Linda Speer, MD Saudia Mushkbar, MD Department of Family Medicine, University of Toledo College of Medicine and Life Sciences, Ohio (Drs. Speer and Mushkbar) linda.speer@utoledo.edu
The authors reported no potential conflict of interest relevant to this article.
Other potentially beneficial approaches include a healthy diet, avoidance of more than nominal amounts of alcohol, relative avoidance of caffeine (no more than one cup of a caffeinated beverage in the morning), and stress reduction techniques.
Attention to good sleep hygiene may be especially beneficial, including a regular bedtime routine and sleep schedule, and elimination of bedroom light and noise. Pharmacologic treatments for insomnia should be used with caution, if at all.
Bupropion, which is somewhat stimulating, may be considered as an initial treatment for patients with depression and clinically significant fatigue.CASE › Ms. C receives a referral for CBT and is scheduled for a return visit in 4 weeks.
At the advice of both her primary care physician and the behavioral therapist, Ms. C gradually makes several lifestyle changes. She begins going to bed earlier on weeknights to ensure that she sleeps for at least 7 hours. She improves her diet, with increasing emphasis on vegetables, fruits, and whole grains. She also starts a walking program, increasing gradually to a total of 3 hours per week. After 4 months she adds a weekly trip to a gym, where she practices resistance training for about 40 minutes.
Ms. C also increases her social activities on weekends, and recently accepted an invitation to join a book club. Six months from her initial visit, Ms. C notes that although she is still more easily fatigued than most people, she has made significant improvement.
CORRESPONDENCE Linda Speer, MD; University of Toledo, 3000 Arlington Avenue, MS 1179, Toledo, OH 43614; linda.speer@utoledo.edu
