Lethargy: Causes, Symptoms & Treatment

In medicine, lethargy is used to describe a condition in which the person is extremely tired and has a greatly increased threshold for stimulation. In everyday life, people who appear permanently lazy or tired are also referred to as lethargic. The medically relevant form is a disorder of consciousness.

What is lethargy?

Lethargy essentially consists of severe fatigue on the part of the affected person, as well as an elevated threshold to stimuli. Lethargic people react correspondingly more slowly (sometimes not at all) to stimuli in their environment. This affects their reaction behavior, communication behavior and their activities. They are more difficult to wake up. In addition, those affected do not succeed in achieving a normal state of wakefulness for several hours. Rather, they remain in a state of consciousness that can occur as a symptom of various ailments. In this context, lethargy is not a disease in its own right, but always a symptom of another ailment.

Causes

Causes of lethargy include a range of diseases and conditions that primarily affect the brain. Lethargy represents a major symptom of European sleeping sickness (a form of encephalitis that is now rare). All diseases or conditions that lead to increased intracranial pressure can also cause lethargy. Primary among these are space-occupying lesions in the brain (tumors and edema) and extreme hypertension. Metabolic diseases and diseases that alter the blood count can also be the cause of increased intracranial pressure. Heart failure can also lead to changes in pressure in the brain. Furthermore, psychological conditions can also lead to lethargy. For example, it is one of the most common symptoms of depression. Sleep deprivation, breathing problems during sleep, alcoholism, cardiac arrhythmias, and medications with sedating effects can also lead to lethargy. In this context, lethargy as a disturbance of consciousness is described as fatiguing and raising the stimulus threshold. However, when considering fatigue states (due to sleep deprivation), people are sometimes referred to as lethargic who are very tired but have a greatly reduced irritability threshold. These individuals are thus easily irritable and yet are considered lethargic by some considerations. The colloquial meanings of lethargic and lethargy will be left aside at this point.

Symptoms, complaints, and signs

Lethargy is characterized primarily by the fact that affected persons have a greatly increased need for sleep. This is also present during the day, forcing people to rest at times. Nevertheless, most lethargic people do not manage to get into the deep sleep phase and accordingly cannot recover despite sleep. As a result, affected people become more sluggish in their overall behavior. Details escape them. Spoken words and calls to action pass them by more often. Slumber states often seem to be initiated without a concrete trigger. Lethargic people are also more difficult to wake up, but still do not sleep deeply or well. Lethargic people can appear variously listless. The transition to apathy is correspondingly fluid and difficult to define. People are unable to concentrate. Blood pressure may be elevated. The eyes may become hypersensitive. A form of lethargy, on the other hand, which is primarily triggered by sleep problems, greatly reduces the stimulus threshold, and the affected person will complain primarily of fatigue. However, this condition is temporary – in contrast to true lethargy – and usually resolves with the next good night’s sleep. These lethargic people are often highly irritable and have an increased need to withdraw. Lethargy develops as a condition usually over some time. Depending on the cause, this is then organic or psychological. At a certain point, the body is so overloaded that the person becomes lethargic. Early harbingers of lethargy are fatigue despite the feeling of having slept enough, as well as increased carelessness.

Complications

Lethargy as a condition itself means complications especially for the personal life of the affected person. For example, lethargic people are unable to perform adequately. Social isolation may occur and is often due to increasing listlessness. In addition, the risk of accidents increases enormously with increasing fatigue.Lethargy as a disorder of consciousness knows no real increases. Rather, it has an indirect effect through possible complications. However, the causes of lethargy are more decisive for the consideration of possible complications. For example, untreated depression can, in the worst case, lead to self-injurious and suicidal behavior. Brain tumors and other damage to brain tissue are not infrequently associated with high mortality rates. Heart damage and nocturnal breathing problems can be the harbingers of severe and chronic conditions. Alcoholism as a cause can be final fatal. Another problem with the combination of depression and lethargy is that depression often remains untreated for a long time and lethargy often appears very early. In addition, feelings of guilt that occur because of the failure to perform (but expected to perform) exacerbate depression. Thus, the losses that lethargic people suffer due to their social and general performance sometimes occur very early. In general, the risk of complications affecting the lethargic person’s personal life increases with the increasing duration of an absence of treatment. The same is true for complications due to the triggers of lethargy.

When should you see a doctor?

Lethargy that seems to be causeless and lasts longer than a few days is always a reason to see a doctor. The affected person will notice a strong and unexplainable fatigue in itself. Accordingly, appearing symptoms of lethargy after a bad night are not a reason to seek medical attention. First attempts can take place with the family doctor. Depending on what the cause research reveals, a referral must then be made to a specialist. For example, cardiologists, neurologists and physicians with psychiatric orientation may be considered.

