 "Special:BookSources/978-88-7452-345-0") . - Korean edition: 한병ìČ  지음 \| êč€íƒœí™˜ ì˜źêč€. Moonji, 2011, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-89-320-2396-0](https://en.wikipedia.org/wiki/Special:BookSources/978-89-320-2396-0 "Special:BookSources/978-89-320-2396-0") . - Spanish edition: La sociedad del cansancio. Herder Editorial, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-84-254-2868-5](https://en.wikipedia.org/wiki/Special:BookSources/978-84-254-2868-5 "Special:BookSources/978-84-254-2868-5") . - South, David (1993). [*Professor puts chronic fatigue into historical perspective*](https://www.google.co.uk/books/edition/Hannah_Institute_for_the_History_of_Medi/tyPYa2ZsItMC?hl=en&gbpv=1&dq=chronic+fatigue+hannah+institute&pg=PA1&printsec=frontcover). Hannah Institute for the History of Medicine Number 18 Summer 1993, p. 1 ## External links \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=61 "Edit section: External links")\] ![](https://upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Wikiquote-logo.svg/40px-Wikiquote-logo.svg.png) Wikiquote has quotations related to ***[Fatigue](https://en.wikiquote.org/wiki/Special:Search/Fatigue "q:Special:Search/Fatigue")***. [![Wikimedia Commons logo](https://upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/40px-Commons-logo.svg.png)](https://en.wikipedia.org/wiki/File:Commons-logo.svg) Wikimedia Commons has media related to [Fatigue](https://commons.wikimedia.org/wiki/Category:Fatigue "commons:Category:Fatigue"). - [Fatigue – Information for Patients](http://www.cancer.gov/cancertopics/pdq/supportivecare/fatigue/patient), U.S. National Cancer Institute | | | |---|---| | Classification | [D](https://www.wikidata.org/wiki/Q9690 "d:Q9690") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11")**: [MG22](https://icd.who.int/browse/latest-release/mms/en#1109546957) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [R53](https://icd.who.int/browse10/2019/en#/R53) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes")**: [780\.7](http://www.icd9data.com/getICD9Code.ashx?icd9=780.7) **[MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings")**: [D005221](https://meshb.nlm.nih.gov/record/ui?ui=D005221) **[DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database")**: [30079](http://www.diseasesdatabase.com/ddb30079.htm) | | External resources | **[MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus")**: [003088](https://www.nlm.nih.gov/medlineplus/ency/article/003088.htm) | | [v](https://en.wikipedia.org/wiki/Template:General_symptoms_and_signs "Template:General symptoms and signs") [t](https://en.wikipedia.org/wiki/Template_talk:General_symptoms_and_signs "Template talk:General symptoms and signs") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:General_symptoms_and_signs "Special:EditPage/Template:General symptoms and signs")[Signs and symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") that are general or [constitutional](https://en.wikipedia.org/wiki/Constitutional_symptoms "Constitutional symptoms") | | |---|---| | [Temperature](https://en.wikipedia.org/wiki/Temperature "Temperature") | | | | | | *heat* | [Fever](https://en.wikipedia.org/wiki/Fever "Fever") [of unknown origin](https://en.wikipedia.org/wiki/Fever_of_unknown_origin "Fever of unknown origin") [drug-induced](https://en.wikipedia.org/wiki/Drug-induced_hyperthermia "Drug-induced hyperthermia") [postoperative](https://en.wikipedia.org/wiki/Postoperative_fever "Postoperative fever") [Hyperthermia](https://en.wikipedia.org/wiki/Hyperthermia "Hyperthermia") [Hyperhidrosis](https://en.wikipedia.org/wiki/Hyperhidrosis "Hyperhidrosis") [Night sweats](https://en.wikipedia.org/wiki/Night_sweats "Night sweats") | | *cold* | [Chills](https://en.wikipedia.org/wiki/Chills "Chills") [Hypothermia](https://en.wikipedia.org/wiki/Hypothermia "Hypothermia") | | Aches and [pains](https://en.wikipedia.org/wiki/Pain "Pain") | [Headache](https://en.wikipedia.org/wiki/Headache "Headache") [Chronic pain](https://en.wikipedia.org/wiki/Chronic_pain "Chronic pain") [Cancer pain](https://en.wikipedia.org/wiki/Cancer_pain "Cancer pain") [Myalgia](https://en.wikipedia.org/wiki/Myalgia "Myalgia") [Tenderness](https://en.wikipedia.org/wiki/Tenderness_\(medicine\) "Tenderness (medicine)") | | [Malaise](https://en.wikipedia.org/wiki/Malaise "Malaise") and [fatigue]() | [Lassitude]() [Lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy") [Atrophy](https://en.wikipedia.org/wiki/Atrophy "Atrophy") [of muscle](https://en.wikipedia.org/wiki/Muscle_atrophy "Muscle atrophy") [Asthenia](https://en.wikipedia.org/wiki/Weakness "Weakness") | | Miscellaneous | [Cachexia](https://en.wikipedia.org/wiki/Cachexia "Cachexia") [Anorexia](https://en.wikipedia.org/wiki/Anorexia "Anorexia") [Polyphagia](https://en.wikipedia.org/wiki/Polyphagia "Polyphagia") and [polydipsia](https://en.wikipedia.org/wiki/Polydipsia "Polydipsia") [Flu-like symptoms](https://en.wikipedia.org/wiki/Influenza-like_illness "Influenza-like illness") | | [v](https://en.wikipedia.org/wiki/Template:Common_cold "Template:Common cold") [t](https://en.wikipedia.org/wiki/Template_talk:Common_cold "Template talk:Common cold") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Common_cold "Special:EditPage/Template:Common cold")[Common cold](https://en.wikipedia.org/wiki/Common_cold "Common cold") | | |---|---| | [Viruses](https://en.wikipedia.org/wiki/Virus "Virus") | [Adenovirus](https://en.wikipedia.org/wiki/Adenoviridae "Adenoviridae") [Coronavirus](https://en.wikipedia.org/wiki/Coronavirus "Coronavirus") [Enterovirus](https://en.wikipedia.org/wiki/Enterovirus "Enterovirus") [Rhinovirus](https://en.wikipedia.org/wiki/Rhinovirus "Rhinovirus") | | [Symptoms](https://en.wikipedia.org/wiki/Symptom "Symptom") | [Cough](https://en.wikipedia.org/wiki/Cough "Cough") [Fatigue]() [Fever](https://en.wikipedia.org/wiki/Fever "Fever") [Headache](https://en.wikipedia.org/wiki/Headache "Headache") [Loss of appetite](https://en.wikipedia.org/wiki/Anorexia_\(symptom\) "Anorexia (symptom)") [Malaise](https://en.wikipedia.org/wiki/Malaise "Malaise") [Muscle aches](https://en.wikipedia.org/wiki/Myalgia "Myalgia") [Nasal congestion](https://en.wikipedia.org/wiki/Nasal_congestion "Nasal congestion") [Rhinorrhea](https://en.wikipedia.org/wiki/Rhinorrhea "Rhinorrhea") [Sneezing](https://en.wikipedia.org/wiki/Sneeze "Sneeze") [Sore throat](https://en.wikipedia.org/wiki/Sore_throat "Sore throat") [Weakness](https://en.wikipedia.org/wiki/Weakness "Weakness") | | [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Acute bronchitis](https://en.wikipedia.org/wiki/Acute_bronchitis "Acute bronchitis") [Bronchiolitis](https://en.wikipedia.org/wiki/Bronchiolitis "Bronchiolitis") [Croup](https://en.wikipedia.org/wiki/Croup "Croup") [Otitis media](https://en.wikipedia.org/wiki/Otitis_media "Otitis media") [Pharyngitis](https://en.wikipedia.org/wiki/Pharyngitis "Pharyngitis") [Pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") [Sinusitis](https://en.wikipedia.org/wiki/Sinusitis "Sinusitis") [Strep throat](https://en.wikipedia.org/wiki/Streptococcal_pharyngitis "Streptococcal pharyngitis") | | Drugs | [Antiviral drugs](https://en.wikipedia.org/wiki/Antiviral_drug "Antiviral drug") [Cold medicine](https://en.wikipedia.org/wiki/Cold_medicine "Cold medicine") | | [v](https://en.wikipedia.org/wiki/Template:Mental_processes "Template:Mental processes") [t](https://en.wikipedia.org/wiki/Template_talk:Mental_processes "Template talk:Mental processes") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Mental_processes "Special:EditPage/Template:Mental processes")Mental processes | | |---|---| | [Cognition](https://en.wikipedia.org/wiki/Cognition "Cognition") | [Association](https://en.wikipedia.org/wiki/Association_\(psychology\) "Association (psychology)") [Awareness](https://en.wikipedia.org/wiki/Awareness "Awareness") [Cognitive flexibility](https://en.wikipedia.org/wiki/Cognitive_flexibility "Cognitive flexibility") [Cognitive liberty](https://en.wikipedia.org/wiki/Cognitive_liberty "Cognitive liberty") [Forecasting](https://en.wikipedia.org/wiki/Forecasting "Forecasting") [affective](https://en.wikipedia.org/wiki/Affective_forecasting "Affective forecasting") [Foresight](https://en.wikipedia.org/wiki/Foresight_\(psychology\) "Foresight (psychology)") [Comprehension](https://en.wikipedia.org/wiki/Understanding "Understanding") [Consciousness](https://en.wikipedia.org/wiki/Consciousness "Consciousness") [Critical thinking](https://en.wikipedia.org/wiki/Critical_thinking "Critical thinking") [Decision-making](https://en.wikipedia.org/wiki/Decision-making "Decision-making") [Imagination](https://en.wikipedia.org/wiki/Imagination "Imagination") [Intuition](https://en.wikipedia.org/wiki/Intuition "Intuition") [Problem solving](https://en.wikipedia.org/wiki/Problem_solving "Problem solving") [methods](https://en.wikipedia.org/wiki/Problem_solving#Problem-solving_methods "Problem solving") [strategies](https://en.wikipedia.org/wiki/Problem_solving#Problem-solving_strategies "Problem solving") [Prospection](https://en.wikipedia.org/wiki/Prospection "Prospection") | | [Perception](https://en.wikipedia.org/wiki/Perception "Perception") | [Amodal](https://en.wikipedia.org/wiki/Amodal_perception "Amodal perception") [Color](https://en.wikipedia.org/wiki/Color_vision "Color vision") [RGB model](https://en.wikipedia.org/wiki/RGB_color_model "RGB color model") [Depth](https://en.wikipedia.org/wiki/Depth_perception "Depth perception") [Form](https://en.wikipedia.org/wiki/Form_perception "Form perception") [Haptic](https://en.wikipedia.org/wiki/Haptic_perception "Haptic perception") ([Touch](https://en.wikipedia.org/wiki/Touch "Touch")) [Perception as interpretation](https://en.wikipedia.org/wiki/Aesthetic_interpretation "Aesthetic interpretation") [Peripheral](https://en.wikipedia.org/wiki/Peripheral_vision "Peripheral vision") [Social](https://en.wikipedia.org/wiki/Social_perception "Social perception") [Sound](https://en.wikipedia.org/wiki/Psychoacoustics "Psychoacoustics") [Harmonics](https://en.wikipedia.org/wiki/Harmonic "Harmonic") [Pitch](https://en.wikipedia.org/wiki/Pitch_\(music\) "Pitch (music)") [Speech](https://en.wikipedia.org/wiki/Speech_perception "Speech perception") [Visual](https://en.wikipedia.org/wiki/Visual_perception "Visual perception") | | [Memory](https://en.wikipedia.org/wiki/Memory "Memory") | [Consolidation](https://en.wikipedia.org/wiki/Memory_consolidation "Memory consolidation") [Encoding](https://en.wikipedia.org/wiki/Encoding_\(memory\) "Encoding (memory)") [Storage](https://en.wikipedia.org/wiki/Storage_\(memory\) "Storage (memory)") [Recall](https://en.wikipedia.org/wiki/Recall_\(memory\) "Recall (memory)") | | Other | [Attention](https://en.wikipedia.org/wiki/Attention "Attention") [Experiential avoidance](https://en.wikipedia.org/wiki/Experiential_avoidance "Experiential avoidance") [Higher nervous activity](https://en.wikipedia.org/wiki/Institute_of_Higher_Nervous_Activity "Institute of Higher Nervous Activity") [Intention](https://en.wikipedia.org/wiki/Intention "Intention") [Ironic process theory](https://en.wikipedia.org/wiki/Ironic_process_theory "Ironic process theory") [Learning](https://en.wikipedia.org/wiki/Learning "Learning") [Mental fatigue](https://en.wikipedia.org/wiki/Fatigue#Mental) [Relational