Managing Fatigue

People with multiple sclerosis (MS) often report feeling extremely tired, either mentally or physically. This is known as fatigue, and it can be very disabling. Fatigue can strongly affect your ability to function. Almost everyone with MS experiences fatigue at some point.¹

Why does fatigue occur with MS?

There are many possible causes of fatigue in people with MS, such as:¹

• Symptoms that disrupt your sleep, like bladder problems
• Mood changes, like depression
• Muscle weakness or spasticity
• Side effects from drug therapy
• MS lesions in the brain

What types of fatigue occur with MS?

One common type of fatigue in people with MS is known as lassitude. Lassitude is a type of physical and mental fatigue that usually happens every day and gets worse as the day goes on. It can come on suddenly, occur early in the morning, and get worse if you get overheated. This type of fatigue can make even daily tasks hard to take on.¹

Fatigue and depression

People with depression often experience fatigue as a symptom. This can be true for both people who have MS and people who don't. Some of your fatigue could be from depression or other mood symptoms that have not been diagnosed yet. Treating depression may also help with fatigue related to MS.¹

Treatment of fatigue

Identifying the potential causes of fatigue is critical to its treatment. Your doctor may ask you certain questions about your symptoms and sleep hygiene and order certain tests to evaluate for other conditions contributing to your fatigue. After you and your doctor have found the cause or causes of your fatigue, there are some ways to try to feel better.¹

Get and stay active

Exercise has many health benefits, including fighting fatigue. If you are exhausted, it might seem impossible to get moving. But start small. You might find that beginning your day with a walk can help you feel more energetic. Movement can be challenging for people with MS, so talk to your doctor about the best way to get and stay active.¹

Turn to physical and occupational therapists

Physical therapists and occupational therapists can teach you ways to save energy and manage your daily tasks. They also can help you develop an exercise program.¹

Avoid getting overheated

When you get overheated, your fatigue may get worse. Try using a cooling vest or wrap or taking cool showers. Avoid hot environments when possible.¹

Make sure to get good sleep

Practicing good sleep habits like keeping to regular bedtimes and cooling down your bedroom can help with sleep problems. Alcohol, caffeine, and some foods might interfere with your sleep. Avoid these and any other triggers that can interfere with your sleep.¹

For MS symptoms that make it hard to sleep, like urinary problems or spasticity, ask your doctor what to do.¹

Take care of your mental health

Depression and anxiety can lead to fatigue. People with MS often experience these mental health conditions. Mental health is just as important as physical health. If you have looked at other reasons for your fatigue and are still feeling it, consider seeing a mental health professional. Your doctor can refer you to someone.¹

Review your current medications

Some drugs can make fatigue worse. Others might help your symptoms. Talk to your doctor about your options and which ones are right for you.¹

Try a new medication

In cases where the cause of fatigue is the MS itself, medications may be a helpful option. There are no drugs approved by the U.S. Food and Drug Administration (FDA) to treat MS-related fatigue. Also, there is conflicting evidence about which drugs, if any, may help with MS-related fatigue.

However, your neurologist may recommend a trial of certain medications, including:^1,2

• Amantadine
• Armodafinil and modafinil
• Methylphenidate
• Dextroamphetamine and amphetamine

Like all drugs, those taken for MS-related fatigue can cause side effects and may interact with other medications or medical conditions. Talk to your doctor about other potential causes of your fatigue before trying any of these drugs. Make sure to tell them about your other medications and past medical history as well.

You might have days when you struggle with fatigue. It is important to rest and take care of yourself on these days. But overall, staying active can help you combat long-term fatigue related to MS. Juggling activity and fatigue can be difficult. With the help of your doctor, work to find ways to stay active while still taking care of yourself.¹