Constantly Tired and Exhausted: Causes and What Can Help You

When you feel constantly tired and exhausted, your first thought is often that you simply had an unrefreshing night. Sleep is indeed a crucial factor in feeling energized during the day, but not all fatigue can be explained by poor sleep quality alone.

Medical guidelines describe a broad spectrum of potential causes for persistent fatigue, including biological, psychological, and social factors. Frequently, fatigue cannot be traced back to a single trigger, rather, different factors can reinforce one another. These potential causes may include:

• Insufficient or unrefreshing sleep
• Persistent sleep disorders
• Long-term stress and feeling overwhelmed
• Depression and other mental health conditions
• Physical illnesses
• Taking certain medications or substances
• Lack of physical activity
• Persistent pain
• Stressful life situations
• Hormonal or metabolic disorders

This also means that persistent tiredness and exhaustion are not always as simple as needing to get more exercise or establish a better bedtime routine. If exhaustion persists over a prolonged period, the first step should be to clarify what might be behind it.

It is not only physical exertion that can deplete our energy. A daily routine in which you are constantly under pressure can eventually manifest as physical and mental exhaustion. You might still find yourself mentally at work long after your workday has ended, constantly planning what still needs to be done, worrying, or trying to live up to the expectations of various people at the same time. This endless loop of thoughts surrounding everyday responsibilities is also known as mental load, or mental burden. As a result, your body may appear externally at rest while you remain internally tense.

Prolonged strain can be accompanied by symptoms such as:

• Concentration difficulties
• Inner restlessness
• Irritability
• Sleep problems
• Muscle tension
• Headaches
• Exhaustion
• Feeling overwhelmed
• Less enjoyment in activities

So-called burnout is also frequently associated with persistent professional or personal stress. However, its symptoms are non-specific and can overlap with depression, anxiety disorders, or physical medical conditions. For this reason, persistent exhaustion alone is not sufficient to diagnose burnout.

Depression can also cause you to feel constantly tired and exhausted. Many people primarily associate depression with sadness. However, for most of those affected, other complaints take center stage at first, such as a lack of drive, sleep disturbances, and a severe sense of exhaustion. In this way, persistent tiredness may be linked to other depressive symptoms:

• Depressed or low mood
• Loss of interest and joy
• Lack of drive or initiative
• Concentration and decision-making difficulties
• Sleep disturbances
• Reduced self-esteem
• Feelings of guilt
• Social withdrawal
• Pessimistic thoughts about the future

For this reason, healthcare professionals explicitly recommend considering depression or an anxiety disorder as a potential cause when experiencing persistent tiredness and exhaustion, and evaluating the corresponding symptoms accordingly.

Physical causes can also explain why you feel constantly tired and exhausted. For this reason, persistent tiredness should not automatically be interpreted as a psychological issue. Possible physical causes include:

• Anemia
• Underactive thyroid (hypothyroidism)
• Certain infections
• Metabolic disorders
• Chronic conditions
• Sleep apnea
• Other physical strains

Conversely, this does not mean that a physical illness lies behind every instance of fatigue. According to medical guidelines, severe physical conditions are comparatively rare as the sole cause of persistent fatigue and exhaustion, and typically present alongside other notable findings in a patient's medical history or examination.

Sometimes fatigue does not stem from a single trigger. Rather, multiple factors come together. You might be getting slightly too little sleep, exercising less than you used to, experiencing high levels of stress at work or in your personal life, and worrying about your ability to perform. Any single factor on its own might not be a major issue, but together they can contribute to feeling increasingly exhausted. For this reason, it can be helpful not to search for a single root cause, but to look at your daily life as a whole.

Questions that can help with this:

• How long am I actually sleeping?
• Do I feel rested after sleeping?
• How much pressure or stress am I currently under at work or in my personal life?
• Am I building in enough breaks throughout the day?
• Do I still find joy in things that used to be important to me?
• Have I been withdrawing more and more recently?
• Has my motivation or drive changed?
• Are there any physical symptoms that occurred at the same time?
• Am I taking any medications that could cause fatigue?
• How long has this tiredness been present?

A symptom diary can also be very helpful in this process. Clinical practice guidelines highlight it as a valuable support tool for dealing with persistent fatigue. Writing down your thoughts, feelings, and general condition helps you uncover specific patterns in your symptoms and brings you closer to identifying the underlying causes of your exhaustion.

If it turns out that your exhaustion is linked to depression, treatment should not focus solely on fighting the fatigue itself. Instead, it can be helpful to address the underlying factors that maintain the depression. These may include unhelpful thought patterns, social withdrawal, lack of activity, or a loss of daily structure.

Which treatment is appropriate depends, among other factors, on the severity of the depression and your individual situation. For a first mild depressive episode, low-barrier interventions such as supportive counseling or online therapy programs may be used initially. For more severe forms of depression, psychotherapy and/or medication may be considered, depending on the specific case.

When your persistent tiredness is part of a depression, deprexis can support you in dealing with depressive thoughts, emotions, and behavioral patterns.

This digital program is based on methods of cognitive behavioral therapy (CBT). It is not about forcing you to perform despite your exhaustion. Rather, it allows you to step-by-step understand the connections between your thoughts, your behavior, and your mood, while trying out new coping strategies.

deprexis is available free of charge on prescription, as the costs are fully covered by your health insurance. This means your doctor or therapist can prescribe deprexis, providing you with an activation code for the program. As soon as you receive your code, you can easily redeem it on our website and start your digital therapy right away.