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Lethargy

Lethargy is a medical term describing a state of profound drowsiness, sluggishness, and reduced mental alertness, where an individual experiences difficulty in initiating or sustaining activities due to impaired consciousness or energy levels.^[1] Unlike simple fatigue, which primarily involves physical exhaustion without cognitive disruption, lethargy often signals underlying disruptions in brain activity and can range from mild listlessness to severe unresponsiveness.^[2]^[3]

Symptoms and Characteristics

Lethargy manifests as a spectrum of symptoms affecting both physical and mental function. Common signs include slow movements, difficulty concentrating or remembering details, excessive sleepiness that persists despite rest, and a general lack of motivation or enthusiasm for daily tasks.^[2] In more severe cases, individuals may appear confused, respond slowly to stimuli, or drift back into sleep after brief arousal, distinguishing it from normal tiredness.^[3] It can interfere with work, social interactions, and self-care, often worsening over time if untreated.^[4]

Causes

Lethargy arises from a variety of underlying conditions that impair neurological or physiological function. Acute causes include head injuries, strokes, infections such as meningitis or encephalitis, and metabolic imbalances like hypoglycemia in diabetes.^[2] Chronic contributors encompass anemia, hypothyroidism, chronic fatigue syndrome, depression, autoimmune disorders, and side effects from medications or substance use.^[5] Lifestyle factors, such as sleep deprivation, poor nutrition, or excessive stress, may exacerbate it but are typically secondary to medical issues.^[6] In rare instances, it signals life-threatening events like sepsis or electrolyte disturbances.^[7]

Diagnosis and Treatment

Diagnosis involves a thorough medical evaluation, including physical exams, blood tests to check for anemia or thyroid function, imaging like CT scans for brain abnormalities, and sleep studies if narcolepsy is suspected.^[4] Treatment targets the root cause: for example, antibiotics for infections, hormone replacement for endocrine disorders, or psychotherapy for mental health-related lethargy.^[2] Supportive measures include ensuring adequate hydration, balanced nutrition, and rest, though persistent lethargy requires prompt professional intervention to prevent complications.^[6] Early detection is crucial, as untreated lethargy can lead to reduced quality of life or indicate progressive diseases.^[5]

Etymology and History

Etymology

The term "lethargy" derives from the Ancient Greek word lēthargia (λήθαργία), referring to a state of morbid drowsiness or forgetfulness, formed from lēthē (λήθη), meaning "forgetfulness" or "oblivion," and argos (ἀργός), signifying "idle" or "inactive."^[8] This etymological root ties directly to Greek mythology, where Lēthē personifies oblivion and names one of the rivers of Hades; souls who drank from the River Lethe forgot their past lives, evoking a profound mental erasure rather than simple physical exhaustion.^[9] The word entered Late Latin as lethargia or litargia, often used in medical contexts to describe a coma-like insensibility, before passing into Old French as letargie.^[10] By the late 14th century, it appeared in Middle English as "lethargy" or "letargye," retaining its connotation of pathological torpor and loss of mental sharpness, distinct from everyday fatigue.^[8] This evolution preserved the Greek emphasis on forgetfulness as a core element, influencing its adoption in European languages to denote both physical and cognitive sluggishness.

