Lethargy is a subjective feeling of lack of vigor and energy, accompanied by a decrease in working capacity and loss of interest in familiar activities. Often, malaise occurs under the influence of external factors: fatigue, overeating, excessive coffee consumption. Symptoms are also caused by pathological causes — endocrine and neurological diseases, mental disorders. To clarify the origin of lethargy, laboratory and instrumental methods, neurological and psychiatric examination are used. To improve the condition, a complex of medications and non-drug effects is used.
Causes of lethargy
Lethargy and fatigue after a hard day’s work or during intense physical exertion are observed in absolutely healthy people. With overwork, there is heaviness in the muscles of the legs and arms, apathy, there is no desire to continue working. Drowsiness occurs, the head “buzzes”. Normally, the symptoms disappear after a break or a full sleep. If weakness develops with minor loads, habitual daily work, a feeling of powerlessness does not go away after sufficient rest, it is necessary to consult a doctor to rule out serious causes of the disorder.
It has been proven that coffee can have both an exciting and depressing effect on the body, which depends on the dose of caffeine and the type of higher nervous activity. In people with a strong nervous system, small amounts of caffeine have a sedative effect, provoke fatigue and lethargy, and large dosages of coffee stimulate mental and physical activity. For people with a weak type of nervous system, the opposite pattern is characteristic – high doses of caffeine cause apathy and drowsiness.
After the abuse of fatty foods, lethargy and drowsiness develop, which is caused by an increased load on the digestive system. With excessive overeating in combination with alcoholic beverages, severe fatigue persists the next day. A sharp weakness that occurs constantly from day to day 20-30 minutes after eating indicates problems with digestion and absorption of food or the presence of dumping syndrome. In such a situation, a full medical examination is required.
Hormonal fluctuations in women
The combination of lethargy and emotional lability is a typical sign of premenstrual syndrome. Apathy and increased fatigue appear 2-3 days before menstruation, normally the symptoms disappear with the onset of bleeding. Similar manifestations develop during menopause, when patients report morning weakness and weakness that occur against the background of tides and chills. Constant lethargy, combined with discomfort in the lower abdomen or cycle disorders, is caused by pathological causes — dishormonal or inflammatory diseases of the female genital organs.
Hypofunction of the thyroid gland
The lack of thyroxine and triiodothyronine in the body causes changes in all organs and tissues, which is associated with the appearance of lethargy, malaise. The symptom occurs in various pathologies — hypothyroidism, autoimmune thyroiditis, thyroid adenomas. The severity of lethargy depends on the degree of hormone deficiency and the duration of the disease. In severe cases, there is a decline in strength, a complete loss of interest in life and favorite activities. Changes in appearance are characteristic: the skin becomes pale and cold to the touch, swelling forms, body weight increases.
The period of reconvalescence
After the disappearance of the main clinical manifestations of various diseases, lethargy and severe fatigue persist for a long time, increasing with minor physical exertion. The malaise is caused by the depletion of the body during the period of illness, the expenditure of muscle glycogen reserves, a lack of proteins and vitamins. Symptoms persist for 2-4 weeks after recovery, with chronic sluggish processes, asthenic syndrome lasts up to several months. Lethargy is caused by various causes — nonspecific inflammatory, dystrophic, infectious processes.
Brain damage is often accompanied by lethargy, apathy. Neurological pathologies deplete the reserves of neurotransmitters, disrupt the work of the reticular formation and the limbic system – structures responsible for mood and general well-being. Residual (residual) manifestations after the transferred diseases persist from several months to a year. In the elderly, lethargy is combined with progressive cognitive impairment. Frequent etiological factors of malaise:
- Infectious CNS lesion: meningitis, encephalitis, arachnoiditis.
- Degenerative processes: dyscirculatory encephalopathy, Alzheimer’s disease.
- Acute conditions: cerebral hemorrhages, ischemic strokes.
- Tumors: neuroblastoma, astrocytoma, glioblastoma, etc.
With VSD, all signs of malaise are present: drowsiness, lethargy, constant fatigue. Pathological symptoms are caused by disturbances in the balance between the sympathetic and parasympathetic nervous system, periodic jumps in blood pressure. Lethargy increases with prolonged stay in a stuffy room without access to fresh air. After short-term work, patients complain of a decline in strength caused by neuropsychiatric exhaustion. Also typical are dull squeezing headaches and dizziness, emotional instability.
Severe lethargy with apathy is characteristic of depression. A person is absolutely indifferent to what is happening around, does not want to do everyday things. There is constant drowsiness – patients sleep for 12-14 hours a day, but do not feel cheerful and energetic. Similar disorders are observed in the depressive phase of bipolar disorder. The decline in strength is typical for neurotic reactions with asthenic syndrome (“irritable weakness”), which more often worries young and middle-aged women.
Chronic fatigue syndrome
With this disorder, severe drowsiness and lethargy do not disappear even after a long rest or several weekends. The patient constantly feels exhausted, because of sleep disorders, fatigue appears in the morning. Against the background of insomnia, headaches and muscle heaviness are progressing. Interest in work and hobbies disappears, anxiety and irritability arise over time. The most common causes of chronic fatigue syndrome are infection with the herpes virus type 6, endocrine and somatic diseases, and an incorrect lifestyle.
