Tiredness that won't lift

Mousumi, 27, is back in Dhaka after six months as an NGO field officer in the char areas of Sirajganj, months of boats at dawn, flood surveys and meetings under a tin roof in the heat. She expected to rest and feel better. Instead she is tired from the moment she wakes, falls asleep on the bus, and has stopped going to her cousins’ Friday adda.

Advice arrives from all directions. Her mother: “Eat kochu shak, it’s full of iron.” Her Nani, on a video call: “Dates and warm milk, every night.” A colleague hands her a strip of multivitamins. Her younger cousin suggests she is simply bored of Dhaka. Mousumi puts her head on the table at the office canteen and says to no one in particular, “Everyone just says, take some vitamins.”

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding tiredness that won’t lift

Tiredness is a symptom, not a diagnosis. Feeling exhausted for weeks can come from anaemia, thyroid problems, diabetes, infections, medicines, poor sleep or sleep disorders, long hours and stress, or depression and anxiety, and sometimes from more than one of these at once. Less often, it is the start of ME/CFS. Depression in particular can show mainly as tiredness, with low mood that the person barely notices. Guessing the cause, and treating it with whatever is in the cupboard, can delay the real answer.

How common is tiredness that won’t lift?

In a review of 26 primary care studies of people with tiredness (the figures here come from its higher-quality studies), depression was found in 18.5%, anaemia in 2.8%, serious physical disease in 4.3%, and cancer in 0.6%. In studies with a comparison group, physical disease was no more common in those who were tired than in those who were not, while depression was. In Bangladesh, blood tests taken in a trial in rural Sylhet found anaemia in 20% of non-pregnant women, but iron deficiency in only 3%, a reminder that anaemia has several causes and is best tested rather than assumed.

Signs and symptoms of tiredness that won’t lift

• Tiredness on most days for more than a few weeks
• Breathlessness, palpitations or pale skin
• Weight change, feeling cold, or changes in periods
• Snoring, waking unrefreshed, or very irregular sleep
• Low mood, loss of interest, or feeling hopeless
• Exhaustion that worsens a day or two after effort

Treatment for tiredness that won’t lift

Assessment begins with a careful history and examination: sleep, work, diet, periods, medicines, mood, and what the last few months have asked of the person. Tests are chosen to match, usually a blood count and thyroid function, and others where the history points. The review above concludes that extensive investigations are warranted only when the history or examination suggests something specific, and that attention should go to depression and life stresses. What is found is treated: iron if it is truly low, a thyroid condition, a sleep problem, or depression with therapy and, where appropriate, medication.

What getting better can look like

Mousumi’s first steps might be a blood test that answers the iron question, a conversation about the months on the char that she has not had with anyone, and a Friday when she makes it to the adda and stays past ten.

Common questions about tiredness that won’t lift

What can cause tiredness all the time?

Common causes include anaemia, thyroid problems, poor sleep, stress, medicines and depression. In studies of people who saw a doctor about tiredness, depression was found far more often than anaemia or serious physical disease. A doctor can work out which applies to you.

Should I take vitamins or iron for tiredness?

It is better to find the cause first. A simple blood test can show whether you are anaemic or low in iron, and in one study of non-pregnant women in rural Sylhet, anaemia was far more common than iron deficiency. Treating the actual cause works better than guessing.

When to see a psychiatrist

If tiredness has lasted more than a few weeks, or comes with low mood, breathlessness, weight change or poor sleep, see a doctor. If tiredness comes with thoughts of not wanting to live, call 999.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Stadje et al., BMC Family Practice, 2016 (PMID 27765009)
• Wendt et al., Maternal and Child Nutrition, 2025 (PMID 40387380)