Therapies for Managing Fatigue in MS

Multiple sclerosis (MS) has a wide set of symptoms, which are variable and unpredictable. Fatigue is among the most common symptoms, affecting more than 80 percent of all patients.

The causes of fatigue in MS are not fully understood. Current studies are seeking tests might identify fatigue as a disease-related condition, and be used as a reliable way of measuring its severity in patients.

Common symptoms of MS caused fatigue

Fatigue in MS patients is different from just feeling tired. It is usually overwhelming and may have no obvious cause.

Many wake up from a night’s sleep feeling as tired and run-down as they were before going to bed, and feel extremely tired even with very little activity. Frequent complaints are that the limbs become heavy, and basic tasks such as writing or getting dressed become difficult.

With fatigue, some of the disease’s other symptoms may worsen temporarily,  such as difficulty seeing and concentrating, or with maintaining balance.

Types of MS-related fatigue

Fatigue can show up mentally and/or physically for patients. Unfortunately, both types prevent patients from performing their everyday activities.

There is one type of fatigue, exclusive to MS patients, which is called lassitude. It has unique characteristics that distinguish it from fatigue experienced by people without MS.

  • It occurs on a daily basis
  • It gets worse as the day progresses
  • It tends to be aggravated by heat and humidity
  • It is more severe than normal fatigue
  • It is more likely to interfere with daily activities, at home and at work (fatigue is a major reason for changes in employment among patients)

Lassitude does not appear to be linked to stages of physical disability in patients, and is a condition apart from other types of fatigue associated with MS, such as fatigue caused by bladder problems that disturb sleep, fatigue by disease-related depression, or fatigue resulting from difficulties in performing daily tasks, like walking, bathing and dressing.

How to manage fatigue

A thorough evaluation can help in identifying factors that work to aggravate or trigger fatigue. Once these triggers are known, an approach can be designed that might help individual patients. Because fatigue can be related to non-MS conditions as well, like thyroid problems or anemia, MS patients should consult with their doctors about its causes and possible treatments.

A number of ways exist to manage fatigue, such as:

  • Occupational therapy, simplifying tasks at home and at work
  • Physical therapy, focused on energy-saving ways of walking or handling necessary tasks, and regular exercise programs
  • Sleep regulation
  • Psychological interventions, including stress management
  • Heat management, so as not to overheat
  • Medication

Pharmacological management of fatigue in MS

Certain drugs can help solve or reduce fatigue in MS patients, including:

Amantadine. Although not a specific drug for MS-related fatigue and with a less than fully understood mechanism of action, amantadine helps decrease fatigue levels and can also improve energy levels in patients with MS.

Provigil (modafinil) is mainly used to induce wakefulness in people with sleep disorders such as narcolepsy and sleep apnea. However,  the drug is occasionally given to MS patients for problems regarding fatigue and sleepiness.

But Provigil has a number of reported side effects, and the European Medicines Agency — following a recommendation by the European Committee for Medicinal Products for Human Use (CHMP) — limited its use in Europe  in November 2010 to the treatment of narcolepsy, where CHMP considered the drug’s benefits to surpass its risks.

Prozac (fluoxetine) is also used off-label to treat MS related fatigue. The drug is most often used to treat depression, obsessive-compulsive disorder (OCD), eating disorders, and panic attacks.

Prozac use is associated to a number of side effects, including the risk of suicidal thoughts in certain users. The drug’s label carries a black-box warning regarding such risks.

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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