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Q. How to find the root cause of extreme fatigue?

Answered by
Dr. K V Anand
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 24, 2016 and last reviewed on: Nov 27, 2019

Hi doctor,

I am a 31 year old male. I am managing an IT company. I have suffered from periods of extreme fatigue for the past one and a half year. The first period of fatigue was one and a half year back and it lasted for around 18 days. Then I felt fine for the next five months. From then till today I have had one to two weeks of fatigue followed by one to two weeks of fine feeling. During these fatigue periods, I sleep an average of one extra hour each night. I get very little work done. I do not have the energy to exercise (which I have always enjoyed). I have no physical or mental energy and brain fog. This is something I have never experienced before. I have attached the blood test results. Abdominal ultrasound and chest x-ray are also done with normal results. My weight is normal and I eat a healthy varied diet. I supplement with fish oils. I do not work very much and I do not feel stressed. My blood pressure is normal. Physical examination was done at doctor’s office. The two doctors I have seen cannot find any problem, but something is clearly wrong with me. What do you suggest me to do next to find the root cause?

Dr. K V Anand

Psychiatry Psychologist/ Counsellor Sexology


Welcome to

  • You pointed that you never had the period of fatigue problem before. Can you try to recall what happened during that period (before one and a half years)? Was there any excess stress situation or anxiety problems?
  • As you are healthy and doing physical exercise, it means physically you are perfect. We need to address the psychological aspect. This is not yet psychiatric, but psychological disorder.
  • When did you come to this place for work? Do you like the job and atmosphere? Do you like the work culture, subordinates and colleagues?
  • What about your family? Do you miss your family?
  • How is your sexual satisfaction?

Revert back with the answers for the above questions to a psychiatrist online -->

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Hi doctor,

Thanks for your reply. For the last few years, I have spent maybe eight months per year here. Yes, I like my job very much and it is very interesting too. I go home every three months. My wife stays with me here and I have a good social life. My sexual satisfaction is good. This fatigue started when I travelled quite much. It is normal of course to be tired after a long trip, but since then the fatigue has come back periodical. The weakness, tiredness and brain fog that appears out of the blue and it is not connected to any mental or psychological challenges. I had my blood test done. Some values are actually high such as IgM, IgA, ferritin, etc. I have attached my report for your reference. Please help me.

Dr. K V Anand

Psychiatry Psychologist/ Counsellor Sexology


Welcome back to

I went through your details and blood reports (attachment removed to protect patient identity).

  • IgM antibodies are the type that form when an infection occurs for the first time, high levels of IgM can mean a new infection is present. But other tests indicate you do not have any of these problems.
  • High levels of IgM appear in cases like macroglobulinemia, early viral hepatitis, mononucleosis, rheumatoid arthritis and kidney damage (nephrotic syndrome). IgM also gets elevated in case of parasite infection.
  • High levels of IgA means monoclonal gammopathy of unknown significance (MGUS) or multiple myeloma is present.
  • Levels of IgA also appear high in some autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE) and in liver diseases such as cirrhosis and chronic hepatitis. But, other tests indicate that you do not have any of these problems.
  • Ferritin reading is normal. The most common causes of elevated ferritin levels are likely obesity, inflammation and daily alcohol consumption.
  • Morning cortisol level is high at 86. Morning cortisol level is always high. When the cortisol is measured at other times of the day, the results were normal. Therefore, there is nothing to worry in that aspect too.
  • All the other laboratory test reports say that there is nothing wrong with you. Therefore, the two doctors you consulted said that there is nothing wrong. I think you should leave the symptoms there and convince yourself that you are fine.
  • You are a healthy person. You told me that you do not have any mental or psychological stress. But, I strongly suspect that you have hypochondriasis (worrying about health and serious illness). Hypochondriasis is health anxiety. You are anxious about your health.
  • Health anxiety can cause symptoms such as tiredness, lack of energy, brain fog (confusion), etc. Health anxiety symptoms will not have any physiological or anatomical or organic causes with regard to the symptoms.
  • The treatment for health anxiety is psychotherapy. First step is to believe the doctors who treated you. Second is to ignore the symptoms because there are no underlying reasons. They are just your imagination.
  • Lead your life as if you were doing before. Convince yourself that you are perfect. Engage in physical, entertaining, hobby rich, social and family activities which keeps you engaged and you think less about health. Eat a balanced and healthy diet.
  • As in your place the climate is hot and humid, you are bound to have lethargy and tiredness and brain fog. Do not connect these issues with what you had earlier. Drink lot of water and have fruits and vegetables. I suggest two tender coconut water per day for 10 days.

For further information consult a psychiatrist online -->

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