frame theory](https://en.wikipedia.org/wiki/Relational_frame_theory "Relational frame theory") [Mental set](https://en.wikipedia.org/wiki/Set_\(psychology\) "Set (psychology)") [Thinking](https://en.wikipedia.org/wiki/Thought "Thought") [Thought suppression](https://en.wikipedia.org/wiki/Thought_suppression "Thought suppression") [Volition](https://en.wikipedia.org/wiki/Volition_\(psychology\) "Volition (psychology)") | | ![](https://upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/20px-Symbol_category_class.svg.png) [Category](https://en.wikipedia.org/wiki/Category:Mental_processes "Category:Mental processes") | | | [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [![Edit this at 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| Fatigue | | |---|---| | Other names | Exhaustion, weariness, tiredness, lethargy, listlessness | | [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/06/Cfs_woman_sketch.jpg/250px-Cfs_woman_sketch.jpg)](https://en.wikipedia.org/wiki/File:Cfs_woman_sketch.jpg) | | | Artistic representation of [ME/CFS](https://en.wikipedia.org/wiki/ME/CFS "ME/CFS") | | | [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [General practice](https://en.wikipedia.org/wiki/General_practice "General practice"), [primary care](https://en.wikipedia.org/wiki/Primary_care "Primary care") [![Edit this on Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q9690?uselang=en#P1995 "Edit this on Wikidata") | | Treatment | Avoid known stressors and unhealthy habits ([drug use](https://en.wikipedia.org/wiki/Substance_abuse "Substance abuse"), [excessive alcohol consumption](https://en.wikipedia.org/wiki/Excessive_alcohol_consumption "Excessive alcohol consumption"), smoking), healthy diet, exercise regularly, [medication](https://en.wikipedia.org/wiki/Medication "Medication"), [hydration](https://en.wikipedia.org/wiki/Drinking "Drinking"), and [vitamins](https://en.wikipedia.org/wiki/Vitamins "Vitamins") | **Fatigue** is a state of being without energy for a prolonged period of time.[\[1\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-2023-1)[\[2\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Cancer-terms-2023-2) The word *fatigue* is used in two contexts: in the medical sense, and in the sense of normal tiredness. In the medical sense, fatigue is seen as a symptom, and is sometimes associated with medical conditions including [autoimmune disease](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease"), [organ failure](https://en.wikipedia.org/wiki/Organ_failure "Organ failure"), [mood disorders](https://en.wikipedia.org/wiki/Mood_disorder "Mood disorder"), [heart disease](https://en.wikipedia.org/wiki/Heart_disease "Heart disease"), [infectious diseases](https://en.wikipedia.org/wiki/Infectious_disease "Infectious disease"), and post-infectious-disease states.[\[3\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid23892338-3) However, fatigue is complex and in up to a third of primary care cases no medical or psychiatric diagnosis is found.[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4)[\[5\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Medically_unexplained_symptoms-2017-5)[\[6\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31574939-6) In the sense of tiredness, fatigue often follows prolonged physical or mental activity. Physical fatigue results from [muscle fatigue](https://en.wikipedia.org/wiki/Muscle_fatigue "Muscle fatigue") brought about by intense [physical activity](https://en.wikipedia.org/wiki/Physical_activity "Physical activity").[\[7\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-7)[\[8\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-8)[\[9\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-9) Mental fatigue results from prolonged periods of [cognitive](https://en.wikipedia.org/wiki/Cognition "Cognition") activity which impairs cognitive ability, can manifest as [sleepiness](https://en.wikipedia.org/wiki/Sleepiness "Sleepiness"), [lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"), or [directed attention fatigue](https://en.wikipedia.org/wiki/Directed_attention_fatigue "Directed attention fatigue"),[\[10\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Marcora_2009_857%E2%80%93864-10) and can also impair physical performance.[\[11\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Martin-11) Fatigue in a medical context is used to cover experiences of low energy that are not caused by normal life.[\[1\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-2023-1)[\[2\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Cancer-terms-2023-2) A 2021 review proposed a definition for fatigue as a starting point for discussion: *"A multi-dimensional phenomenon in which the biophysiological, cognitive, motivational and emotional state of the body is affected resulting in significant impairment of the individual's ability to function in their normal capacity"*.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Another definition is that fatigue is *"a significant subjective sensation of weariness, increasing sense of effort, mismatch between effort expended and actual performance, or exhaustion independent from medications, chronic pain, physical deconditioning, [anaemia](https://en.wikipedia.org/wiki/Anemia "Anemia"), respiratory dysfunction, [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)"), and sleep disorders"*.[\[13\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37180990-13) The use of the term *fatigue* in medical contexts may carry inaccurate connotations from the more general usage of the same word. More accurate terminology may also be needed for variants within the umbrella term of fatigue.[\[14\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-14) ### Comparison with other terms \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=3 "Edit section: Comparison with other terms")\] Tiredness which is a normal result of [work](https://en.wikipedia.org/wiki/Work_\(human_activity\) "Work (human activity)"), mental [stress](https://en.wikipedia.org/wiki/Stress_\(medicine\) "Stress (medicine)"), [anxiety](https://en.wikipedia.org/wiki/Anxiety "Anxiety"), overstimulation and understimulation, [jet lag](https://en.wikipedia.org/wiki/Jet_lag "Jet lag"), active [recreation](https://en.wikipedia.org/wiki/Recreation "Recreation"), [boredom](https://en.wikipedia.org/wiki/Boredom "Boredom"), or [lack of sleep](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") is not considered medical fatigue. This is the tiredness described in MeSH Descriptor Data.[\[15\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-15) Exhaustion is a state of extreme tiredness.[\[16\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-16) Sleepiness refers to a tendency to fall asleep, whereas fatigue refers to an overwhelming sense of tiredness, lack of energy, and a feeling of exhaustion. Sleepiness and fatigue often coexist as a consequence of sleep deprivation.[\[17\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-17) However sleepiness and fatigue may not correlate.[\[18\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-18) Fatigue is generally considered a longer-term condition than sleepiness (somnolence).[\[19\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid16376590-19) "Fatigue" is categorised as [ICD-11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11") code MG22.[\[20\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-20) Distinguishing features of medical fatigue include: - unpredictability, - variability in severity, - fatigue being relatively profound/overwhelming, and having extensive impact on daily living, - lack of improvement with rest, - where an underlying disease is present, the amount of fatigue is often not commensurate with the severity of the underlying disease.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12)[\[21\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-21)[\[22\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Swain2006-22)[\[23\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-23) ### Differentiating features \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=11 "Edit section: Differentiating features")\] Differentiating characteristics of fatigue that may help identify the possible cause of fatigue include: - [Post-exertional malaise](https://en.wikipedia.org/wiki/Post-exertional_malaise "Post-exertional malaise"); a common feature of [ME/CFS](https://en.wikipedia.org/wiki/ME/CFS "ME/CFS"),[\[24\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-24) and experienced by a significant proportion of people with [Long Covid](https://en.wikipedia.org/wiki/Long_Covid "Long Covid"),[\[25\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-25) but not a feature of other fatigues. - Increased by heat or cold; [MS fatigue](https://en.wikipedia.org/wiki/Signs_and_symptoms_of_multiple_sclerosis#Fatigue "Signs and symptoms of multiple sclerosis") is in many cases affected in this way.[\[26\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto5-26)[\[27\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-27) - Flare-ups and Remissions; Some fatigue diseases have flareups of a few weeks ([lupus](https://en.wikipedia.org/wiki/Lupus "Lupus"),[\[28\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-28)[\[29\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-29) [fibromyalgia](https://en.wikipedia.org/wiki/Fibromyalgia "Fibromyalgia")[\[30\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-30)). Other fatigue diseases may have longer patterns of activity and remission, or no remissions at all (MS[\[31\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-31)[\[32\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-32)[\[33\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto3-33)). - Variability within a day; Some fatigues ([rheumatoid arthritis (RA)](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis"),[\[34\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto-34) [cancer-related fatigue](https://en.wikipedia.org/wiki/Cancer-related_fatigue "Cancer-related fatigue")[\[35\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-35)) seem to often be continual (24/7), whilst others (MS, Sjögren's, lupus, brain injury[\[36\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-36)[\[37\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-37)) often vary in intensity at different times within a day.[\[34\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto-34) A 2010 study found that Sjögren's patients reported fatigue after rising, an improvement in mid-morning, and worsening later in the day, whereas lupus (SLE) patients reported lower fatigue after rising followed by increasing fatigue through the day.[\[38\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto1-38) ME/CFS symptoms can be continual, or can fluctuate during the day, from day to day, and over longer periods.[\[33\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto3-33) Fibromyalgia fatigue can be continual or variable.[\[39\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-39) - The pace of onset may be a related differentiating factor; MS fatigue can have abrupt onset.