Historical Concepts

In ancient Greek and Roman medicine, lethargy was conceptualized as "lethargus," a pathological state characterized by prolonged sleep, dulled senses, motor retardation, and sometimes coma-like immobility, often observed in the context of fevers or acute illnesses. Hippocrates, in the Hippocratic Corpus, described lethargus as a form of delirium involving sensory dulling and reduced responsiveness, distinguishing it from more agitated states like phrenitis. Galen, building on this foundation, further elaborated on lethargus as an acute deterioration of mental functions with clouded consciousness, attributing it to imbalances in the four humors—particularly excess phlegm, which was considered cold and moist, leading to brain cooling and stagnation—or occasionally to toxic substances like poisons that impaired vital spirits. These views framed lethargus not as an isolated disease but as a symptom arising from humoral disequilibrium or external agents disrupting the body's natural balance. During the medieval and Renaissance periods, understandings of lethargy shifted toward associations with melancholy and spiritual dimensions, influenced by Islamic and European scholars who preserved and expanded Greco-Roman traditions. Avicenna (Ibn Sina), in his Canon of Medicine, linked lethargic states to an excess of black bile (melaina chole), the cold and dry humor produced by the spleen, which could infiltrate the brain and cause depressive torpor, forgetfulness, and profound inertia; he differentiated this from mania while noting overlaps in pathophysiology. In Christian Europe, such conditions were sometimes interpreted as manifestations of divine punishment for moral failings or sin, aligning with broader theological views of illness as retribution, though humoral explanations remained dominant in medical texts. Renaissance physicians like those following Paracelsus began questioning strict humoralism but retained lethargy as a melancholic variant tied to emotional and environmental imbalances. By the 18th and 19th centuries, perceptions of lethargy evolved from primarily moral or spiritual failings—such as excessive indulgence, idleness, or sexual excess, seen as weakening the will and body—to recognition as a secondary symptom of physical pathologies. Enlightenment-era physicians often moralized fatigue-like states as evidence of character flaws, prescribing regimen and discipline, but by the mid-19th century, amid major epidemics, it was reclassified as indicative of infectious diseases. Notable outbreaks, including typhus and influenza pandemics, prominently featured lethargy as a hallmark symptom: for instance, "lethargic fevers" recurred in European influenza waves through the 1840s, while typhus epidemics during wars and famines exhibited profound somnolence and prostration, prompting pathologists to view it as a vital response to systemic infection rather than a primary entity. Entering the 20th century, lethargy gained further context as a sign of nutritional deficiencies, such as those in vitamins B1 (beriberi) or niacin (pellagra), whose identification through experimental nutrition research underscored its role in metabolic disruptions rather than isolated humoral or moral causes. A pivotal event in the 20th century was the encephalitis lethargica epidemic, which raged from 1915 to 1926 and affected over 1 million people worldwide, resulting in approximately 500,000 deaths. This mysterious illness, possibly linked to an influenza strain or autoimmune response, presented with profound lethargy, oculomotor abnormalities, and parkinsonian symptoms, leading to a catatonic state in survivors. It highlighted lethargy as a central neurological manifestation and spurred research into brain inflammation and post-viral syndromes, influencing modern classifications of sleep disorders and encephalitis.^[11]

Definition and Characteristics

Definition

Lethargy is defined as a state of abnormal fatigue or lack of energy that significantly impairs physical and mental activity, setting it apart from typical tiredness that resolves with rest.^[2] This condition manifests as an unusual reduction in alertness and responsiveness, often involving sluggishness in movement and a diminished capacity for engagement.^[12] Lethargy is typically a symptom of an underlying condition disrupting brain function, rather than a standalone disorder.^[2] In medical classification, lethargy is characterized by a general state of listlessness or disinterest, accompanied by tiredness and challenges in concentration or performing simple tasks, without reaching the level of complete unconsciousness.^[13] It encompasses both physical exhaustion and mental apathy, positioning it between full wakefulness and more severe alterations in consciousness, such as coma.^[2] The scope of lethargy includes both acute presentations, with sudden onset and short duration, and chronic forms that persist over time, potentially lasting months or longer and interfering with motivation, cognitive processes, and everyday functioning.^[2]^[14] Unlike normal fatigue, which primarily affects physical energy without mental disruption, lethargy signals a broader impairment that warrants medical evaluation.^[2]

