Do you feel tired all the time? Many medical and psychiatric issues may contribute to you feeling tired, foggy or worn out.

When I see a patient who is struggling with low energy,  I am always thinking about whether there could be an underlying medical or psychiatric issue.

Here are some tips to always consider when seeing a patient who is worried about feeling tired all the time or struggling with poor sleep.

1. Medication Side Effects

Here is a partial list of the medications that can cause you to feel tired: antihypertensives, Parkinson meds, antibiotics (even the common ones like Cipro), H2 blockers, SSRIs (can often cause dysphoria, especially in patients with ADHD or who are elderly), steroids, muscle relaxants, narcotics, sulfonamides, interferon, and Sustiva.

2. Hypogonadism

Low testosterone can cause low energy, fatigue, and even depression. Suspect this in the male patient who is complaining of new-onset complaints of feeling tired  which came on gradually and when there was no history of family history of depression. Checking total testosterone is helpful but only part of the story. Total testosterone can often be normal even when free testosterone is abnormal. Always check free testosterone. Suspect hypogonadism if the patient is cold even in the spring and summer, if there is a decrease in an overall sense of well being, and if there is a decrease in sex drive from the baseline. Low testosterone is not normal, even in an older patient and treating this can make you a hero in the eyes of your patient.

3. Thyroid Disease

Low thyroid may cause fatigue. Abnormal thyroid levels are very common and screening for this is essential. Treatment is extremely effective but the patient must realize that it can take months to “kick in”. I had one patient on the inpatient unit who became suicidal when her Synthroid didn’t help her mood. No one told her that it could take months for the treatment to be effective. Also, I like to be pretty aggressive when replacing the thyroid. People use different TSH levels but one of my former mentors at Mass General Hospital, Dr. Jonathon Alpert, recommends to treat anything TSH that is above 6.1 rather than the typical 20 used in most labs as abnormal. I have had excellent results when I headed his advice.

4. Ovarian Cancer

Always think OVARIAN CANCER with women who present with low energy or other symptoms of depression. Ovarian cancer is awful and kills patients. Often, one of the first symptoms of ovarian cancer is depression and it can precede the diagnosis of ovarian cancer for many months or even years before the cancer is discovered and when treatment for the cancer is too late.

5. Sleep Disorders and Apnea

Sleep disorders such as restless leg syndrome, periodic leg movement and sleep apnea can disturb your sleep. Even though you may be sleeping seven to eight hours, you may not be receiving effective rest.

This is a shortlist of items to consider when a patient presents with feeling tired all the time.

If you have any questions about whether medications or illness may be causing or exacerbating energy level, please feel free to contact Dr. Scott Shapiro.

Scott Shapiro, MD, Board-Certified Psychiatrist in NYC, provides comprehensive counseling + treatment for fatigue, low energy, feeling tired, anxiety, depression and adult ADD + ADHD. If you have any questions, please contact Dr. Shapiro at 212-631-8010 or scott@scottshapiromd.com.