[\[40\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-40) - Feeling of weight; some fatigues, including that caused by MS, create a sense of weight or gravity; *"I feel like I have lead weights attached to my limbs ... or I am being pulled down by gravity."*[\[41\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-41) Some people may have multiple causes of fatigue. Fatigue is complex and can be driven and maintained by a potentially wide range of [biopsychosocial factors](https://en.wikipedia.org/wiki/Biopsychosocial_model "Biopsychosocial model").[\[42\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-w053-42) Tiredness is a common [medically unexplained symptom](https://en.wikipedia.org/wiki/Medically_unexplained_physical_symptoms "Medically unexplained physical symptoms").[\[5\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Medically_unexplained_symptoms-2017-5) In up to a third of fatigue primary care cases, no medical or psychiatric diagnosis is found.[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4)[\[5\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Medically_unexplained_symptoms-2017-5)[\[6\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31574939-6) ### Adverse life events \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=13 "Edit section: Adverse life events")\] Adverse life events have been associated with fatigue.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) A 2021 study in a Korean city found that alcohol consumption was the variable with the most correlation with overall fatigue.[\[43\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-43) A 2020 Norway study found that 69% of substance use disorder patients had severe fatigue symptoms, and particularly those with extensive use of [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepines "Benzodiazepines").[\[44\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto4-44) Causality, as opposed to correlation, were not proven in these studies.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] The protracted use of digital screens—such as those associated with computers, laptops and smartphones—can cause eye fatigue, and induce a general state of mental and physical exhaustion.[\[45\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-45) Specific symptoms may include sore eyes, blurred vision, headaches and associated orthopedic issues such as a sore neck and back. These symptoms collectively are known as [computer vision syndrome](https://en.wikipedia.org/wiki/Computer_vision_syndrome "Computer vision syndrome") (CVS) or in colloquial parlance as *screen fatigue*.[\[46\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-46) Fatigue can often be traced to poor sleep habits.[\[47\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-Causes-2023-47) [Sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") and disruption is associated with subsequent fatigue.[\[48\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-48)[\[49\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-49) Sleep disturbances due to disease may impact fatigue.[\[50\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-50)[\[51\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-51) Caffeine and alcohol can disrupt sleep, causing fatigue.[\[52\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Tiredness-and_fatigue-2018-52) Fatigue may be a side effect of certain [medications](https://en.wikipedia.org/wiki/Medication "Medication") (e.g., [lithium salts](https://en.wikipedia.org/wiki/Lithium_salt "Lithium salt"), [ciprofloxacin](https://en.wikipedia.org/wiki/Ciprofloxacin "Ciprofloxacin")); [beta blockers](https://en.wikipedia.org/wiki/Beta_blocker "Beta blocker"), which can induce [exercise intolerance](https://en.wikipedia.org/wiki/Exercise_intolerance "Exercise intolerance"), medicines used to treat allergies or coughs,[\[47\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-Causes-2023-47) and many cancer treatments, particularly [chemotherapy](https://en.wikipedia.org/wiki/Chemotherapy "Chemotherapy") and [radiotherapy](https://en.wikipedia.org/wiki/Radiotherapy "Radiotherapy"). Use of [benzodiazepines](https://en.wikipedia.org/wiki/Benzodiazepines "Benzodiazepines") has been found to correlate with higher fatigue.[\[44\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto4-44) ### Association with diseases and illnesses \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=18 "Edit section: Association with diseases and illnesses")\] Fatigue is often associated with diseases and conditions. Some major categories of conditions that often list fatigue as a symptom include physical diseases, substance use illness, mental illnesses, and other diseases and conditions.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] - [autoimmune diseases](https://en.wikipedia.org/wiki/Autoimmune_disease "Autoimmune disease"),[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) such as [celiac disease](https://en.wikipedia.org/wiki/Celiac_disease "Celiac disease"), [lupus](https://en.wikipedia.org/wiki/Lupus "Lupus"), [multiple sclerosis](https://en.wikipedia.org/wiki/Signs_and_symptoms_of_multiple_sclerosis#fatigue "Signs and symptoms of multiple sclerosis"), [myasthenia gravis](https://en.wikipedia.org/wiki/Myasthenia_gravis "Myasthenia gravis"), [NMOSD](https://en.wikipedia.org/wiki/NMOSD "NMOSD"), [Sjögren's syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_syndrome "Sjögren's syndrome"),[\[38\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto1-38) [rheumatoid arthritis](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis"),[\[54\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-54)[\[55\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-55)[\[56\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-56)[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) [spondyloarthropathy](https://en.wikipedia.org/wiki/Spondyloarthropathy "Spondyloarthropathy") and [UCTD](https://en.wikipedia.org/wiki/UCTD "UCTD");[\[57\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-57) this population's primary concern is fatigue;[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53)[\[58\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-58) - [blood disorders](https://en.wikipedia.org/wiki/Blood_disorders "Blood disorders"), such as [anemia](https://en.wikipedia.org/wiki/Anemia "Anemia") and [hemochromatosis](https://en.wikipedia.org/wiki/Hemochromatosis "Hemochromatosis");[\[59\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Cleveland_Clinic_medical_professional_2022_z395-59)[\[60\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Hamilton_2022_g129-60) - [brain injury](https://en.wikipedia.org/wiki/Traumatic_brain_injury "Traumatic brain injury");[\[61\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-61)[\[62\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-62) - [cancer](https://en.wikipedia.org/wiki/Cancer "Cancer"), in which case it is called [cancer fatigue](https://en.wikipedia.org/wiki/Cancer_fatigue "Cancer fatigue");[\[63\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-63) - [COVID-19](https://en.wikipedia.org/wiki/COVID-19 "COVID-19") and [long COVID](https://en.wikipedia.org/wiki/Long_COVID "Long COVID");[\[64\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-64) - [endocrine diseases](https://en.wikipedia.org/wiki/Endocrine_disease "Endocrine disease") or [metabolic disorders](https://en.wikipedia.org/wiki/Metabolic_disorder "Metabolic disorder"): [diabetes mellitus](https://en.wikipedia.org/wiki/Diabetes_mellitus "Diabetes mellitus"), [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism") and [Addison's disease](https://en.wikipedia.org/wiki/Addison%27s_disease "Addison's disease");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [fibromyalgia](https://en.wikipedia.org/wiki/Fibromyalgia "Fibromyalgia");[\[66\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Beyond_pain-66) - [heart failure](https://en.wikipedia.org/wiki/Heart_failure "Heart failure") and [heart attack](https://en.wikipedia.org/wiki/Heart_attack "Heart attack");[\[67\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-67) - [HIV](https://en.wikipedia.org/wiki/HIV "HIV")[\[68\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Fatigue_Symptom_Management-68) - [inborn errors of metabolism](https://en.wikipedia.org/wiki/Inborn_error_of_metabolism "Inborn error of metabolism") such as [fructose malabsorption](https://en.wikipedia.org/wiki/Fructose_malabsorption "Fructose malabsorption");[\[69\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-69)[\[70\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-70) - [infectious diseases](https://en.wikipedia.org/wiki/Infectious_diseases "Infectious diseases") such as [infectious mononucleosis](https://en.wikipedia.org/wiki/Infectious_mononucleosis "Infectious mononucleosis") or [tuberculosis](https://en.wikipedia.org/wiki/Tuberculosis "Tuberculosis");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [irritable bowel syndrome](https://en.wikipedia.org/wiki/Irritable_bowel_syndrome "Irritable bowel syndrome");[\[71\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Fatigue_in_irritable_bowel_syndrome-71) - [kidney diseases](https://en.wikipedia.org/wiki/Kidney_disease "Kidney disease"), e.g., [acute renal failure](https://en.wikipedia.org/wiki/Acute_renal_failure "Acute renal failure"), [chronic renal failure](https://en.wikipedia.org/wiki/Chronic_renal_failure "Chronic renal failure");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [leukemia](https://en.wikipedia.org/wiki/Leukemia "Leukemia") or [lymphoma](https://en.wikipedia.org/wiki/Lymphoma "Lymphoma");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [liver failure](https://en.wikipedia.org/wiki/Liver_failure "Liver failure") or liver diseases, e.g., [hepatitis](https://en.wikipedia.org/wiki/Hepatitis "Hepatitis");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65)[\[22\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Swain2006-22) - [Low blood pressure](https://en.wikipedia.org/wiki/Hypotension "Hypotension") - [Lyme disease](https://en.wikipedia.org/wiki/Lyme_disease "Lyme disease");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [neurological disorders](https://en.wikipedia.org/wiki/Neurological_disorder "Neurological disorder") such as [narcolepsy](https://en.wikipedia.org/wiki/Narcolepsy "Narcolepsy"), [Parkinson's disease](https://en.wikipedia.org/wiki/Parkinson%27s_disease "Parkinson's disease"), [postural orthostatic tachycardia syndrome](https://en.wikipedia.org/wiki/Postural_Orthostatic_Tachycardia_Syndrome "Postural Orthostatic Tachycardia Syndrome") (POTS) and [post-concussion syndrome](https://en.wikipedia.org/wiki/Post-concussion_syndrome "Post-concussion syndrome");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - nutritional deficiencies, such as, [sodium](https://en.wikipedia.org/wiki/Hyponatremia "Hyponatremia"), [iron](https://en.wikipedia.org/wiki/Iron-deficiency_anemia "Iron-deficiency anemia"), [vitamin B12](https://en.wikipedia.org/wiki/Vitamin_B12_deficiency "Vitamin B12 deficiency"), and [folate](https://en.wikipedia.org/wiki/Folate_deficiency "Folate deficiency") deficiencies - [physical trauma](https://en.wikipedia.org/wiki/Physical_trauma "Physical trauma") and other [pain](https://en.wikipedia.org/wiki/Pain "Pain")\-causing conditions, such as [arthritis](https://en.wikipedia.org/wiki/Arthritis "Arthritis");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") or [sleep disorders](https://en.wikipedia.org/wiki/Sleep_disorder "Sleep disorder"), e.g. [sleep apnea](https://en.wikipedia.org/wiki/Sleep_apnea "Sleep apnea");[\[65\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Friedman-65) - [stroke](https://en.wikipedia.org/wiki/Stroke "Stroke")\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [thyroid disease](https://en.wikipedia.org/wiki/Thyroid_disease "Thyroid disease") such as [hypothyroidism](https://en.wikipedia.org/wiki/Hypothyroidism "Hypothyroidism");\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - sarcoidosis - [mast cell activation syndrome](https://en.wikipedia.org/wiki/Mast_cell_activation_syndrome "Mast cell activation syndrome")[\[72\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMID33261124-72)[\[73\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMID28262205-73)[\[74\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMID38948000-74) - [anxiety disorders](https://en.wikipedia.org/wiki/Anxiety_disorder "Anxiety disorder"), such as [generalized anxiety disorder](https://en.wikipedia.org/wiki/Generalized_anxiety_disorder "Generalized anxiety disorder");[\[75\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-DSM5-75) - [developmental disorders](https://en.wikipedia.org/wiki/Developmental_disorder "Developmental disorder") such as [autism spectrum disorder](https://en.wikipedia.org/wiki/Autism_spectrum "Autism spectrum");[\[76\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Williams_Gotham_p.