Up to 10% of patients in a primary care setting have concerns over their fatigue. 

Fatigue does not necessarily get better with more rest or sleep, which often leads patients feeling frustrated. It feels obvious to us that more sleep would lead to feeling more vibrant, yet fatigue leaves you feeling under-resourced even with adequate sleep. 

What I want to talk about today is what comes after all your bloodwork results show everything is normal… 

Beyond the typical culprits of physiologic fatigue such as nutritional deficiencies, following a viral infection and issues with sleep I want to scan through the mental states we can experience that we may so easily overlook as culprit for daytime fatigue.

When you come into my office, I want you to know my job is to give you a thorough assessment, explain my process, generate a plan with you that is sustainable within your life then check in with you to note if you are responding well to treatment or if we need troubleshooting. This approach makes it impossible for me to not consider the two diagnoses below as possible contributors to your fatigue. 

Depression 

Fatigue is a core symptom of depression, and fatigue greatly influences the choices we make. I wish more people understood this. 

Depression paired with fatigue comes up against many difficulties, one of which being the development of fatigue causes us to avoid high mental load/effort tasks. Evidently a lot of treatments require mental load/effort to engage in and working with a Doctor who understands the nuances here is incredibly important to patient success. 

Treatment targets can include 

• • Estrogen replacement in perimenopause. Based on North American Menopause Society (NAMS) guidelines, estradiol therapy is recognized as an effective treatment for mild to moderate depression in perimenopause, particularly when concurrent perimenopausal symptoms are present.
  • Testing for nutrient deficiencies. There are multiple nutrient deficiencies that can contribute to depression. 
  • Managing sleep quality & insomnia
  • Discussing pharmaceutical options. It is incredibly frustrating to feel like the first pharmaceutical prescribed is not working. This is common, but what gets missed is an open discussion on options and expectations. 
  • Introducing Supplements & Herbs.  Not everyone is comfortable with a pharmaceutical approach, or seeing a clinically meaningful benefit. We have incredible clinical trials showing benefit to adding hers to depression care. 
  • Management of the condition contributing to depression. It is important to never forget mild to moderate depression can come secondary to conditions such as irritable bowel syndrome, low back pain etc. 
  • Behaviour changes – exercise improves secondary depression considerably, although it can understandably be difficult to engage in with overlapping fatigue 

I develop each treatment plan uniquely, because my patients are involved in the decision making process and planning. I work within your preferences and capacity while always offering the most effective care available. 

Excessive Psychosocial Stress & Burnout 

Burnout is a distinct syndrome separate from depression, although many symptoms overlap. Characteristics of burnout are:

1. Mental/emotional exhaustion
2. Loss of empathy and motivation that you previously had 
3. Low sense of personal accomplishment

Trying to identify if your perceived stress, and avoidance as a coping strategy may be associated with your fatigue may not feel straight forward. Below is an online questionnaire for you to self assess if you feel under-resourced due to your perceived stress. 

CLICK HERE FOR QUESTIONNAIRE 

Treatment targets include 

• Herbal & Nutraceutical support. 
• Blood sugar stabilization. Symptomatic hypoglycemia due to irregular eating patterns are quite common within the burnout demographic.  
• Sleep assessment. 
• Heart rate variability management. 

Attention Deficit Hyperactivity Disorder (ADHD)

Individuals living with ADHD have higher wake time slow-wave activity within the brain compared to those who do not live with ADHD. These slow waves typically build sleep pressure for all humans and the higher density of slow waves the more sleepiness we tend to feel, as a collective. 

The more daytime sleepiness the ADHD brain experiences the more likely the mind is to wander, making focus and attention towards basic tasks more difficult as the day goes on.

Treatment targets include 

• Avoid medication or supplements that increase wake time slow wave activity

• Build standard operating procedures that work with the ADHD brain 
• Herbals and nutraceutical adjunctive care for ADHD 
• Nutrition practices to manage ADHD induced sleepiness. 

The Bottom Line

Fatigue isn’t simple, and causes rooted in mental health such as depression (even seasonal affective disorder) are severely underestimated. This leaves patients feeling exhausted for far longer than they need to be. 

If this resonates with you, and you’re wondering how to support your mental health beyond talk therapy, you are welcome to look at my schedule. I offer a free 15 minute consult so we can make sure Naturopathic support is the next best step for you. 

With Gratitude, 

Dr. Rachel Fobert, ND 

Naturopathic Doctor 

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