Dr Matthew Cullen, Psychiatrist, St Vincent’s Hospital, Sydney

So people with chronic fatigue, or chronic fatigue syndrome, describe this propensity to become tired, physically tired, an inability to do a great deal of physical activity. And at the same time, there’s this inability to focus, concentrate, perform in the way they would normally at a cognitive or neurocognitive level.

What is the cause of chronic fatigue?

Often, there’s some sort of viral illness that will trigger this. Glandular fever is well-described as being a trigger for chronic fatigue syndrome. Although in many instances, working out exactly where chronic fatigue has started and what the cause is, can be quite difficult.

What is the treatment?

Where it gets complicated though, even when there is a clear biological or viral illness as a trigger, is that the ongoing treatment of the ongoing disorder can be quite hard to actually address.

So let me give you an example. In someone who has chronic fatigue, this ability every time they overdo it to become quite exhausted and physically unable to perform their activities or cognitively unable to perform, a cycle emerges of trying to push things a bit further, then a set back, trying to push things a little bit further, then a setback. And over the top of the physical fatigue, not surprisingly, the person starts to become depressed, low in mood, their motivation to address things. And this vicious cycle develops between physical and mental elements that perpetuate chronic fatigue.

Sometimes chronic fatigue syndrome will spontaneously remit, but on other times it requires a very thoughtful approach, both at a physical level and a psychological level to gradually work that person up from being unable to perform many activities at all, and just in a slow step-wise manner, progressively helping them to get back to their normal level of activity. The key being not to overdo it, graduated, careful, slow progression to help them recover.

Last Reviewed: 20/08/2020

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