By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER SHOULD ASK DOCTOR IF DEPRESSION IS CAUSE OF HIS FATIGUE

Question: I’m a 50-year-old man, and for the last few months I’ve been feeling tired all the time, even right after I get up in the morning. I went to my family doctor and she examined me and gave me a bunch of tests. All the tests came back negative. Can you give me some guidance about what I should do next? Thanks.

Answer: Doctors often call the condition you describe fatigue. It’s a very common complaint among patients that we family doctors see in our offices. These patients use a variety of words to describe the problem. They may say they are weary, are constantly tired or have no energy. But these terms all mean about the same thing.

An abnormality in practically any body system can produce fatigue. That's why the physician needs to treat each case of fatigue like a detective. His or her job is to find the clues necessary to solve the mystery. The first step is to interview the patient about the development of the symptoms and relevant medical history. Then, more evidence is gathered by conducting a physical examination and analyzing the results of a first battery of tests. At this stage, the physician-detective often has a good hunch what the culprit might be.

From your description, it sounds like your doctor has completed these stages but has failed to come up with a "suspect." You should consider that good news. Although normal test results may seem frustrating to you because they fail to identify the cause of your illness, they are actually a good sign because they suggest that you do not have one of the common but serious causes of fatigue. Diabetes, cancer, heart disease, kidney disease and many other life-threatening conditions cause fatigue. These are the sorts of illnesses that doctors test for first if the history and physical examination fail to direct the search toward a specific illness.

Anemia, low thyroid hormone and a variety of other illnesses can have subtle symptoms that include fatigue. The most common of these illnesses is depression. Unfortunately, the term depression means different things to different people. I’m not talking about the type of severe episode where an individual is obviously emotionally distressed for a long period of time and talking about committing suicide. Most cases of depression are more subtle. The day may seem gray even when the sun shines; there appears to be no hope and no fun left in life.

There are no blood tests for depression, but there are paper-and-pencil tests that check for it. Some doctors choose to ask a series of targeted questions instead of using the written form of the test.

Over the years, I’ve found that a number of the patients that I believe to be depressed will argue with me about the diagnosis. They’ll admit to being nervous, anxious, easily upset, unhappy at work or home, but they balk at the idea that they are suffering from depression. While I’ve found this a little less true in recent years, there is still a stigma associated with the label “depression” among many people in our society. This is unfortunate because this attitude can prevent a person from receiving the proper treatment for his or her condition.

I suggest that you return to your doctor for further evaluation. Your fatigue is a clue to a complex mystery that may take her considerable time and effort to solve. Finally, I’d recommend that you ask specifically about depression.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.