14 Observations on Fatigue and Depression

  • Physical fatigue or loss of energy is included as a single item in the DSM–IV criteria for major depressive disorder
  • Some think of lack of concentration as a mental form of fatigue and lack of concentration is also a symptom of depression
  • Anhedonia is an inability to experience pleasure from normally pleasurable life events. This is considered to be a core symptom of depression. Some describe it as emotional fatigue
  • Atypical depression is associated with hypersomnia, weight gain or increase in appetite, inertia, and leaden paralysis (i.e., severe lethargy and fatigue; heavy, weighted-down feeling in arms and legs)
  • Patients with atypical depression are significantly more likely than patients with other forms of depression to report fatigue
  • A recent twin study showed that fatigue during a severe major depressive episode is more likely to be reported by women than men
  • Fatigue is common in major depressive disorder
  • Fatigue is more common especially in the atypical subtype
  • Fatigue is the depressive symptom that correlates most strongly with diminished functioning
  • Fatigue is a common prodromal symptom in patients with their first major depressive episode
  • Fatigue strongly predicts progression to a chronic course of depression
  • Fatigue is one of the symptoms that appears to be less responsive
    to antidepressant treatment
  • After remission of major depressive disorder, approximately
    10%–35% of patients continue to experience fatigue
  • Pharmacological augmentation of antidepressant therapy has shown promise in the treatment of residual fatigue. Modafinil and bupropion are the only two augmentation strategies published on this subject

Now lets’ be careful, these observations about depression and fatigue were published in a review, not a systematic review. You could at best consider these observations as the opinion of an expert, not the scientific truth about the relationship between fatigue and depression. Moreover most of these observation are recognizable but don’t have to be true. I have linked as much as possible to the references used by the author.

To my opinion does fatigue play an important role in depression but you can’t say that fatigues always implies depression. Even in science this mistake is often made. It is comparable to using depression severity scales in somatic ill patients and concluding that a large part of these patients have a depression because they have a high score on these scales. They have a high score due to their medical illness not due to a depression, you need a diagnostic scale for that.

Arnold, L.M. (2008). Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders. Psychosomatics, 49(3), 185-190. DOI: 10.1176/appi.psy.49.3.185