Fatigue: When to Get Help and the Risks of Self-Treating

Urgent help first

In an emergency, use your local emergency number (in the US, 911). NHS guidance on serious dehydration says unusual tiredness together with dizziness that does not go away, dark urine or passing little urine needs an urgent appointment or NHS 111 in the UK. Difficulty breathing, confusion, cold or blue, grey or pale skin, or being sleepier than normal or hard to wake needs a 999 call or emergency care. [1]

MedlinePlus says to contact your provider right away if tiredness comes with any of these: [2]

• confusion or dizziness
• blurred vision
• little or no urine output
• recent swelling and weight gain
• thoughts of harming yourself or of suicide

If you are in the US and having thoughts of suicide or self-harm, call or text 988 (free, 24/7). Elsewhere, use your local emergency number.

Book an appointment if

MedlinePlus advises contacting a provider if fatigue has lasted weeks without improvement. [3] NHS says to see a GP if: [4]

• you have felt tired for a few weeks and are not sure why
• tiredness affects your daily life
• you also have other symptoms, such as weight loss or mood changes
• you have been told you make gasping, snorting or choking noises when asleep

MedlinePlus also lists, for an appointment: unexplained weakness or fatigue with fever, unintentional weight loss or regular sweats; constipation, dry skin, weight gain or cold intolerance; waking many times in the night; frequent headaches; low mood; insomnia; and taking medicines or substances that may cause fatigue or drowsiness. [2]

Fatigue that gets worse after activity, sometimes days later, should be mentioned clearly. See ME/CFS and post-exertional malaise. [5]

What an assessment may include

A provider will take a history, usually do a physical exam, and may order blood tests for anemia, diabetes, inflammatory diseases and infection, along with kidney, liver and thyroid tests and a urine test. [2] Treatment depends on the cause, and may include talking therapies, sleep advice or lifestyle changes. [4]

The risks of self-treating a presumed deficiency

It is tempting to try iron, B12 or an "energy" supplement. Reasons to test first:

• Tiredness has many possible causes. Sleep, mood, medicines, thyroid, diabetes, infections and more. [4] [3]
• Anemia can signal something else, such as bleeding in the stomach, kidney disease, cancer or autoimmune disease. [6]
• Too much iron can harm. In haemochromatosis iron builds up and can damage the liver, joints, pancreas and heart, and tiredness is a symptom. [7] Iron overdose in a young child can be fatal. [8] If a child may have swallowed iron or supplements, see Poisoning: what to do first, call Poison Help at 1-800-222-1222 in the US, or call 911 for an emergency.
• B12 deficiency needs prompt, proper treatment. Some problems it causes can be irreversible if delayed. [9]
• Stimulants can backfire. Caffeine is not an effective treatment for fatigue and can make it worse when stopped. [2]
• Unlabelled ingredients exist. One case report describes harm from a recalled supplement with undeclared dexamethasone. [10]
• Do not stop prescribed medicines on your own. Talk to your provider first. [2]

Read Supplements and surgery, How interactions work and Talking with a health professional to prepare for your visit.

How to prepare

• Bring a list of medicines and supplements.
• Keep a fatigue diary to show when you feel more and less tired. [3]
• Describe the pattern: constant tiredness, sleepiness, weakness, or worse-after-effort. See Why am I so tired?.
• Mention snoring or breathing pauses (Sleep apnea), low mood (Fatigue from medicines and mood) and any recent infection.