Medication side effects
If depression is a fatigue-causing factor, a wide variety of antidepressants are available to help relieve it. In fact, low doses of antidepressants often are used to treat symptoms of fibromyalgia and as fatigue treatments. But up to 20 percent of patients taking selective serotonin-reuptake inhibitor (SSRI) antidepressants, including Paxil, Prozac, or Zoloft, report drowsiness as a side effect. While you might think drowsiness would help fatigued people get the sleep they crave, daytime drowsiness related to oversedation can be a source of fatigue.
Many other medications list drowsiness as a common side effect: pain medications such as oxycodone (OxyContin); some prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (Voltaren) or naproxen (Naprosyn); tricyclic antidepressants such as amitriptyline hydrochloride (Endep); disease-modifying antirheumatic drugs (DMARDs) such as azathioprine (Imuran); antihistamines such as diphenhydramine (Benadryl) and some blood pressure medications.
If drowsiness or insomnia is a side effect of your medication, do not stop taking it without talking to your doctor first. Abruptly stopping medications, especially SSRIs, or missing several doses can lead to discontinuation syndrome, which causes flu-like symptoms.
Inflammation
The body’s immune system normally helps keep people healthy, fighting off illness-causing invaders. But in those with autoimmune diseases, the system targets the person’s own tissues. Researchers have found the foremost fatigue inducers to be higher-than-normal levels of cytokines – chemical messengers that regulate the intensity and duration of immune responses.
Researchers in Australia recently studied symptoms related to “acute sickness behavior.” These consisted of fatigue, malaise, listlessness, inability to concentrate, poor memory, fever and decreased appetite. The researchers interviewed 69 people with infections to learn which symptoms of acute sickness behavior they had. The researchers then measured the amount of cytokines in the patients’ blood samples and cell cultures. Results showed that fatigue consistently correlated with levels of interleukin-1 (IL-1) and IL-6, both of which are connected with inflammatory forms of arthritis. The higher the levels, the more unwell the study participants felt.
Anemia
Anemia affects up to two-thirds of RA patients and is most common in those with severe joint disease. Fortunately, if the anemia can be successfully treated, the joint pain, swelling and tenderness respond better to treatment, and improving those symptoms helps beat fatigue, according to a 2004 review of a dozen studies focusing on anemia in people with RA.
In Grant’s case, Dr. Pischel determined that one reason she felt fatigued was anemia of inflammation, formerly called anemia of chronic disease. This type of anemia occurs when chronic illnesses cause a drop in the longevity of red blood cells. Her hematocrit, a measure of the number and size of red blood cells, is 30 (normal is between 36 and 44). With too few or too-small blood cells, her body has too little iron. And too little iron means less energy, because iron is what holds onto oxygen in the red blood cells, and oxygen is vital for energy production.
“Because Grant’s hematocrit is 20 percent lower than normal, her body has to work an extra 20 percent harder whenever she moves,” says Dr. Pischel. When performing normal daily physical activities, the muscles are taxed closer to their maximum capacity – similar to a healthy person working out intensely. Overtaxed muscles result in fatigue after even a short burst of activity.