-76) - [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder");[\[77\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-77)[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) - [eating disorders](https://en.wikipedia.org/wiki/Eating_disorder "Eating disorder"), which can produce fatigue due to inadequate nutrition;\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] - [myalgic encephalomyelitis/chronic fatigue syndrome](https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome "Myalgic encephalomyelitis/chronic fatigue syndrome") (ME/CFS)[\[78\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-78) - [idiopathic chronic fatigue](https://en.wikipedia.org/wiki/Idiopathic_chronic_fatigue "Idiopathic chronic fatigue"), a term used to describe chronic fatigue which does not have symptoms of ME/CFS.[\[79\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-PMC6522773-79)[\[80\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-80) However ICF does not have a dedicated diagnostic code in the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization")'s [ICD-11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11") classification.[\[81\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-81) - [Gulf War syndrome](https://en.wikipedia.org/wiki/Gulf_War_syndrome "Gulf War syndrome");[\[82\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-82) #### Primary vs. secondary \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=22 "Edit section: Primary vs. secondary")\] In some areas, it has been proposed that fatigue be separated into - primary fatigue, caused directly by a disease process, and - ordinary or secondary fatigue, caused by a range of causes including exertion and also secondary impacts on a person of having a disease (such as disrupted sleep).[\[83\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-83)[\[84\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-84)[\[85\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Gerber_et_al_2019-85)[\[86\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-86)[\[87\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-87)[\[88\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-88) The ICD-11 MG22 definition of fatigue[\[89\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-89) captures both types of fatigue; it includes fatigue that "occur\[s\] in the absence of... exertion... as a symptom of health conditions."\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] Obesity correlates with higher fatigue levels and incidence.[\[90\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-90)[\[91\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid15851643-91)[\[92\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-92) ### Somatic symptom disorder \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=24 "Edit section: Somatic symptom disorder")\] In [somatic symptom disorder](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder")[\[93\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-93) the patient is overfocused on a physical symptom, such as fatigue, that may or may not be explained by a medical condition.[\[94\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-94)[\[95\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-95)[\[96\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-96) ### Scientifically unsupported causes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=25 "Edit section: Scientifically unsupported causes")\] The concept of [adrenal fatigue](https://en.wikipedia.org/wiki/Adrenal_fatigue "Adrenal fatigue") is often raised in media but no scientific basis has been found for it.[\[97\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-97)[\[98\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-webmd-98)[\[99\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-99) The mechanisms that cause fatigue are not well understood.[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) Several mechanisms may be in operation within a patient,[\[100\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31682277-100) with the relative contribution of each mechanism differing over time.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Proposed fatigue explanations due to permanent changes in the brain may have difficulty in explaining the "unpredictability" and "variability" (i.e. appearing intermittently during the day, and not on all days) of the fatigue associated with inflammatory rheumatic diseases and autoimmune diseases (such as [multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis")).[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Inflammation distorts neural chemistry, brain function and functional connectivity across a broad range of brain networks,[\[101\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-101) and has been linked to many types of fatigue.[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53)[\[102\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-102) Findings implicate [neuroinflammation](https://en.wikipedia.org/wiki/Neuroinflammation "Neuroinflammation") in the [etiology](https://en.wikipedia.org/wiki/Etiology "Etiology") of fatigue in [autoimmune](https://en.wikipedia.org/wiki/Autoimmunity "Autoimmunity") and related disorders.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12)[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) Low-grade [inflammation](https://en.wikipedia.org/wiki/Inflammation "Inflammation") may cause an imbalance between energy availability and expenditure.[\[103\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-103) [Cytokines](https://en.wikipedia.org/wiki/Cytokines "Cytokines") are small protein molecules that modulate immune responses and inflammation (as well as other functions) and may have causal roles in fatigue.[\[104\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-104)[\[105\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Tarn_Evans_Traianos_et_al_2023-105) However a 2019 review was inconclusive as to whether cytokines play any definitive role in [ME/CFS](https://en.wikipedia.org/wiki/ME/CFS "ME/CFS").[\[106\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-106) ### Reduced brain connectivity \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=28 "Edit section: Reduced brain connectivity")\] Fatigue has been correlated with reductions in structural and functional connectivity in the brain.[\[107\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Qi-2019-107) This has included in post-stroke,[\[108\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-108) MS,[\[109\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-109) NMOSD and MOG,[\[13\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37180990-13) and ME/CFS.[\[110\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-110) This was also found for fatigue after brain injury,[\[111\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid35221951-111) including a significant linear correlation between self-reported fatigue and brain functional connectivity.[\[112\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid26878885-112) Areas of the brain for which there is evidence of relation to fatigue are the [thalamus](https://en.wikipedia.org/wiki/Thalamus "Thalamus") and middle frontal cortex,[\[112\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid26878885-112) fronto-parietal and cingulo-opercular,[\[111\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid35221951-111) and default mode network, salience network, and thalamocortical loop areas.[\[107\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Qi-2019-107)[\[113\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-113) A 2024 review found that structural connectivity changes may underlie fatigue in pwRRMS but that the overall results were inconclusive, possibly explained by heterogeneity and limited number of studies.[\[114\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-114) A small 2023 study found that infratentorial lesion volume (cerebellar and brainstem) was a relatively good predictor of RRMS fatigue severity.[\[115\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-115) ### Damage to brain white matter \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=29 "Edit section: Damage to brain white matter")\] Studies have found [MS fatigue](https://en.wikipedia.org/wiki/Signs_and_symptoms_of_multiple_sclerosis#Fatigue "Signs and symptoms of multiple sclerosis") correlates with damage to NAWM (normal appearing [white matter](https://en.wikipedia.org/wiki/White_matter "White matter")) (which will not show on normal [MRI](https://en.wikipedia.org/wiki/Magnetic_resonance_imaging "Magnetic resonance imaging") but will show on [DTI (diffusion tensor imaging)](https://en.wikipedia.org/wiki/Diffusion_MRI "Diffusion MRI")).[\[116\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-116)[\[13\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37180990-13)[\[117\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-117)[\[118\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-118)[\[119\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-119)[\[120\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-120) The correlation becomes unreliable in patients aged over 65 due to damage due to ageing.[\[121\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-121) ### Heat shock proteins \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=30 "Edit section: Heat shock proteins")\] A small 2016 study found that primary [Sjögren's syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_syndrome "Sjögren's syndrome") patients with high fatigue, when compared with those with low fatigue, had significantly higher plasma concentrations of [HSP90α](https://en.wikipedia.org/wiki/Hsp90 "Hsp90"), and a tendency to higher concentrations of HSP72.