Neurasthenia: what this condition is, signs and causes

Sometimes a person leaves the doctor's office with a note saying "neurasthenia" or "asthenic neurosis" and is left alone with it: it is unclear whether this is an illness or accumulated fatigue. Behind the word lies a long tradition of describing exhaustion, and it has changed noticeably.

What neurasthenia is and how this concept has changed

Neurasthenia was described by the American physician George Beard in 1869 — as a mental disorder from the group of neuroses with increased irritability, fatigability and loss of the ability for prolonged mental and physical exertion.

The status of the concept has changed. In ICD-10, neurasthenia belongs to section F48 "Other neurotic disorders", while in ICD-11 it is absent: instead, "Mood disorder, unspecified" (6A8Z) is proposed. There is a view that neurasthenia essentially reflects dysautonomia — an imbalance of the autonomic nervous system.

Causes and risk factors

Neurasthenia occurs, as a rule, when psychological trauma is combined with excessively intense work and physiological deprivations — chronic sleep deprivation, lack of rest. Its development is facilitated by infections and intoxications that weaken the body, smoking and alcohol, endocrine disorders, and inadequate nutrition.

Fatigability as a symptom has many causes: lack of sleep, stress, depression and life difficulties, hormonal changes — during puberty, pregnancy, menopause, and certain diseases such as infectious mononucleosis and COVID-19. A similar picture is produced by diabetes, heart, liver, kidney and thyroid diseases, anemia, sleep apnea, and anxiety disorders.

Symptoms: fatigability, irritability and bodily complaints

Descriptions of neurasthenia distinguish three stages. The first, hypersthenic, is more common than the others and begins with irritability: the slightest noise, conversations and sounds, people's rapid movements, and crowds are irritating. Work capacity declines not so much because of fatigue as because of disorganization and weakness of active attention — a person cannot start a task for a long time and is quickly distracted.

Sleep is almost always disturbed: falling asleep is difficult, awakenings are frequent, dreams are abundant, getting up in the morning is hard, with a feeling of being worn out that subsides somewhat by evening. Complaints of headache, heaviness in the head, pressure in the temples, and poor memory are common.

The second stage is irritable weakness: outbursts of irritation over minor triggers are combined with fatigability and rapid exhaustion, and tearfulness, intolerance of loud sounds, bright light, and strong odors appear. The third, hyposthenic, stage — lethargy, apathy, drowsiness, low mood and focus on bodily sensations. Bodily complaints are varied: palpitations, decreased appetite, belching, heartburn, constipation, heaviness in the stomach.

Asthenic neurosis: weakness, exhaustion and an anxious background

The name "asthenic neurosis" is used for conditions in which asthenia — weakness and exhaustion — comes to the fore. In the third stage, the mood background becomes somewhat anxious, with a tinge of sadness and weakening of interests, although there are no affects of anguish or anxiety.

How a doctor makes the diagnosis and rules out other causes

Fatigability is not a disease but a symptom, so the conversation begins with sleep, daily activities, appetite and workload. The doctor performs an examination and may order blood tests — for anemia, diabetes, increased thyroid function — and if the cause is unclear, refers the patient to a specialist. Separately, conditions that masquerade as exhaustion are ruled out — sleep apnea — loud snoring and sounds of suffocation or gasping, anemia, diabetes, thyroid diseases.

When to see a doctor

Several situations become a reason to talk to a doctor.

• fatigue persists for several weeks and it is unclear where it comes from;
• it interferes with work, daily tasks and ordinary life;
• other symptoms are added — weight loss, mood changes;
• loved ones notice that you snore loudly in your sleep or make sounds of suffocation or gasping;
• extreme fatigue persists for at least three months and interferes with everyday tasks.

Neurasthenia and asthenic conditions are not in themselves a reason to call an ambulance. The numbers 103 and 112 — if there is a threat to life: for example, signs of stroke or heart attack or a serious injury.

This text is for reference: it does not make a diagnosis and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer