A common characteristic of multiple sclerosis, fatigue is more significant than simply being tired. It is one of many symptoms that affect patients with MS. Fatigue is not relieved by sleep. It is characterized by a persistent and pervasive lack of energy, and the entire body feels unusually and excessively tired.

Fatigue is physical exhaustion that is not related to a particular level of activity. The National Multiple Sclerosis Society states that fatigue occurs in 80 percent of patients who suffer from multiple sclerosis. In hot or humid weather, fatigue may increase throughout the day.

Possible Causes for Fatigue in Patients with Multiple Sclerosis

There may be a connection between fatigue and sleep disturbance in patients with MS.  Many patients complain of feeling exhausted when they awaken in the morning, even though they may have thought they were sleeping soundly.

There are many different symptoms experienced by patients with multiple sclerosis, and any of these symptoms can contribute to fatigue. The list of problems that may cause fatigue includes sleep disorders, or sleeplessness that is the result of muscle spasms or bladder problems.

Depression occurs among patients with MS. Depression in patients without a debilitating underlying illness like MS can frequently result in feelings of exhaustion or a sense of being overwhelmed. Problems with mobility during an exacerbation can add to the sense of exhaustion simply through the extra effort required, or due to frustration. Problems with gait can be tiring in similar ways.

Multiple sclerosis patients experience medical causes of fatigue, including thyroid disease, sleep apnea, or anemia. There are some medications that have the potential to further decrease energy levels, including antihistamines, some anti-inflammatory medications, blood pressure or heart medications, muscle relaxants, and some anti-hyperglycemic medications. Some problems can be treated easily by changing medication regimens.

Medications That Can Restore Energy

There are medications, including stimulants that can be used to alleviate symptoms of fatigue related to multiple sclerosis. Methylphenidate, or Ritalin, taken in divided doses two or three times each day, at doses of somewhere between 10 and 60 mg per day, may be helpful. Amantadine, 100 mg twice daily, has few side effects, and is well tolerated by most patients.1 Adverse effects may occur in patients with renal disease or seizure disorders.

Modafinil is a medication that is used to treat narcolepsy. There have been several studies that have shown promising results for modafinil (Provigil). However, all studies have not been equally positive.5 Modafinil is also an expensive drug, when compared to other medications that are used in attempts to relieve the fatigue associated with multiple sclerosis.

Aspirin, at a dose of 1,300 mg per day, was found to have benefits, although small, when compared to a placebo in the treatment of MS-associated fatigue. Further study will be necessary to confirm these benefits.

The class of antidepressants known as selective serotonin reuptake inhibitors has long been used to treat depression in patients with multiple sclerosis, and these medications seem to have the additional benefit of relieving fatigue. Some doctors recommend a starting dose of 10 to 20 mg once or twice each day.6  There are atypical anti-depressants on the market that can be taken as a dose one time a week 

Fatigue and Depression

Because depression can occur in up to two-thirds of patients with MS8, it is worth considering the fatigue associated with depression as a possible explanation for the exhaustion experienced among MS patients from time to time. Depression may be caused by the burden of chronic disease.

Some studies have demonstrated an increased risk of suicide in patients with multiple sclerosis,  when compared to the general population.9   Medications for depression, or psychotherapy as a treatment modality, should be considered in patients with multiple sclerosis who complain of anhedonia, loss of appetite, rumination, and other symptoms consistent with depression. Further study will be necessary to arrive at an evidence-based standard of care, or to make generalized conclusions about these therapeutic interventions. At present, it is not possible to state with certainty that one treatment is better than another. 

Treating the Underlying Problem of Multiple Sclerosis Will Help

Treating the underlying multiple sclerosis is the best solution to the problem of fatigue, as the causes of fatigue in patients with multiple sclerosis are not yet well understood..

There is evidence of a correlation between fatigue and intracranial neuronal damage in patients with multiple sclerosis, but the evidence of a relationship between fatigue and the overall progression of multiple sclerosis is not strong. Further studies will be useful.

Changes in lifestyle should be discussed systematically, although this may result in curtailing even some pleasurable activities. Patients should be advised to organize their tasks, and should be encouraged to delegate tasks and to acknowledge that it may be healthy to reduce their responsibilities at certain times.

As much as possible, encourage patients with MS and comorbid fatigue to simplify the details of both work and recreation. These patients may need “permission” to take time  for periods of rest.

Some other suggestions for patients with multiple sclerosis include limitations on tasks that require reaching overhead. Simple tips include learning to use proper body mechanics. All patients with multiple sclerosis should have firm support when sitting in a chair. This particular patient population should be reminded often to minimize movements that require bending over. They should be encouraged to closely monitor their activities. Simple changes may help significantly, including use of the leg muscles to lift, sparing the back and upper body.

Work that increases muscle tension seems to be helpful with MS. Using a few of these tips may allow your patients to regain some of the energy and positivity that they have on” good days. “.