[\[122\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-122) A small 2020 study of Crohn's disease patients found that higher fatigue visual analogue scale (fVAS) scores correlated with higher HSP90α levels.[\[123\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31601148-123) A related small 2012 trial investigating if application of an IL-1 receptor antagonist ([anakinra](https://en.wikipedia.org/wiki/Anakinra "Anakinra")) would reduce fatigue in primary Sjögren's syndrome patients was inconclusive.[\[124\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-124)[\[125\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-125)[\[126\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-126) Fatigue is currently measured by many different self-measurement surveys.[\[127\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-127) Examples are the Fatigue Symptom Inventory (FSI)[\[128\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-128)[\[129\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-129)[\[130\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-130) and the Fatigue Severity Scale.[\[131\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-131)[\[132\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-132)[\[133\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-133) There is no consensus on best practice,[\[134\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-134) and the existing surveys do not capture the intermittent nature of some forms of fatigue. [Heart rate variability](https://en.wikipedia.org/wiki/Heart_rate_variability "Heart rate variability") cannot currently distinguish between physical fatigue and mental fatigue.[\[135\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37637168-135) Many studies have shown that [salivary](https://en.wikipedia.org/wiki/Saliva "Saliva") [cortisol](https://en.wikipedia.org/wiki/Cortisol "Cortisol") can measure mental fatigue.[\[135\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37637168-135) A 2023 guidance indicates the following[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4) - in the primary care setting, a medical or psychiatric diagnosis is found in at least two-thirds of patients; - the most common diagnoses are [viral illness](https://en.wikipedia.org/wiki/Viral_disease "Viral disease"), upper respiratory infection, iron-deficiency anaemia, acute bronchitis, adverse effects of a medical agent in the proper dose, and depression or other mental disorder, such as panic disorder, and [somatisation disorder](https://en.wikipedia.org/wiki/Somatic_symptom_disorder "Somatic symptom disorder"); - the origin of fatigue may be central, brain-derived, or peripheral, usually of a neuromuscular origin—it may be attributed to physical illness, psychological (e.g., psychiatric disorder), social (e.g., family problems), and physiological factors (e.g., old age), occupational illness (e.g., workplace stress); - when unexplained, clinically evaluated chronic fatigue can be separated into [ME/CFS](https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome "Myalgic encephalomyelitis/chronic fatigue syndrome") and [idiopathic chronic fatigue](https://en.wikipedia.org/wiki/Idiopathic_chronic_fatigue "Idiopathic chronic fatigue").[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4) A 2016 German review found that - about 20% of people complaining of tiredness to a GP (general practitioner) suffered from a depressive disorder. - [anaemia](https://en.wikipedia.org/wiki/Anemia "Anemia"), malignancies and other serious somatic diseases were only very rarely found in fatigued primary care patients, with prevalence rates hardly differing from non-fatigued patients. - if fatigue occurred in primary care patients as an isolated symptom without additional abnormalities in the medical history and in the clinical examination, then extensive diagnostic testing rarely helped detect serious diseases. Such testing might also lead to false-positive tests.[\[136\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-136) A 2014 Australian review recommended that a period of watchful waiting may be appropriate if there are no major warning signs.[\[137\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-137) A 2009 study found that about 50% of people who had fatigue received a diagnosis that could explain the fatigue after a year with the condition. In those people who had a possible diagnosis, musculoskeletal (19.4%) and psychological problems (16.5%) were the most common. Definitive physical conditions were only found in 8.2% of cases.[\[138\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid19858240-138) ##### Uni- or multi-dimensional \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=36 "Edit section: Uni- or multi-dimensional")\] Fatigue can be seen as a uni-dimensional phenomenon that influences different aspects of human life.[\[139\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-139)[\[140\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-140) It can be multi-faceted and broadly defined, making understanding the causes of its manifestations especially difficult in conditions with diverse pathology including autoimmune diseases.[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) A 2021 review considered that different "types/subsets" of fatigue may exist and that patients normally present with more than one such "type/subset". These different "types/subsets" of fatigue may be different dimensions of the same symptom, and the relative manifestations of each may depend on the relative contribution of different mechanisms. Inflammation may be the root causal mechanism in many cases.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Physical fatigue, or [muscle fatigue](https://en.wikipedia.org/wiki/Muscle_fatigue "Muscle fatigue"), is the temporary physical inability of muscles to perform optimally. The onset of muscle fatigue during physical activity is gradual, and depends upon an individual's level of physical fitness – other factors include [sleep deprivation](https://en.wikipedia.org/wiki/Sleep_deprivation "Sleep deprivation") and overall health.[\[141\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-WebMD-141) Physical fatigue can be caused by a lack of energy in the muscle, by a decrease of the efficiency of the [neuromuscular junction](https://en.wikipedia.org/wiki/Neuromuscular_junction "Neuromuscular junction") or by a reduction of the drive originating from the [central nervous system](https://en.wikipedia.org/wiki/Central_nervous_system "Central nervous system"), and can be reversed by rest.[\[142\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-142) The central component of fatigue is triggered by an increase of the level of [serotonin](https://en.wikipedia.org/wiki/Serotonin "Serotonin") in the central nervous system.[\[143\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid10919962-143) During motor activity, serotonin released in synapses that contact [motor neurons](https://en.wikipedia.org/wiki/Motor_neuron "Motor neuron") promotes [muscle contraction](https://en.wikipedia.org/wiki/Muscle_contraction "Muscle contraction").[\[144\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-144) During high level of motor activity, the amount of serotonin released increases and a spillover occurs. Serotonin binds to extrasynaptic receptors located on the [axonal initial segment](https://en.wikipedia.org/wiki/Axonal_initial_segment "Axonal initial segment") of motor neurons with the result that [nerve impulse](https://en.wikipedia.org/wiki/Action_potential "Action potential") initiation and thereby muscle contraction are inhibited.[\[145\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-145) Muscle strength testing can be used to determine the presence of a [neuromuscular disease](https://en.wikipedia.org/wiki/Neuromuscular_disease "Neuromuscular disease"), but cannot determine its cause. Additional testing, such as [electromyography](https://en.wikipedia.org/wiki/Electromyography "Electromyography"), can provide diagnostic information, but information gained from muscle strength testing alone is not enough to diagnose most neuromuscular disorders.[\[146\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-146) Mental fatigue is a temporary inability to maintain optimal cognitive performance. The onset of mental fatigue during any cognitive activity is gradual, and depends upon an individual's cognitive ability, and also upon other factors, such as sleep deprivation and overall health. Mental fatigue has also been shown to decrease physical performance.[\[10\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Marcora_2009_857%E2%80%93864-10) It can manifest as [somnolence](https://en.wikipedia.org/wiki/Somnolence "Somnolence"), [lethargy](https://en.wikipedia.org/wiki/Lethargy "Lethargy"), [directed attention fatigue](https://en.wikipedia.org/wiki/Directed_attention_fatigue "Directed attention fatigue"), or disengagement. Research also suggests that mental fatigue is closely linked to the concept of [ego depletion](https://en.wikipedia.org/wiki/Ego_depletion "Ego depletion"), though the validity of the concept is disputed. For example, one pre-registered study of 686 participants found that after exerting mental effort, people are likely to disengage and become less interested in exerting further effort.[\[147\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-147) Decreased attention can also be described as a more or less decreased [level of consciousness](https://en.wikipedia.org/wiki/Level_of_consciousness "Level of consciousness").[\[148\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-148) In any case, this can be dangerous when performing tasks that require constant concentration, such as operating large vehicles. For instance, a person who is sufficiently somnolent may experience [microsleep](https://en.wikipedia.org/wiki/Microsleep "Microsleep"). However, objective cognitive testing can be used to differentiate the neurocognitive deficits of brain disease from those attributable to tiredness.[\[149\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid29355911-149)[\[150\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid30884965-150)[\[151\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid38079429-151) The [perception](https://en.wikipedia.org/wiki/Perception "Perception") of mental fatigue is believed to be modulated by the brain's [reticular activating system](https://en.wikipedia.org/wiki/Reticular_activating_system "Reticular activating system") (RAS).[\[152\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid24926625-152)[\[153\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid28690375-153)[\[154\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31216564-154)[\[155\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid37155119-155)[\[156\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31751025-156) Fatigue impacts a driver's reaction time, awareness of hazards around them and their attention. Drowsy drivers are three times more likely to be involved in a car crash, and being awake over 20 hours is the equivalent of driving with a blood-alcohol concentration level of 0.08%.