The Problem of Fatigue

The word fatigue describes a broad spectrum of complaints - from moderate everyday tiredness to extreme exhaustion or burnout. The causes of fatigue can be difficult to tease apart because often more than one is to blame. Fatigue can be a symptom of medical illness, a sign of physiological distress, the aftermath of an infection, or a combination of all these. There is also mental fatigue - the fuzzy thinking and impaired concentration that can result from overwork, stress or aging.

Nearly everyone - even those in excellent health - experiences bouts of fatigue at certain points in their life. In most cases, fatigue is not a diagnosable disease that can be detected in a lab. For some people, bouts of extreme fatigue are intermittent and time-limited. Other people experience extreme physical and/or mental fatigue following treatment for infections, such as Lyme disease. Even when antibiotics are presumed to have cleared away the active infection, residual symptoms may persist for months or even years. Endless fatigue, pain and impaired function can lead to depression and anxiety.

Women seem to be the hardest hit. Over the past few decades women are taking on demanding jobs - often positions with greater responsibilities - while still serving as chief cook, and bottle washer and nurturer on the home front. The result is a high-stress balancing act, too often without a safety net below.

The problem of fatigue is global. In a survey of women public health employees in Sweden, between 26 and 24 percent reported job-related emotional exhaustion. Many also complained of fatigue, sleep disturbances and cognitive impairment. In the United States, a 2003 survey of the population in Wichita, Kansas found that 373 women per 100,000 had been diagnosed with chronic fatigue syndrome, versus 83 men per 100,000.

Adapted from The Rhodiola Revolution

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The Rhodiola Revolution
Richard P. Brown, MD and Patricia L. Gerbarg, MD
Rodale Press, 2004

How to Combat Fatigue

In the same way that fatigue has many origins and expressions that are often intertwined, there are many ways to combat fatigue on both physical and emotional levels. Complementary and alternative medicine (CAM) includes nutrients, neuroprotective supplements and mind-body practices to enhance cellular repair, thereby helping replenish energy stores on all levels.

Nutritional Supplements

Nutritional supplements help us maintain our energy, and reduce our chances of getting sick. Most of us don’t get everything we need from the foods we eat. Taking supplements can help ensure our bodies get a full complement of essential nutrients.

Omega-3 Fatty Acids

Omega-3 fatty acids are included in the group of polyunsaturated fatty acids that are necessary to maintain fluidity of the cellular membranes, enzyme activity and production of the molecules involved in modulating inflammation in our bodies. Omega-3s are also important in antioxidant defense against neuronal damage from free radicals, preserving brain, nerve and eye functions, as well as lowering risk of high cholesterol, cardiovascular disease and cancer. Good sources of Omega-3s include salmon and trout, walnuts, and dark, green vegetables.

B Vitamins, Folate and Homocysteine

B vitamins are necessary for maintenance of cell membranes and production of antioxidants in our bodies. Deficiencies have been associated with abnormalities of mood, memory and cognitive function. Homocysteine and high folate concentrations are also associated with better cognitive performance.

S-Adenosyl-L-Methionine (SAMe)

SAMe is crucial for maintaining energy metabolism, as well as integrity and fluidity of nerve membranes, synthesis of neurotransmitters. It contributes to more than 100 biochemical reactions in every cell of the body. SAMe plays a supportive role in maintaining cellular energy, protecting against free radical damage, repair of damaged cells, production of essential neurotransmitters, proteins and antioxidants. It has been shown to be a highly effective treatment for depression, arthritis and liver disease.


Picamilon contains the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and vitamin B3. It increases cerebral blood flow by decreasing cerebral blood vessel tone. Picamilon can be beneficial in particular with decreased alertness, anxiety and depression.


Acetyl-l-carnitine (Alcar) increases energy production in the mitochondria of our cells. In those with traumatic brain injury (TBI) and cardiovascular disease, it is found to often improve energy and cognitive function within two weeks. It has been shown to improve reaction time, memory and cognitive performance.


Adaptogens are plants containing bioactive compounds that act as metabolic regulators. An adaptogen increases resistance against multiple stressors (biological, chemical, physical), normalizes physiology and does not disturb normal body functions more than necessary to improve stress resistance. Combining adaptogens can create a synergistic effect on stress response and significantly improve intellectual and physical performance, and endurance under stress-related conditions.

Rhodiola rosea

Rhodiola rosea is the first CAM treatment of choice for both mental and physical fatigue from all origins. Rhodiola enhances energy metabolism and increases the capacity of the mitochondria to produce energy-rich compounds in the brain, as well as in the muscles, liver and blood. Rhodiola was found to protect every organism tested - from snails to humans - against physical and mental stresses, fatigue, heat, cold, toxins and radiation.

Ginseng (Panax, Korean)

Ginseng root has been used as traditional medicine in China, Korea and Japan for thousands of years. It is now used worldwide. Studies have shown ginseng’s beneficial effects on cardiovascular diseases, cancer, immune deficiency and liver toxicity. It also contains protective mechanisms as an antioxidant, anti-inflammatory and immune-stimulatory activities.


Evidence indicates that herbs can enhance cognition and memory through a variety of mechanisms, including maintaining fluidity of cell membranes and antioxidant defenses.

Gingko biloba

Gingko biloba is extracted from the leaves of the maidenhair tree. The mechanisms underlying gingko’s benefits include increasing blood supply by dilating blood vessels, modifying neurotransmitter systems and reducing free radicals. Traditional Chinese Medicine (TCM) uses gingko biloba to treat cerebral vascular diseases and Alzheimer’s. In treatment of traumatic brain injury (TBI), the authors’ clinical experience has shown that its benefits as an augmenting agent.


Nootropics are agents with cognitive enhancing and neuroprotective benefits. It is believed that this occurs through free radical scavenging, increasing antioxidants, improving membrane fluidity and neurotransmitter levels and improving function of mitochondria - the energy-producing part of the cells. Data suggests that nootropics work better when combined with vitamins and minerals.

Centrophenoxine (Meclofenoxate, Lucidril) and BCE-001

Centrophenoxine has therapeutic effects in cerebral atrophy, dementia and traumatic brain injury (TBI). It has been shown to deliver significant improvements in memory, cognitive function and behavior. BCE-001 is a nootropic drug currently in phase IV testing.

Selegiline (L-Deprenyl, Eldepryl, Emsam, Jumex)

Selegiline has been used as a prescription antidepressant in the United States. Evidence suggests that it improves mitochondrial function in the brain by reducing production of free radicals. Selegiline may help slow neurodegenerative changes of aging, neurological disease and traumatic brain injury.


Traditional neurotherapy (neurofeedback or EEG biofeedback) trains people to become aware of and influence their state of alertness based on EEG-driven feedback. This method of operant conditioning requires following instructions and actively cooperation during many treatments over a period of months.

The low frequency neurotherapy system (LENS) is a short, painless procedure requiring minimal cooperation, and readily tolerated even by young children. LENS has been successful in significantly reducing symptoms of ADHD, PTSD, mental fatigue, chronic fatigue and fibromyalgia and traumatic brain injury (TBI), including those with seizures.

The book How to Use Herbs, Nutrients & Yoga in Mental Health is a comprehensive resource for learning about CAM treatments, their applications and how to find quality products.

How to Use Herbs, Nutrients & Yoga in Mental Health
Richard P. Brown, MD, Patricia L. Gerbarg, MD, Philip R. Muskin, MD
W.W. Norton & Company, 2009

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