10.6 Fatigue and problems initiating activities

There are a number of other symptoms after a brain injury that do not really fit into mental health problems.

i) Fatigue

After a brain injury often people can be very fatigued. They get tired very easily.

These fatigue problems can be mistaken for depression or they can occur in combination with depression.

Fatigue is often managed by educating the person about their fatigue.  Using rest breaks and limiting the day’s activities.  If this does not work there are some medications that can be used. Treating the depression is easier because antidepressants are very safe and easy to use. If fatigue persists after treatment for depression, then we will sometimes use medication to control that fatigue or to make it better.

Some of the typical medications are:

  • Dexamphetamine
  • Methylphenidate
  • Modavigil

Modavigil is the most modern drug to be used for the treatment of fatigue but at present it is very expensive. So not many people can use it.

One of the issues about treating fatigue with medication is that it does not fix the underlying problem. So if a person has a problem with fatigue and they are taking medication the fatigue catches up with them when the medication wears off. You cannot take medicine for fatigue 24 hours a day because it interferes with your sleeping.


ii) Difficulties initiating activities

Another common problem after a brain injury is difficulty with initiating activities. They may not concentrate well. They may sometimes have memory problems.

There is some research happening overseas where people are using drugs that we normally use to treat dementia such as Alzheimer's disease, and giving this to people who have had a brain injury.  Sometimes it helps improve some of the problems - problems with behaviour, poor concentration, initiating or low motivation. The medication does not work for every person but sometimes it will.

Some common drugs for initiative problems, memory and attention difficulties are:

Dementia medicines (Aricept, Reminyl) Stimulant drugs (Dexamphetamine, Methylphenidate).

Some of the stimulant drugs like Dexamphetamine, Methylphenidate will also sometimes work for the initiative problem.

If the problems with initiative and fatigue are severe it is important for you to talk about it with your rehabilitation specialist and your case manager because there may be some treatment that they can try.

It is important to remember that these treatments do not address the underlying problem and once you start treatment you have to make a decision as to how long you want to continue with the treatment.