[\[157\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-157) ##### Neurological fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=39 "Edit section: Neurological fatigue")\] People with [multiple sclerosis](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis") experience a form of overwhelming tiredness that can occur at any time of the day, for any duration, and that does not necessarily recur in a recognizable pattern for any given patient, referred to as "neurological fatigue", and often as "multiple sclerosis fatigue" or "lassitude".[\[158\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid32672087-158)[\[159\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-159)[\[160\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-160) People with [autoimmune diseases](https://en.wikipedia.org/wiki/Autoimmune_diseases "Autoimmune diseases") including inflammatory rheumatic diseases such as [rheumatoid arthritis](https://en.wikipedia.org/wiki/Rheumatoid_arthritis "Rheumatoid arthritis"), [psoriatic arthritis](https://en.wikipedia.org/wiki/Psoriatic_arthritis "Psoriatic arthritis") and primary [Sjögren's syndrome](https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_syndrome "Sjögren's syndrome"), experience similar fatigue.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12)[\[53\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31447842-53) Attempts have been made to isolate causes of [central nervous system fatigue](https://en.wikipedia.org/wiki/Central_nervous_system_fatigue "Central nervous system fatigue"). Acute Acute fatigue is that which is temporary and self-limited. Acute fatigue is most often caused by an [infection](https://en.wikipedia.org/wiki/Infection "Infection") such as the [common cold](https://en.wikipedia.org/wiki/Common_cold "Common cold") and can be cognized as one part of the [sickness behavior](https://en.wikipedia.org/wiki/Sickness_behavior "Sickness behavior") response occurring when the [immune system](https://en.wikipedia.org/wiki/Immune_system "Immune system") fights an [infection](https://en.wikipedia.org/wiki/Infection "Infection").[\[161\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Brain,_Behavior,_and_Immunity_2012_pp._552%E2%80%93558-161) Other common causes of acute fatigue include [depression](https://en.wikipedia.org/wiki/Major_depressive_disorder "Major depressive disorder") and chemical causes, such as [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration"), [poisoning](https://en.wikipedia.org/wiki/Poison "Poison"), [low blood sugar](https://en.wikipedia.org/wiki/Low_blood_sugar "Low blood sugar"), or [mineral](https://en.wikipedia.org/wiki/Mineral_\(nutrient\) "Mineral (nutrient)") or [vitamin](https://en.wikipedia.org/wiki/Vitamin "Vitamin") deficiencies. Prolonged Prolonged fatigue is a self-reported, persistent (constant) fatigue lasting at least one month.[\[162\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34589772-162)[\[163\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid18458765-163) Chronic Chronic fatigue is a self-reported fatigue lasting at least 6 consecutive months. Chronic fatigue may be either persistent or relapsing.[\[164\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-CDC1994-164) Chronic fatigue is a symptom of many chronic illnesses and of [idiopathic chronic fatigue](https://en.wikipedia.org/wiki/Idiopathic_chronic_fatigue "Idiopathic chronic fatigue").[\[165\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-mitochondrial_content-165) Fatigue can have significant negative impacts on quality of life.[\[166\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-166) Profound and debilitating fatigue is the most common complaint reported among individuals with autoimmune disease, such as systemic lupus erythematosus, multiple sclerosis, type 1 diabetes, celiac disease, [Myalgic Encephalomyelitis/chronic fatigue syndrome](https://en.wikipedia.org/wiki/Myalgic_encephalomyelitis/chronic_fatigue_syndrome "Myalgic encephalomyelitis/chronic fatigue syndrome"), and rheumatoid arthritis.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) Fatigue has been described by sufferers as 'incomprehensible' due to its unpredictable occurrence, lack of relationship to physical effort and different character as compared to tiredness.[\[167\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-167) The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization")'s [ICD-11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11") classification[\[168\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-ICD-11-168) includes a category MG22 Fatigue (typically fatigue following exertion but sometimes may occur in the absence of such exertion as a symptom of health conditions), and many other categories where fatigue is mentioned as a secondary result of other factors.[\[169\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-169) It does not include any fatigue-based psychiatric illness (unless it is accompanied by related psychiatric symptoms).[\[170\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Desai2018-170)[\[171\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid32701520-171) [DSM-5](https://en.wikipedia.org/wiki/DSM-5 "DSM-5") lists 'fatigue or loss of energy nearly every day' as one factor in diagnosing depression.[\[172\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-172) ## Treatment and management \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=43 "Edit section: Treatment and management")\] Management may include review of factors and methods as explained below.\[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed "Wikipedia:Citation needed")*\] ### Cessation of medications causing fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=44 "Edit section: Cessation of medications causing fatigue")\] Taking of medications with side effects of contributing to fatigue may be ceased.[\[173\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-173) [\[47\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Mayo-Clinic-Fatigue-Causes-2023-47)[\[174\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-174)\[*[better source needed](https://en.wikipedia.org/wiki/Wikipedia:Verifiability#Questionable_sources "Wikipedia:Verifiability")*\][\[175\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-175) ### Medications to treat fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=45 "Edit section: Medications to treat fatigue")\] The UK [NICE](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence") recommends consideration of [amantadine](https://en.wikipedia.org/wiki/Amantadine "Amantadine"), [modafinil](https://en.wikipedia.org/wiki/Modafinil "Modafinil"), and [selective serotonin reuptake inhibitors](https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor "Selective serotonin reuptake inhibitor") (SSRIs) for MS fatigue.[\[176\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-176) A [PCORI](https://en.wikipedia.org/wiki/Patient-Centered_Outcomes_Research_Institute "Patient-Centered Outcomes Research Institute") review, however, found amantadine, methylphenidate, and modafinil no more effective than placebo in reducing fatigue, with side effects reported.[\[177\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-177) [Psychostimulants](https://en.wikipedia.org/wiki/Psychostimulant "Psychostimulant") such as [methylphenidate](https://en.wikipedia.org/wiki/Methylphenidate "Methylphenidate"), [amphetamines](https://en.wikipedia.org/wiki/Amphetamine-type_stimulant "Amphetamine-type stimulant"), and modafinil have been used in the treatment of fatigue related to [depression](https://en.wikipedia.org/wiki/Depression_\(mood\) "Depression (mood)"),[\[178\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid18425966-178)[\[179\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid19281939-179)[\[180\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid26906078-180)[\[181\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34144366-181) and [medical illness](https://en.wikipedia.org/wiki/Medical_illness "Medical illness") such as [chronic fatigue syndrome](https://en.wikipedia.org/wiki/Chronic_fatigue_syndrome "Chronic fatigue syndrome")[\[182\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid20088743-182)[\[183\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid18505357-183) and [cancer](https://en.wikipedia.org/wiki/Cancer "Cancer").[\[179\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid19281939-179)[\[184\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid8856815-184)[\[185\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid20870637-185)[\[186\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid21251796-186)[\[187\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid24416225-187)[\[188\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid25299141-188)[\[189\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid25814977-189) They have also been used to counteract fatigue in [sleep loss](https://en.wikipedia.org/wiki/Sleep_loss "Sleep loss")[\[190\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid16268386-190) and in [aviation](https://en.wikipedia.org/wiki/Aviation "Aviation").[\[191\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid33754977-191) ### Mental health tools \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=46 "Edit section: Mental health tools")\] [CBT](https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy "Cognitive behavioral therapy") can be useful for fatigue,[\[192\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-192)[\[193\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto2-193) including ME/CFS[\[194\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-194)[\[195\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-195) but is not included in [NICE](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence "National Institute for Health and Care Excellence") guidelines for ME/CFS treatment.[\[196\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-196)[\[197\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-197) #### Avoidance of body heat \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=48 "Edit section: Avoidance of body heat")\] Fatigue in [MS](https://en.wikipedia.org/wiki/Multiple_sclerosis "Multiple sclerosis") often correlates with relatively high [endogenous](https://en.wikipedia.org/wiki/Endogeny "Endogeny") body temperature.[\[198\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-198)[\[26\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto5-26)[\[199\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-199)[\[200\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-200)[\[201\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-201)[\[202\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-202)[\[203\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-203)[\[204\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-204)[\[205\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid35963205-205)[\[206\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-206)[\[207\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-207)\[*[excessive citations](https://en.wikipedia.org/wiki/Wikipedia:Citing_sources#Bundling_citations "Wikipedia:Citing sources")*\] Improving sleep has been associated with reduced fatigue but only in small studies.