During the intercalary period, pathological changes in the lungs and bronchi persist, which cause chronic hypoxia. Against the background of light oxygen starvation, lethargy develops, which increases with physical activity. There is shortness of breath, heaviness in the arms and legs. The clinical picture is complemented by objective signs: pallor of the nasolabial triangle, changes in the frequency and nature of breathing. In the case of an attack of bronchial asthma, the condition is replaced by sharp weakness and lack of air, a person needs emergency help.
A prolonged inflammatory process causes the accumulation of cytokines and mediators in the body, which negatively affect the overall well-being. Lethargy increases gradually, at first it becomes more difficult to perform professional duties, when doing sports it is necessary to take long breaks. Over time, motivation disappears, a person becomes indifferent, complains of a general decline in strength, sharp weakness and drowsiness. Autoimmune causes that most often provoke malaise are the initial stage of rheumatoid arthritis, vasculitis, systemic lupus erythematosus.
- Allergic diseases: rhinitis and pharyngitis, angioedema, anaphylactic reactions.
- Pathology of the blood system: thrombocytopenia, aplastic anemia, lymphomas and leukemias.
- Kidney damage: glomerulonephritis and chronic pyelonephritis, renal failure, uremia.
Lethargy is a symptom of many diseases, so the organization of the primary examination is handled by a general practitioner. The diagnostic plan involves a combination of laboratory and instrumental studies designed to find or exclude a possible cause of lethargy. The most informative are:
- Blood testing. In the general analysis, nonspecific signs of inflammation are detected, sharp changes in the number of platelets indicate violations of the hemostasis system. Biochemical analysis is carried out to determine the level of protein and individual protein fractions, acute phase indicators. The immunogram is designed to exclude allergic reactions.
- Hormonal profile. In women, progesterone and estrogen levels are necessarily examined, if necessary, the amount of FSH and LH, prolactin. To exclude thyroid diseases, the levels of free thyroxine, triiodothyronine, and thyroid-stimulating hormone of the pituitary gland are evaluated. Additionally, the concentration of insulin is determined.
- Bacteriological analysis. Often, lethargy is a sign of infectious diseases, so it requires back-sowing of blood, sputum on selective nutrient media. For express diagnostics, smear microscopy is performed after staining with aniline dyes. Serological reactions are used to confirm the diagnosis, especially in viral infections.
- X-ray imaging. To assess the condition of the kidneys, an overview radiography and excretory urography are performed. To exclude damage to brain tissue, CT is prescribed, which allows to identify focal formations or diffuse inflammatory changes. Magnetic resonance imaging is used to detail the lesion area.
- Additional methods. In order to exclude bronchial asthma, spirography and bronchodilation test with salbutamol are necessary. If neurological causes of malaise are suspected, the reactions of the autonomic nervous system are examined, deep and superficial reflexes are studied. Women are shown a comprehensive gynecological examination.
Help before diagnosis
Lethargy and weakness caused by ordinary overwork are not indications for specific therapy. It is enough for a person to sleep 8-9 hours, and the feeling of loss of strength disappears. It is important to normalize the daily routine, try to go to bed no later than 11 pm. For dinner, it is better to choose light protein dishes, in the evening limit the use of strong tea and coffee. Soothing herbal teas are recommended for women with premenstrual syndrome, and analgesics are recommended for severe pain. If lethargy bothers you constantly, you need to consult a specialist to clarify the cause of the malaise.
Given the variety of etiological factors of lethargy and malaise, medical tactics are determined only after a full examination and verification of the cause of the disorder. As a rule, etiotropic and pathogenetic treatment is carried out, supplemented with symptomatic and general restorative medications. For the treatment of diseases manifested by constant fatigue and weakness, the following drugs are usually used:
- Thyroid hormones. To correct hypothyroidism, a synthetic analogue is prescribed — levothyroxine, with goiter, the treatment regimen is supplemented with potassium iodide. The substance must be taken for a long time, the dosage is selected taking into account the level of T3 and T4 in the blood.
- Estrogenic drugs. In women in the menopausal period, replacement therapy with sex hormones — estrogens is recommended to relieve symptoms. For greater efficiency, they are combined with progesterone derivatives.
- Nootropics. With the help of nootropic drugs, they eliminate the residual symptoms of severe neurological diseases, activate blood flow in the brain and improve cognitive abilities. The drugs are also effective in dyscirculatory encephalopathy.
- Antidepressants. Lethargy and apathy caused by depression are successfully treated with the help of specific serotonin receptor agonists. In case of severe anxiety, tranquilizers and herbal sedatives are additionally indicated.
- Vitamins. To improve the functioning of the nervous system, thiamine and other vitamins from group B, the antioxidant tocopherol are used. In the period of convalescence, metabolic drugs (riboxin, etc.) have a good effect.
Physiotherapeutic methods are combined with medications. Most often, electromagnetic and laser therapy, balneotherapy, acupuncture are prescribed, which have a restorative and tonic effect. Group and individual psychotherapy is recommended for depression and neurosis. Patients with chronic fatigue syndrome are prescribed unloading and dietary therapy, general or segmental massage.