Distinguishing Features

Lethargy is characterized by a profound lack of energy that manifests as slowed physical movements, diminished initiative to engage with activities, and a general indifference to one's surroundings, setting it apart from simpler fatigue by involving an altered level of consciousness.^[2] Unlike fatigue, which primarily reflects physical exhaustion without significant mental impairment, lethargy includes a subjective sense of mental sluggishness and reduced responsiveness, often persisting even after adequate rest with prolonged recovery periods required to regain normal function.^[2] This inertia emphasizes the experiential quality of feeling "stuck" or disoriented, rather than just worn out from exertion.^[2] Behaviorally, lethargy presents with marked difficulty in initiating even routine tasks, emotional flatness that borders on detachment, and impaired concentration that hinders cognitive processing, distinguishing it from the motivational deficits seen in depression.^[2] While depression involves core emotional symptoms such as persistent sadness, hopelessness, and loss of interest in pleasurable activities (anhedonia), lethargy focuses more on a pervasive psychomotor retardation without the profound mood alterations central to depressive disorders.^[15] These indicators typically endure beyond what would be expected from normal sleep deprivation or temporary tiredness, highlighting lethargy's role as a state of reduced alertness rather than purely emotional or volitional lapse.^[2] The condition's hallmark remains the subjective experience of profound inertia and decreased awareness, prioritizing the patient's reported sense of unresponsiveness over objective metrics.^[2] This focus on internal sensation underscores lethargy's differentiation from conditions with more measurable physiological disruptions.^[2]

Causes

Physiological Causes

Lethargy, characterized by profound physical and mental exhaustion, often arises from physiological disruptions in bodily functions that impair energy production, oxygen delivery, or neural efficiency. These causes stem from organic diseases or interventions that directly affect systemic homeostasis, leading to reduced vitality without primary psychological origins. Infections represent a primary physiological trigger for lethargy through systemic inflammation and immune activation. Bacterial and viral infections, such as mononucleosis caused by the Epstein-Barr virus, induce fatigue by prompting cytokine release that interferes with normal energy metabolism and promotes a state of generalized weakness lasting weeks to months.^[16] Similarly, COVID-19 and its long-term sequelae involve persistent viral effects and inflammatory responses that contribute to debilitating lethargy in many affected individuals, often via ongoing immune dysregulation.^[17] This cytokine-mediated mechanism, common across infections, elevates pro-inflammatory signals like interleukin-6, which suppress mitochondrial function and amplify feelings of exhaustion.^[18] Metabolic disorders further exacerbate lethargy by compromising cellular energy pathways or nutrient transport. Anemia, resulting from insufficient red blood cells or hemoglobin, diminishes oxygen delivery to tissues, leading to persistent tiredness as the body compensates with increased cardiac effort.^[19] Hypothyroidism, where the thyroid gland underproduces hormones like thyroxine, slows basal metabolic rate and impairs thermogenesis, manifesting as profound lethargy in nearly all untreated cases.^[20] Electrolyte imbalances, such as hypokalemia (low potassium), disrupt muscle and nerve function, causing weakness and fatigue through altered membrane potentials that hinder contraction efficiency.^[21] Neurological conditions contribute to lethargy by interfering with central nervous system signaling and energy regulation in the brain. Multiple sclerosis (MS), an autoimmune demyelinating disease, affects over 80% of patients with fatigue due to disrupted axonal conduction and inefficient neural energy use in affected white matter tracts.^[22] Post-concussion syndrome, following mild traumatic brain injury, induces neural fatigue through microstructural damage and altered cerebral blood flow, resulting in rapid exhaustion during cognitive or physical tasks that persists for months.^[23] These disruptions often involve impaired dopamine pathways, reducing motivational drive and amplifying perceived effort. Certain medications provoke lethargy as a side effect by depressing central nervous system activity or altering cardiovascular dynamics. Beta-blockers, used for hypertension and cardiac conditions, reduce heart rate and cardiac output, leading to decreased tissue perfusion and subsequent fatigue in a significant portion of users.^[24] Antihistamines, such as diphenhydramine for allergies, cross the blood-brain barrier to block histamine receptors, inducing drowsiness and lethargy as a common adverse reaction.^[25] Opioids, prescribed for pain management, suppress respiratory drive and activate mu-receptors in the brainstem, causing profound sedation and energy depletion that can limit daily functioning.^[26]