[\[208\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-208)[\[209\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-209)[\[193\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto2-193) #### Intermittent fasting \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=50 "Edit section: Intermittent fasting")\] A very small 2022 study found 40% reductions in fatigue categorisations after three months of 16:8 [intermittent fasting](https://en.wikipedia.org/wiki/Intermittent_fasting "Intermittent fasting").[\[210\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-210) #### Vagus nerve stimulation \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=51 "Edit section: Vagus nerve stimulation")\] A very small 2023 study of [Sjogren's](https://en.wikipedia.org/wiki/Sjogren%27s "Sjogren's") patients showed reductions in self-reported fatigue after 56 days of [vagus nerve stimulation](https://en.wikipedia.org/wiki/Vagus_nerve_stimulation "Vagus nerve stimulation").[\[105\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-Tarn_Evans_Traianos_et_al_2023-105) [Qigong](https://en.wikipedia.org/wiki/Qigong "Qigong") and [Tai chi](https://en.wikipedia.org/wiki/Tai_chi "Tai chi") have been postulated as helpful to reduce fatigue, but the evidence is of low quality.[\[211\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-211)[\[212\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-212)[\[213\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-213) ### Approaches to managing fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=53 "Edit section: Approaches to managing fatigue")\] Some health systems help people manage their fatigue better through attitude changes and skills transference.[\[193\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-auto2-193)[\[214\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-214)[\[215\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-215)[\[216\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-216)[\[217\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-217)[\[218\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-218) 2023 guidance stated fatigue prevalence is between 4.3% and 21.9%. Prevalence is higher in women than men.[\[4\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-BMJ-Best-Practice-2023-4)[\[219\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-219) A 2021 German study found that fatigue was the main or secondary reason for 10–20% of all consultations with a primary care physician.[\[220\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-220) A large study based on the 2004 Health and Retirement Study (HRS), a biennial longitudinal survey of US adults aged 51 and above, with mean age 65, found that 33% of women and 29% of men self-reported fatigue.[\[221\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-221) Fatigue represents a large health economic burden and unmet need to patients and to society.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ## Possible purposes of fatigue \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=55 "Edit section: Possible purposes of fatigue")\] ### Body resource management purposes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=56 "Edit section: Body resource management purposes")\] Fatigue has been posited as a bio-psycho-physiological state reflecting the body's overall strategy in resource (energy) management. Fatigue may occur when the body wants to limit resource utilisation ("rationing") in order to use resources for healing (part of [sickness behaviour](https://en.wikipedia.org/wiki/Sickness_behaviour "Sickness behaviour"))[\[123\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31601148-123) or conserve energy for a particular current or future anticipated need, including a threat.[\[12\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid34599320-12) ### Evolutionary purposes \[[edit](https://en.wikipedia.org/w/index.php?title=Fatigue&action=edit&section=57 "Edit section: Evolutionary purposes")\] It has been posited that fatigue had evolutionary benefits in making more of the body's resources available for healing processes, such as immune responses, and in limiting disease spread by tending to reduce social interactions.[\[100\]](https://en.wikipedia.org/wiki/Fatigue#cite_note-pmid31682277-100) - [Acquiescence](https://en.wikipedia.org/wiki/Acquiescence "Acquiescence") - [Affect](https://en.wikipedia.org/wiki/Affect_\(psychology\) "Affect (psychology)") - [Cancer-related fatigue](https://en.wikipedia.org/wiki/Cancer-related_fatigue "Cancer-related fatigue") - [Central governor](https://en.wikipedia.org/wiki/Central_governor "Central governor") - [Chronic stress](https://en.wikipedia.org/wiki/Chronic_stress "Chronic stress") - [Clouding of consciousness](https://en.wikipedia.org/wiki/Clouding_of_consciousness "Clouding of consciousness") - [Combat stress reaction](https://en.wikipedia.org/wiki/Combat_stress_reaction "Combat stress reaction") - [Directed attention fatigue](https://en.wikipedia.org/wiki/Directed_attention_fatigue "Directed attention fatigue") - [Disorders of diminished motivation](https://en.wikipedia.org/wiki/Disorders_of_diminished_motivation "Disorders of diminished motivation") - [Effects of fatigue on safety](https://en.wikipedia.org/wiki/Effects_of_fatigue_on_safety "Effects of fatigue on safety") - [Feeling](https://en.wikipedia.org/wiki/Feeling "Feeling") - [Gaucher's disease](https://en.wikipedia.org/wiki/Gaucher%27s_disease "Gaucher's disease") - [Heat illness](https://en.wikipedia.org/wiki/Heat_illness "Heat illness") - [Malaise](https://en.wikipedia.org/wiki/Malaise "Malaise") - [Microsleep](https://en.wikipedia.org/wiki/Microsleep "Microsleep") - [Museum fatigue](https://en.wikipedia.org/wiki/Museum_fatigue "Museum fatigue") - [Presenteeism](https://en.wikipedia.org/wiki/Presenteeism "Presenteeism") - [Sleep-deprived driving](https://en.wikipedia.org/wiki/Sleep-deprived_driving "Sleep-deprived driving") - [Pacing (activity management)](https://en.wikipedia.org/wiki/Pacing_\(activity_management\) "Pacing (activity management)") - [Zoom fatigue](https://en.wikipedia.org/wiki/Zoom_fatigue "Zoom fatigue") 1. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Mayo-Clinic-Fatigue-2023_1-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Mayo-Clinic-Fatigue-2023_1-1) ["Fatigue"](https://www.mayoclinic.org/symptoms/fatigue/basics/definition/sym-20050894). *[Mayo Clinic](https://en.wikipedia.org/wiki/Mayo_Clinic "Mayo Clinic")*. [Archived](https://web.archive.org/web/20230106193733/https://www.mayoclinic.org/symptoms/fatigue/basics/definition/sym-20050894) from the original on 2023-01-06. Retrieved 2023-01-06. 2. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Cancer-terms-2023_2-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Cancer-terms-2023_2-1) ["Cancer terms"](https://www.cancer.gov/publications/dictionaries/cancer-terms/def/fatigue#:~:text=\(fuh-TEEG\),may%20be%20acute%20or%20chronic). [Archived](https://web.archive.org/web/20230106193733/https://www.cancer.gov/publications/dictionaries/cancer-terms/def/fatigue#:~:text=\(fuh-TEEG\),may%20be%20acute%20or%20chronic) from the original on 2023-01-06. Retrieved 2023-01-06. 3. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-pmid23892338_3-0)** Finsterer J, Mahjoub SZ (August 2014). "Fatigue in healthy and diseased individuals". *Am J Hosp Palliat Care*. **31** (5): 562–575\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1177/1049909113494748](https://doi.org/10.1177%2F1049909113494748). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [23892338](https://pubmed.ncbi.nlm.nih.gov/23892338). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12582944](https://api.semanticscholar.org/CorpusID:12582944). 4. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-1) [***c***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-2) [***d***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-3) [***e***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-BMJ-Best-Practice-2023_4-4) ["Evaluation of fatigue — Differential diagnosis of symptoms"](https://bestpractice.bmj.com/topics/en-us/571). *BMJ Best Practice*. [Archived](https://web.archive.org/web/20231203113928/https://bestpractice.bmj.com/topics/en-us/571) from the original on 2023-12-03. Retrieved 2024-03-25. 5. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Medically_unexplained_symptoms-2017_5-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Medically_unexplained_symptoms-2017_5-1) [***c***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Medically_unexplained_symptoms-2017_5-2) ["Medically unexplained symptoms"](https://www.nhs.uk/conditions/medically-unexplained-symptoms/). 19 October 2017. [Archived](https://web.archive.org/web/20170929113241/http://www.nhs.uk/conditions/medically-unexplained-symptoms/Pages/Somatisation.aspx) from the original on 29 September 2017. Retrieved 6 January 2023. 6. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-pmid31574939_6-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-pmid31574939_6-1) Haß U, Herpich C, Norman K (September 2019). ["Anti-Inflammatory Diets and Fatigue"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835556). *Nutrients*. **11** (10): 2315. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3390/nu11102315](https://doi.org/10.3390%2Fnu11102315). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6835556](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835556). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31574939](https://pubmed.ncbi.nlm.nih.gov/31574939). 7. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-7)** Gandevia SC (February 1992). "Some central and peripheral factors affecting human motoneuronal output in neuromuscular fatigue". *Sports Medicine*. **13** (2): 93–98\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.2165/00007256-199213020-00004](https://doi.org/10.2165%2F00007256-199213020-00004). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [1561512](https://pubmed.ncbi.nlm.nih.gov/1561512). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [20473830](https://api.semanticscholar.org/CorpusID:20473830). 8. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-8)** Hagberg M (July 1981). "Muscular endurance and surface electromyogram in isometric and dynamic exercise". *Journal of Applied Physiology*. **51** (1): 1–7\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1152/jappl.1981.51.1.1](https://doi.org/10.1152%2Fjappl.1981.51.1.1). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [7263402](https://pubmed.ncbi.nlm.nih.gov/7263402). 9. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-9)** Hawley JA, Reilly T (June 1997). "Fatigue revisited". *Journal of Sports Sciences*. **15** (3): 245–246\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1080/026404197367245](https://doi.org/10.1080%2F026404197367245). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [9232549](https://pubmed.ncbi.nlm.nih.gov/9232549). 10. ^ [***a***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Marcora_2009_857%E2%80%93864_10-0) [***b***](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Marcora_2009_857%E2%80%93864_10-1) Marcora SM, Staiano W, Manning V (March 2009). "Mental fatigue impairs physical performance in humans". *Journal of Applied Physiology*. **106** (3): 857–864\. