Evaluating and Treating Fatigue in Multiple Sclerosis

Addressing Your Fatigue with Your Doctor

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The majority of people with MS suffer from fatigue, so you are not alone if you are burdened by this debilitating and frustrating symptom. The good news is that there are a number of therapies that can help you. While these therapies will not cure your fatigue, they can give you back some energy to enjoy your life and function better, which you deserve. 

Diagnosing and Evaluating Fatigue in MS

While people with MS experience what is referred to as "MS lassitude," which is caused by the disease itself, there are many other causes of fatigue in MS.

Examples include certain disease-modifying therapies, medications that help MS symptoms, sleep problems, depression, exertion, and infection. 

In addition to understanding the cause or causes of your fatigue (there are usually multiple sources), your doctor will need to assess the level of your fatigue. If your fatigue has come on suddenly or has gotten much worse, she may suspect a relapse and follow her protocol for evaluating and treating relapses, including sending you for an MRI scan. Also, your doctor will probably also ask you to rate how severe your fatigue is, and how much it is interfering with your life, so that she can decide how aggressive to be in terms of medications and dosages.

Medications to Treat Fatigue in MS

There are a number of approaches to treating fatigue and using medications is one of them. Commonly prescribed medications for MS-related fatigue are Provigil (modafinil) and Symmetrel (amantidine).

 Ritalin (methylphenidate), a central nervous system stimulant, may also be prescribed to help with fatigue, especially if a person does not receive benefit from Provigil or Symmetrel. 

Adjusting Medications to Treat Fatigue in MS

Some disease-modifying therapies, like those made from beta-interferon (Avonex, Betaseron and Rebif), can cause fatigue.

It's important to report to your doctor if you notice a pattern to your fatigue in relation to your medications (for example, it is worse the day after an injection or infusion). Your doctor will probably not switch your disease-modifying therapy, but may prescribe one of the drugs used to treat MS fatigue and tell you to take it on an as-needed basis. She may also suggest changing the times when you take your medication (if possible) to ensure that your worst fatigue occurs when you have the opportunity to rest (for example, take your Avonex injection on Friday night, so that you can rest the next day).

Fatigue is also a side effect of some medications taken for MS symptoms such as spasticity (including baclofen, Valium, and Zanaflex) or pain (Neurontin). Depending on which drug your doctor suspects is the problem, she may switch you to another medication or have you alter the times when you take your meds (for example, time them so your largest dose is at night, if that is appropriate).

Investigate and Treat Other Causes of Fatigue in MS

Sleep disturbances are common in people with MS, and the resulting lack of sleep at night leads to sleepiness during the day. Insomnia can be caused by spasms, depression, anxiety, pain, and/or the frequent need to urinate at night (nocturia). All of these can be effectively treated.

In addition, corticosteroids like Solu-Medrol often cause sleep disturbances and anxiety. Since these are taken short-term, your doctor may prescribe a sleeping aid or anti-anxiety drug to help you get rest during your treatment.

Exertion causes fatigue in people with MS when they constantly need to compensate for symptoms like spasticity or muscle weakness, which may make it harder to walk, maintain balance or complete household tasks. In this case, your doctor may prescribe physical therapy to help build your muscles, improve balance or move more efficiently. She may also refer you to an occupational therapist, who can help you adjust your actions to use less energy, as well as make adjustments in your home to make it easier to perform self-care and household tasks.

Depression often causes people to feel overwhelmingly tired. In some people, the fatigue itself causes depression. In the case of depression, your doctor may start with an anti-fatigue drug to see if that helps both the fatigue and depression. If you are still depressed, she will probably refer you to a psychiatrist so that you can get help with your depression, including anti-depressant medications. Again, some of the medications used to treat depression can also cause fatigue, so you must make sure that your psychiatrist is aware of your fatigue, as well as other MS symptoms.

Infections, such as colds, flu or urinary tract infections can cause fatigue. If your doctor suspects that you may have a urinary tract infection, she will test your urine and prescribe an antibiotic. In the case of a cold or flu, you will probably be told to rest until you are better, then come back if you are still experiencing fatigue.

Bottom Line

If fatigue is interfering with your daily life, it's important to talk to your doctor about it. It might be helpful to keep a "fatigue log" where you can record your levels of fatigue, times of day when it occurs, what you were doing, times you took your medications, and anything you did that relieved your fatigue.


Birnbaum, M.D. George. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2nd Edition. New York, New York. Oxford University Press.

Turkington, Carol. The A to Z of Multiple Sclerosis. New York: Checkmark Books. 2005.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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