Table 3. The treatment of diseases that cause fatigue.
| Type of disease and treatment | Results, differences in effect strength*1 [95% confidence intervals] |
| Anxiety, generalized | |
| SSRI and SNRI (e48, 37) | As first-line therapy, vs. placebo: SSRI: g = 0.33 (limits: 0.26–0.39), SNRI: g = 0.36 (limits: 0.29–0.42) (e49); Pp d: SSRI: 3.48 [3.18; 3.78], SNRI: 2.47 [2.09; 2.84]) (e50) |
| CBT (e51, 37) | Strong effect compared to waiting list: d = 1.23 [1.02; 1.45], weak to moderate effect compared to routine treatment and placebo: d = 0.57 [0.20; 0.94] (effect strengths of individual CBT pooled over all anxiety disorders) (e50) |
| Panic disorder | |
| CBT and psychodynamic therapy (e52, 37) | Best long-term treatment outcome of all psychological therapies. Pp individual CBT: d = 1.24 [1.10; 1.39]; Pp psychodynamic therapy: d = 0.97 [0.58; 1.36] (e50) |
| Depression | |
| Antidepressants (38) | More effective than placebo against major depression: odds ratios of 21 antidepressants vs. placebo range from 1.37 [1.16; 1.63] to 2.13 [1.89; 2.41] (e53) |
| Exercise therapy (38) | Only moderate effect: SMD compared to no treatment –0.62 [–0.81; –0.42], no significant effect in high-quality studies: –0.18 [−0.47; 0.11] (e54) |
| Behavior therapy (38) | Similar efficacy to other forms of psychotherapy: response rate of BT vs. all other forms of psychotherapy: risk reduction 0.97 [0.86; 1.09] (e55) |
| Insomnia | |
| Antidepressants (39) | Doxepin pooled with imipramine vs. placebo, for improved sleep quality: SMD −0.39 [−0.56; −0.21) (e56) |
| Antihistamines (39) | Inadequate evidence |
| Antipsychotic drugs (39) | Inadequate evidence |
| Benzodiazepines and benzodiazepine receptor agonists (39)*2 | Improvement of sleep parameters: benzodiazepines: g for TST: 0.64 [0.12; 1.16], for SOL: –0.76 [−1.28; −0.24] benzodiazepine receptor agonists: g for TST: 0.52 [0.33; 0.71], for SOL: −0.46 [−0.61; −0.31] (e57) |
| Melatonin (39) | Generally not recommended because of low efficacy |
| Phytotherapeutic drugs (39) | No improvement to moderate improvement of sleep quality |
| CBT (39)*3 | CBT is recommended as the first line of treatment for adults of any age. CBT vs. placebo: Hedges’ g: 1.07 [0.10; 2.05] (e58) |
| Chronic obstructive pulmonary disease (COPD) | |
| Complex rehabilitation (exercise training and psychological counseling) after a COPD exacerbation (e59) | Good evidence for improvement of fatigue-related quality of life Fatigue domain: mean difference 0.81 [0.16; 1.45] (e60) |
| Congestive heart failure | |
| Exercise training (e61, e62) | Questionable improvement of quality of life |
| Behavior therapy (relaxation, meditation, and guided imagery) (e63, e64) | Potential benefit with regard to quality of life |
| Neurological diseases (residual deficit after stroke, multiple sclerosis, Parkinson’s disease, other) | |
| Exercise training (e65, e66) | May lessen fatigue |
| CBT (e65, e66) | May lessen fatigue |
| Pharmacotherapy (e65, e66) | Individual decision in the absence of convincing evidence |
| Somatoform disorders | |
| Newer-generation antidepressants (30) | Compared to placebo (with very low study quality) moderately effective against somatic symptoms (SMD −0.91, [−1.36; −0.46]), anxiety (SMD −0.88, [−1.81; 0.05]), depression (SMD −0.56, [−0.88; −0.25]) (e67) *4 |
| Cancer | |
| Exercise training (40) | Moderate improvement of CRF: mean weighted effect size (WES) = 0.30 [0.25; 0.36] (e68) |
| CBT (40) | Moderate improvement of CRF: mean weighted effect size (WES) = 0.37 [0.28; 0.47] (e68) |
| Psychological interventions overall (40) | Moderate improvement of CRF: mean weighted effect size (WES) = 0.27 [0.21; 0.33] (e68) |
| Pharmacotherapy (40) | Very little improvement of CRF: mean weighted effect size (WES) = 0.09 [0.00; 0.19] (e68) |
BT, behavior therapy; CRF, cancer-related fatigue; CBT, cognitive behavior therapy; d, Cohen’s d; g, Hedges’ g; SMD, standardized mean difference; SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin-noradrenaline reuptake inhibitor; TST, total sleep time; SOL, sleep onset latency; WES, weighted effect size; Pp, pre-post
*1 In general, effect strengths (Cohen’s d, Hedges’ g) of > 0.2 are considered weak, > 0.5 as moderate, and > 0.8 as strong. The effect strengths presented here for COPD, neurological diseases and cancer are with respect to fatigue as a symptom of these conditions; the strengths presented for the other diseases are with respect to the overall disease process.
*2 This can be offered if CBT is insufficiently effective or not feasible. Beware of the risk of tolerance and dependence, no information on daytime fatigue
*3 Risk of daytime fatigue and somnolence in sleep restriction therapy
*4 The potential benefit must be weighed against the risk of side effects.