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2009JAPh..106..857M](https://ui.adsabs.harvard.edu/abs/2009JAPh..106..857M). [CiteSeerX](https://en.wikipedia.org/wiki/CiteSeerX_\(identifier\) "CiteSeerX (identifier)") [10\.1.1.557.3566](https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.557.3566). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1152/japplphysiol.91324.2008](https://doi.org/10.1152%2Fjapplphysiol.91324.2008). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [19131473](https://pubmed.ncbi.nlm.nih.gov/19131473). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [12221961](https://api.semanticscholar.org/CorpusID:12221961). 11. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-Martin_11-0)** Martin K, Meeusen R, Thompson KG, Keegan R, Rattray B (September 2018). "Mental Fatigue Impairs Endurance Performance: A Physiological Explanation". *Sports Med*. **48** (9): 2041–2051\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1007/s40279-018-0946-9](https://doi.org/10.1007%2Fs40279-018-0946-9). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [29923147](https://pubmed.ncbi.nlm.nih.gov/29923147). 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["Thermoregulation in multiple sclerosis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980380). *Journal of Applied Physiology*. **109** (5): 1531–1537\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1152/japplphysiol.00460.2010](https://doi.org/10.1152%2Fjapplphysiol.00460.2010). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2980380](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980380). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20671034](https://pubmed.ncbi.nlm.nih.gov/20671034). 207. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-207)** Davis SL, Jay O, Wilson TE (2018). "Thermoregulatory dysfunction in multiple sclerosis". *Thermoregulation: From Basic Neuroscience to Clinical Neurology, Part II*. Handbook of Clinical Neurology. Vol. 157. Elsevier. pp. 701–714\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/B978-0-444-64074-1.00042-2](https://doi.org/10.1016%2FB978-0-444-64074-1.00042-2). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-444-64074-1](https://en.wikipedia.org/wiki/Special:BookSources/978-0-444-64074-1 "Special:BookSources/978-0-444-64074-1") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [30459034](https://pubmed.ncbi.nlm.nih.gov/30459034). 208. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-208)** Orlandi AC, Ventura C, Gallinaro AL, Costa RA, Lage LV (October 2012). "Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia". *Revista Brasileira de Reumatologia*. **52** (5): 666–678\. 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[PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [35371410](https://pubmed.ncbi.nlm.nih.gov/35371410). 210. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-210)** Anic K, Schmidt MW, Furtado L, Weidenbach L, Battista MJ, Schmidt M, Schwab R, Brenner W, Ruckes C, Lotz J, Lackner KJ, Hasenburg A, Hasenburg A (October 10, 2022). ["Intermittent Fasting—Short- and Long-Term Quality of Life, Fatigue, and Safety in Healthy Volunteers: A Prospective, Clinical Trial"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9571750). *Nutrients*. **14** (19): 4216. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3390/nu14194216](https://doi.org/10.3390%2Fnu14194216). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [9571750](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9571750). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [36235868](https://pubmed.ncbi.nlm.nih.gov/36235868). 211. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-211)** Xiang Y, Lu L, Chen X, Wen Z (5 April 2017). ["Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381792). *PLOS ONE*. **12** (4) e0174872. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2017PLoSO..1274872X](https://ui.adsabs.harvard.edu/abs/2017PLoSO..1274872X). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1371/journal.pone.0174872](https://doi.org/10.1371%2Fjournal.pone.0174872). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [5381792](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381792). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [28380067](https://pubmed.ncbi.nlm.nih.gov/28380067). 212. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-212)** Wang R, Huang X, Wu Y, Sun D (22 June 2021). ["Efficacy of Qigong Exercise for Treatment of Fatigue: A Systematic Review and Meta-Analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257957). *Frontiers in Medicine*. **8** 684058. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3389/fmed.2021.684058](https://doi.org/10.3389%2Ffmed.2021.684058). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8257957](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257957). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34239889](https://pubmed.ncbi.nlm.nih.gov/34239889). 213. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-213)** Chan JS, Ng S, Yuen L, Chan CL (2019). "Qigong exercise for chronic fatigue syndrome". *Exercise on Brain Health*. International Review of Neurobiology. Vol. 147. Academic Press. pp. 121–153\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/bs.irn.2019.08.002](https://doi.org/10.1016%2Fbs.irn.2019.08.002). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-0-12-816967-4](https://en.wikipedia.org/wiki/Special:BookSources/978-0-12-816967-4 "Special:BookSources/978-0-12-816967-4") . [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31607352](https://pubmed.ncbi.nlm.nih.gov/31607352). 214. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-214)** Trust RU. ["Royal United Hospitals Bath NHS Foundation Trust"](https://www.ruh.nhs.uk/rnhrd/patients/services/fatigue_services/index.asp?menu_id=1&RNHRD=y). *www.ruh.nhs.uk*. [Archived](https://web.archive.org/web/20250120122805/https://www.ruh.nhs.uk/rnhrd/patients/services/fatigue_services/index.asp?menu_id=1&RNHRD=y) from the original on 2025-01-20. Retrieved 2025-01-06. 215. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-215)** ["Energy & Fatigue"](https://www.health.harvard.edu/topics/energy-and-fatigue#boosting-energy-managing-fatigue2). *Harvard Health*. April 12, 2023. [Archived](https://web.archive.org/web/20250118080657/https://www.health.harvard.edu/topics/energy-and-fatigue#boosting-energy-managing-fatigue2) from the original on January 18, 2025. Retrieved January 6, 2025. 216. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-216)** ["Managing MS Fatigue - Help & Support \| MS Society"](https://www.mssociety.org.uk/about-ms/signs-and-symptoms/fatigue/managing-fatigue). *www.mssociety.org.uk*. 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Retrieved 2025-01-06. 219. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-219)** Loge JH, Ekeberg Ø, Kaasa S (July 1998). "Fatigue in the general norwegian population". *Journal of Psychosomatic Research*. **45** (1): 53–65\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/s0022-3999(97)00291-2](https://doi.org/10.1016%2Fs0022-3999%2897%2900291-2). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [9720855](https://pubmed.ncbi.nlm.nih.gov/9720855). 220. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-220)** Maisel P, Baum E, Donner-Banzhoff N (August 30, 2021). ["Fatigue as the Chief Complaint"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579431). *Deutsches Ärzteblatt International*. **118** (33–34\): 566–576\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.3238/arztebl.m2021.0192](https://doi.org/10.3238%2Farztebl.m2021.0192). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [8579431](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579431). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [34196270](https://pubmed.ncbi.nlm.nih.gov/34196270). 221. **[^](https://en.wikipedia.org/wiki/Fatigue#cite_ref-221)** Meng H, Hale L, Friedberg F (October 2010). ["Prevalence and Predictors of Fatigue in Middle-Aged and Older Adults: Evidence from the Health and Retirement Study"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981161). *Journal of the American Geriatrics Society*. **58** (10): 2033–2034\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1111/j.1532-5415.2010.03088.x](https://doi.org/10.1111%2Fj.1532-5415.2010.03088.x). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [2981161](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2981161). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [20929479](https://pubmed.ncbi.nlm.nih.gov/20929479). - [Byung-Chul Han](https://en.wikipedia.org/wiki/Byung-Chul_Han "Byung-Chul Han"): *MĂŒdigkeitsgesellschaft*. Matthes & Seitz, Berlin 2010, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-3-88221-616-5](https://en.wikipedia.org/wiki/Special:BookSources/978-3-88221-616-5 "Special:BookSources/978-3-88221-616-5") . (Philosophical essay about fatigue as a sociological problem and symptom). - Danish edition: TrĂŠthedssamfundet. MĂžller, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-87-994043-7-7](https://en.wikipedia.org/wiki/Special:BookSources/978-87-994043-7-7 "Special:BookSources/978-87-994043-7-7") . - Dutch edition: De vermoeide samenleving. van gennep, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-94-6164-071-0](https://en.wikipedia.org/wiki/Special:BookSources/978-94-6164-071-0 "Special:BookSources/978-94-6164-071-0") . - Italian editions: La societĂ  della stanchezza. nottetempo, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-88-7452-345-0](https://en.wikipedia.org/wiki/Special:BookSources/978-88-7452-345-0 "Special:BookSources/978-88-7452-345-0") . - Korean edition: 한병ìČ  지음 \| êč€íƒœí™˜ ì˜źêč€. Moonji, 2011, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-89-320-2396-0](https://en.wikipedia.org/wiki/Special:BookSources/978-89-320-2396-0 "Special:BookSources/978-89-320-2396-0") . - Spanish edition: La sociedad del cansancio. Herder Editorial, 2012, [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)") [978-84-254-2868-5](https://en.wikipedia.org/wiki/Special:BookSources/978-84-254-2868-5 "Special:BookSources/978-84-254-2868-5") . - South, David (1993). [*Professor puts chronic fatigue into historical perspective*](https://www.google.co.uk/books/edition/Hannah_Institute_for_the_History_of_Medi/tyPYa2ZsItMC?hl=en&gbpv=1&dq=chronic+fatigue+hannah+institute&pg=PA1&printsec=frontcover). Hannah Institute for the History of Medicine Number 18 Summer 1993, p. 1 ![](https://upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Wikiquote-logo.svg/40px-Wikiquote-logo.svg.png) Wikiquote has quotations related to ***[Fatigue](https://en.wikiquote.org/wiki/Special:Search/Fatigue "q:Special:Search/Fatigue")***. [![Wikimedia Commons logo](https://upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/40px-Commons-logo.svg.png)](https://en.wikipedia.org/wiki/File:Commons-logo.svg) Wikimedia Commons has media related to [Fatigue](https://commons.wikimedia.org/wiki/Category:Fatigue "commons:Category:Fatigue"). - [Fatigue – Information for Patients](http://www.cancer.gov/cancertopics/pdq/supportivecare/fatigue/patient), U.S. National Cancer Institute
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