Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Exhaustion/fatigue

Forum: Neurology Forum
Topic: Sleep

Re: Exhaustion/fatigue

Re: Exhaustion/fatigue

Posted by CCF Neuro MD on June 28, 1997 at 22:52:05:

In Reply to: Exhaustion/fatigue posted by James Sack on June 19, 1997 at 07:03:46:


I am a 26 year old male living in a town of 200,000, north of Tokyo,
JAPAN. I am currently seeing a general prac. for my problem, but have
not been able to make any headway. Here's the problem: always exhausted,
no matter how much sleep I get (usually 8-9 hrs. of good sleep each night).
I bike 6 kilometers to and from school each day, and by the time I make
it to my destination, I can hardly lift an arm. Many times, I feel like
fainting/passing out, just from the exhaustion, although this has never
actually happened. Sometimes feel dizzy. Appetite is excellent, and eat
very well-lots of fish, vegetables, teas, fruits, in addition to daily
vitamins. Have had tests done for low red and white blood cell count,
thyroid, diabetes, brain tumors, anemia, iron deficiency, Ca K Mag defic-
iency, liver and heart problems, presence of cancer, cholesterol.

Doctor thinks it is depression, though I have a fairly stress-free job,
great wife, friends, no money problems, no recent tragedies, no homesick-
ness, etc... We've tried three different types of anti-depressants over
a 6 month period, but only made me sleepy, and energy level never improved.

Is it possible to have a chemical imbalance in the brain that would cause
extreme exhaustion, without giving me any other mental problems? Please
help me, as professional medical information and advice is scarce in
this country. Thank you very much.

James Sack


Hi, James,
As you understand, fatigue is a nonspecific symptom that can be both physiological or pathological. The causes of fatigue can be both neurological and non-neurological. It looks that your doctors have done a rather comprehensive work-up to rule out the most common causes. From our neurological perspective, fatigue may be a significant feature of myopathic disease, in which muscles are weak to begin with. Other neurologic diseases with feature of futigue include MS, Parkinson's disease, and depression. However, it sounds like you are otherwise quite healthy, which makes a neurologic disorder a unlikely possibility. During the preparation of this response, I looked up the current literatures and could not find any work that directly associated fatigue with neurotransmitter imbalance in human brain.
As far as any further work-ups that may offer some help, I would recommand you concentrate on endocrine aspects, looking harder on blood sugar imbalances, thyroid function abnormalities. In addition, other well-known systems that tend to be affected include hematological, cardiac, metabolic and nutritional.
Cleveland Clinic Foundation is a comprehensive medical center which encompasses virturely all subspecialties. If you like to have a visit to the Clinic, please call 1(800)223-2273 ext. 45559. We will have your visit start at Neurology.

This information is provided for general medical education purpose only. Please consult your primary physician for your specific medical conditions.
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