Although fatigue is common in Parkinson’s, it attracts very little
attention from most doctors or specialists.
To complicate matters, there are also numerous causes of fatigue that
are unrelated to Parkinson’s but still need to be recognised for treatment to
be successful.
The first step must be a frank discussion with your doctor or
specialist to let them know how fatigue affects you and what changes you have
noticed over recent months. They will
then carry out any screening tests they feel are appropriate.
If
your doctor suspects that your Parkinson’s treatment is a factor they may
recommend a change in medication.
Rigorous studies have not so far been conducted, but anecdotal evidence suggests that medications such as
amantadine and
selegiline, which have a reputation for having
stimulant effects, may be useful, as may the MAO-B inhibitor
rasagiline.
Dopamine
agonists are reported both as improving fatigue and/or
causing it. Other studies argue that
fatigue is not related to anti-Parkinsonian medications.
Low doses of amphetamine-like drugs (methylphenidate) have also been
shown to be clinically helpful in limited trials in some patients, but such
medications would only be used under the careful direction of a
specialist.
The medication modafanil (Provigel) has been successfully used in
people who have a condition called ‘sleep apnoea syndrome’, in which their
day-time activities are affected by excessive sleeping. Modafanil has been shown in small studies to
improve fatigue, as well as relieving excessive day-time sleepiness.
If depression is recognised or suspected, then your doctor may recommend
that you try a course of appropriate antidepressant medication. He or she may also suggest appropriate
medications to reduce any significant anxiety or abnormal stress responses as these
can worsen fatigue. See also depression.
Treatments such as one-to-one or group counselling, cognitive
behavioural therapy, relaxation therapy or neuro-linguistic
training can be very effective in treating depression
and anxiety, so your doctor may refer you to an appropriate counsellor or
psychotherapist.
Your doctor or specialist nurse might also consider other approaches as
appropriate, for example weight reduction and advice on sleep hygiene. A sleep assessment may be recommended to
unravel factors which disrupt sleep, such as bladder problems, obstructivesleep apnoea, restless legs etc.
Advice on lifestyle to improve fitness, such as regular daily exercise,
may also be useful. Depending on the
country in which you live, it could be possible to be referred to an
occupational therapist specially trained in the management of fatigue, who can
give you a personal daily programme of activity and relaxation, or you could be
referred to a specialist physiotherapist who can recommend an appropriate
exercise programme. In some countries
your doctor may refer you to specialist community teams who help people manage
chronic fatigue syndrome and can advise on fatigue disorders.
General physical activities, together with social activities and mental
activities, play an important role in overcoming fatigue. So the more energetic you are, both mentally
and physically, the less likely it is that fatigue will become intrusive.
