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HomeAnswersNeurologysevere fatigueI am experiencing extreme exhaustion and trembling after physical activity or if I have not eaten for five to six hours. What could be causing this?

Can antidepressants and a healthy lifestyle, including spending time in natural settings, help with severe fatigue?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At December 13, 2023
Reviewed AtDecember 13, 2023

Patient's Query

Hello doctor,

I have some questions about symptoms I often experience after physical activity or if I have not eaten for five to six hours. I have not been very active for one to two years due to depression and PTSD. Now, I am making an effort to be more active to lose weight and improve my overall well-being. However, after about an hour of walking, I feel extremely exhausted and dizzy. Sometimes, my hands even tremble a bit. When I eat afterward, I constantly feel nauseous, experience trembling, and get chills throughout my body, as if I am on the verge of collapsing. Various doctors have suggested it might be chronic fatigue. What could be causing this? Am I pushing myself too hard too quickly?

Not long ago, I had blood sugar, blood pressure, hormone, and vitamin tests, and all the results were normal. What additional tests do you recommend, and what might be the underlying issue?

Thank you.


Welcome to icliniq.com.

How has your sleep been, and how is your mood lately? I recommend that you obtain a cardiovascular clearance to ensure safety during exercise. Please include a serum total vitamin D test in your workup. Also, try to avoid binge eating and opt for small, frequent meals. Snacking on fruits is a better choice. Spending time in natural settings, such as at the beach, near a river, or in the mountains, can be beneficial. In the meantime, while awaiting the results of your workup, we can try Escitalopram 10mg once a day at 6pm. If it is well tolerated, please continue taking it for six months.

I hope this helps. Thank you.

Patient's Query

Thank you doctor for the reply,

My mood has been low, and I occasionally feel depressed due to my anxiety and PTSD. I believe my lack of physical activity may be making it worse. However, I will make an effort to obtain a cardiovascular clearance. I had a cardio exercise check two years ago, and it was fine, but I will get it checked again. I am willing to try Escitalopram. However, based on the symptoms and readings, can you confirm that it is not diabetes? I am quite concerned about diabetes, even though my doctor has consistently said that my blood sugar is fine. After eating meals, especially those containing rice, meat, and fatty foods, I do not feel well.


Welcome back to icliniq.com.

Avoid foods that cause sugar rushes and high-calorie foods for now. Focus on consuming more vegetables and fruits. Consider having an apple in the morning to feel refreshed and a banana in the evening to aid in sleep (as bananas are high in Tryptophan). You can also try aromatherapy with peppermint during the daytime and lavender in the evening to help calm you down. Reading a good inspirational or motivational book before bedtime can be beneficial. Additionally, try to minimize your use of gadgets and avoid browsing the internet before sleep. I hope these home remedies will contribute to your well-being.

Thank you. I hope your queries are resolved and any further queries are welcome.

Same symptoms don't mean you have the same problem. Consult a doctor now!

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Dr. Florilyn Joyce Chulsi Bentrez


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