Extreme Fatigue

I don't know if these is the right post Well I have been suffering from fatigue for years every time I go to the doctor They do the Regular Blood test everything comes up normal except from too small red blood cells which leads to Anemia and i keep taking Iron for a month  but It doesn't seem to work. I was diagnosed with depression since I was 13 I am 31 now But I can't believe that depression could cause these extreme fatigue. There's also these weird symptom A tenderness in the back of my skull but is differents sides of my head it hurts to the touch.

[Jigisha S. Amin, MD]

Without an examination,a review of lab test results, and your medication list,  I can't give you an exact diagnosis.  Fatigue is a very common sign of depression or dysthymic disorder (depressed mood along with other symptoms over atleast a 2-year period).  In fact, along with some of the following symptoms:

1)overeating/poor appetite
2)insomnia/hypersomnia
3)low self-esteem
4)poor concentration
5)difficutly making decisions and feelings of hopelessness,

low energy or fatigue helps make the diagnosis of  depression and/or dysthymic disorder.  

You mentioned "small red blood cells" and "taking iron for a month".  There are many different things that can cause small red blood cells - iron deficiency is common in young women.  If you have heavy periods with blood clots or bleeding from the rectum, your doctor should order more tests to investigate further.  Usually iron therapy is taken for a longer time than a month because it takes much longer (3-6 months) to replenish body iron stores.  If you are getting constipated from the iron, then you may want to consider adding fiber (up to 30 gm) slowly to your diet.   Exercise (walking 20 minutes a day for 3-5 days a week) is always good for constipation and depression.

People can have all sorts of aches in different places over their body that go along with depression. Also, you may want to consider discussing with your doctor Chronic Fatigue Syndrome and Fibromyalgia.  

Lastly, make sure you get your thyroid checked periodically with a simple blood test.  A low thyroid can also make you feel tired.  Also, if you are feeling more tired than usual, make sure you aren't pregnant with a pregnancy test.

[Jaquta]

The length of time taken to replenish iron stores surprised me a little.  I too have been anemic and was asked by my GP to take iron supplements for three months.

Thanks for the information.

[Jigisha S. Amin, MD]

I wrote 3-6 months, but that is actually a conservative number.  It does take 6-12 months of iron therapy to fully replenish iron stores in the boday as referenced in a couple of reputable websites:  nlm.nih.gov (National Institutes of Health) and linkinghub.elsevier.com (Elsevier is a well-known medical publishing company).

[rj2]

i think it is easy to label anemia as IDA since it is common.  However, it might not be a normal IDA.  Have you had iron studies done? CBC with reticulocye count and peripheral blood smear? Do you take zinc supplements?  There are many things that microcytic anemia can mean.  Please see a hematologist to get a complete work-up.

[Jaquta]

Dear Dr Amin

Thank you for your response to my comment.  6- 12 months is a long time.  Thank you also for the web addresses.