The management of fatigue in depressed patients.

Three quarters of patients who respond to treatment with the newer antidepressants still complain of fatigue. Fatigue is one of the most common and disturbing residual symptoms of depression. Increased serotonin activity in certain areas of the brain contributes to fatigue. It can be counteracted by dopaminergic agents which, interestingly, are enhanced by exercise. Specific steps that can be used to address residual fatigue include cognitive interventions based on those used to address somatoform disorders; graded aerobic exercise; dose reduction or discontinuation of fatigue-inducing antidepressants; and the prescription of such medications as dopaminergic antidepressants (bupropion), stimulants, thyroid preparations, and modafinil.