Tired of Being Tired?

[Guest guest]

Nate and Grove

Of Two MInds

Tired of Being Tired?

No, this is not a Geritol or Vita-Vita-Vegamin advertisement. The topic for today is fatigue. Our definition of fatigue is feeling tired all of the time no matter how much rest or sleep you get. Fatigue is a symptom; group of feelings and conditions, as opposed to a disease. It can interfere with your daily activities or your ability to socialize. Being tired all of the time may be physical or psychological, but since we tend to see mind and body has the same, it is really a little of both. Everyone experiences it from time to time, but it requires treatment if it is frequent or lasts for sustained periods of time.

About 40% of HIV positive men and women have true fatigue. It is a common reason for leaving work or disability. If it gets in the way too much of our ability to socialize or get out and do things, it can lead to depression. It can even affect our ability to be compliant with medications. It is important to remember also that fatigue is one of the symptoms of depression. Differentiating it from depression is not that difficult. Look for other indicators of depression such as and increase or decrease of appetite, changes in sleep patterns like sleeping too much or having insomnia, a sad mood, crying spells, thoughts of death or suicide, or a low energy level. Depression is the most common cause of fatigue and is very treatable with antidepressants and/or talk therapy.

Fatigue may be due to the HIV virus itself or to the medications we take for HIV. Because it is such a prevalent problem and results in so many of people with HIV going on disability due to fatigue, it is a very expensive problem. It interferes with your ability to concentrate, remember things, maintain attention, and learn new things. There are other non-HIV causes for fatigue. Anemia, low testosterone levels, other infections such as hepatitis C or drugs used to treat hepatitis C (interferon/ribavirin), and low thyroid levels. These can be diagnosed with routine lab tests. Once those causes have been eliminated, your doctor will either try to treat the cause or treat the symptoms. Testosterone, either in injectable or gel form, has clear-cut positive effects on energy level and stamina. DHEA is a precursor of testosterone that is sold in 50 mg. tablets over the counter and taken either alone or with prescription testosterone, boosts testosterone levels.

The other main class of medications used to treat fatigue in HIV is called psychostimulants. Drugs such as Dexedrine, Ritalin, Cylert, and Adderall are used in HIV patients to combat fatigue. In a small study done at Columbia University, Dexedrine was given to HIV + people with a CD4 counts below 50 and fatigue and a major positive effect was noted on energy as well as mood. Stimulants are contraindicated in those with previous addiction histories since they are in the class of drugs containing amphetamines. Physicians are reluctant to prescribe them because of their potential for abuse and dependency.

Another medication used in treatment of fatigue is called Provigil. It was developed as an anti convulsive used to treat epilepsy. Scientists do not understand how it works in the brain but it raises energy levels and is non-addictive. Its use to treat fatigue is off label, meaning that is legal to prescribe it, but insurance companies and social service agencies may not pay for it. In a preliminary study with a 30 HIV positive men and women with persistent fatigue it was very helpful. It had few side effects other than feeling a bit "wired" or having a headache. By the end of this 12 week trial five patients started back to work again, two others increased their hours at work, and two enrolled in vocational training programs.

Fatigue is as a very real problem. If you have true fatigue you are not just being lazy. The treatment options are good for most causes. Make note of the times you sleep well and still feel tired and report it to your doctor. With proper treatment, you will start associating fatigues with what soldiers wear rather than with another bad day. Wake up and have a good fortnight.

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