Diagnosis

A doctor usually determines whether a person is lethargic by taking a medical history. It is necessary to find out whether the condition can be explained by life circumstances or whether it has a disease value. If the second turns out to be the case, various causes must be considered. For this purpose, the patient’s mental and physical health are considered. An examination of the brain using imaging techniques is usually the final step in the search for the causes of lethargy. Occasionally, no clear diagnosis can be made. In such cases, a psychological cause is usually assumed and action is taken accordingly. In addition, for an accurate diagnosis, other conditions and conditions with similar symptoms must be ruled out. These include, for example, somnolence or drowsiness resulting from an accident.

Treatment and therapy

Treatment of lethargy, insofar as the triggers are organic and known, is ideally causal. This means that any triggers of lethargy that can be traced to the heart or brain, for example, are treated. Due to the amount of conditions that come into question here, there are many treatment methods involved. They can be medicinal and surgical. Brain tumors and brain edema often require complicated interventions in and on the brain. If heart failure is the cause, treatment usually consists of medication and lifestyle changes. Increased intracranial pressure must be considered on a case-by-case basis. If, on the other hand, psychological triggers of lethargy are known or suspected, various psychotropic drugs are used. In most cases, these are drugs that are supposed to have a stimulating and motivating effect. In the case of depression, antidepressants (usually SSRI reuptake inhibitors) are prescribed by default, which at the same time have a positive effect on lethargy. Otherwise, lethargy can also be treated with methylphenidate and other psychostimulants. Depression also requires other treatment methods, for example, talk therapy or formulating and achieving new goals. If the patient’s sleep is the main problem, methods from the field of sleep hygiene are used to try to facilitate better sleep. This means that the patient’s sleep is analyzed and he is then shown ways to improve his sleep. This may involve sleep equipment, lighting and more.

Outlook and prognosis

The prognosis for lethargy depends on the underlying condition present. It is not a disease in its own right, with an outlook on how the disease will progress.Rather, the severe fatigue and low physical as well as mental performance is a symptom. Therefore, the clarification as well as elimination of the cause is imperative in order to be able to give further assessments. In most cases, patients suffer from an underlying mental illness. They include depression or burnout. The disorders are characterized by a mostly protracted course of illness. Nevertheless, there is the prospect of a cure. If the disease is chronic, the prognosis is usually unfavorable overall. Often, the existing state of health is maintained over a long period of time or deteriorates continuously. If the affected person succeeds in recovering from the main illness in cooperation with a therapist as well as his or her own cooperation, the complaints of lethargy will normally also be alleviated. If physical disorders are present, the administration of medication is usually required to improve health. Long-term treatment is needed, usually irreparable disorders of the heart, circulation or metabolism are present. Without medical help, a good prognosis is rarely possible. Too extensive and complex are the diseases that symptomatically lead to lethargy.

Prevention

As varied as the causes of lethargy are, so are the measures to prevent the condition. The heart and brain, for example, can be well protected by an overall healthy lifestyle. Nevertheless, the risk of developing a brain tumor, for example, cannot be completely avoided. However, each individual can eliminate risk factors. Depression can only be prevented to a limited extent. In theory, it can affect anyone, and people vary in their susceptibility to it. However, there is evidence that the risk of depression can be reduced by having sufficient serotonin and dopamine. Both are linked to day-night rhythms as well as adequate intakes of sunlight. Accordingly, healthy and regular sleep and sufficient daytime activities can be beneficial. Preventing problems falling asleep and staying asleep is also a way to prevent lethargy. This looks different for each person. For example, some people sleep better if they eat their last meal a few hours beforehand, and others sleep better if they engage in light exercise before sleeping. What has a beneficial effect on one’s sleep, each person must find out for themselves.

Aftercare

In most cases, there are no aftercare measures available to those affected by this disease. In the first place, the disease itself must be directly examined and treated by a doctor, so that there are no further complications that can continue to complicate the everyday life of the affected person. The affected person should consult a doctor at the first signs of this disease so that it can be treated quickly. If the disease is left untreated, it can lead to serious complications that significantly reduce the quality of life of the affected person. In most cases, patients with lethargy rely on treatment by a psychologist. In this regard, the treatment should be carried out regularly in order to properly alleviate the symptoms. Contact with other patients with the same disease can also be useful, as it leads to an exchange of information. As a rule, life expectancy is not reduced by this disease.

What you can do yourself

The self-help options for lethargy largely coincide with the self-help measures that are also recommended for the underlying diseases. Furthermore, lethargic episodes can be cushioned by planned rest and sleep breaks that are ideally integrated into daily life. On the other hand, the basically motivational and powerless mood can hardly be overcome without outside help. Resorting to supposedly stimulating drugs is not advisable. If the person concerned has learned relaxation methods, such as autogenic training, he can also resort to these. Since entering the deep sleep phase is not possible for most lethargics, more sleep is not a sensible self-help option. All in all, the possibilities of self-help to causally counteract lethargy are limited.