Psychological and Lifestyle Causes

Mental health disorders frequently contribute to lethargy through mechanisms that impair motivation and energy regulation. In major depressive disorder, symptoms such as anhedonia—a profound loss of interest or pleasure in activities—and psychomotor retardation, characterized by slowed thinking, speaking, or body movements, often manifest as persistent tiredness and lack of energy, making even minor tasks feel overwhelming.^[15] Anxiety disorders, including generalized anxiety disorder, can similarly lead to fatigue as a core physical symptom, stemming from chronic worry that depletes cognitive and emotional resources.^[27] Burnout, a psychological syndrome arising from prolonged occupational stress, exacerbates this by causing emotional, physical, and mental exhaustion, where individuals report dragging themselves through daily routines with diminished energy and motivation.^[28] Lifestyle factors play a significant role in fostering lethargy by disrupting foundational physiological processes. Poor sleep hygiene, such as irregular bedtimes or exposure to screens before rest, results in sleep deprivation that directly induces daytime tiredness and reduced alertness, as the body fails to restore energy during insufficient or fragmented sleep cycles.^[29] Inadequate nutrition, particularly vitamin D deficiency, is associated with fatigue and low energy levels, as evidenced in studies linking low vitamin D to disrupted sleep and overall tiredness in adults and children.^[30] Sedentary behavior further perpetuates a cycle of deconditioning, where prolonged inactivity weakens muscles, impairs circulation, and reduces endurance, leading to increased feelings of fatigue even with minimal exertion.^[31] Environmental influences can trigger or amplify lethargy through sustained psychosocial pressures. Chronic stress from work overload or life demands elevates cortisol levels, contributing to emotional exhaustion and persistent low energy that persists beyond acute episodes.^[32] Seasonal affective disorder (SAD), triggered by reduced sunlight in fall and winter, causes low energy and sluggishness alongside oversleeping and carbohydrate cravings, disrupting circadian rhythms and serotonin production.^[33] Substance use, such as chronic alcohol consumption followed by withdrawal, induces fatigue and lethargy as the body readjusts to the absence of depressant effects, often compounding motivational deficits.^[34] Grief and adjustment disorders exemplify how emotional processing can drain cognitive resources and lead to lethargy. In prolonged grief disorder, intense yearning and emotional numbness following loss are accompanied by physical fatigue, muscle weakness, and lethargy, impairing daily functioning for over a year.^[35] Adjustment disorders, arising from identifiable stressors like job loss or relocation, involve excessive emotional responses that manifest as low energy, withdrawal, and difficulty with routine tasks, typically resolving within six months but contributing to temporary motivational deficits in the interim.^[36]

Symptoms and Diagnosis

Associated Symptoms

Lethargy is frequently accompanied by physical symptoms that indicate broader systemic effects, such as muscle weakness, which manifests as reduced strength and endurance during routine tasks.^[37] Headaches, often tension-type or migraine-like, and dizziness, particularly orthostatic upon standing, are common, potentially stemming from dehydration, low blood pressure, or neurological involvement.^[38] Gastrointestinal issues, including nausea and constipation, may also occur, signaling disruptions in autonomic function or related infections.^[4]^[37] Cognitively, individuals experiencing lethargy often report difficulty concentrating, with challenges in maintaining focus or processing information, alongside memory lapses.^[38] Emotionally, apathy—a profound lack of motivation or interest in activities—predominates, frequently paired with irritability, where minor stressors provoke disproportionate frustration.^[37]^[39] These signs can intensify daily impairments, contributing to social withdrawal or reduced productivity.^[39] In more severe instances, lethargy may involve confusion, characterized by disorientation or muddled thinking, and slowed speech, reflecting impaired cognitive processing without progressing to full delirium.^[4] Such indicators warrant prompt evaluation, as they can signal acute underlying issues like infections or metabolic imbalances.^[37] Symptom patterns vary by cause; for instance, in chronic fatigue syndrome, exertion may trigger post-exertional malaise, where symptoms worsen after physical or mental activity.^[38] Temporary relief may occur with rest, though in chronic cases, symptoms persist despite adequate sleep, highlighting the need to address root factors.^[4]

Diagnostic Approaches

Diagnosing lethargy begins with a thorough clinical history, where clinicians interview patients about the onset, duration, severity, and potential triggers of their symptoms, such as recent illnesses, lifestyle changes, or medications, to identify patterns suggestive of underlying causes.^[40] Physical examination follows, focusing on vital signs, reflexes, neurological function, and general appearance to detect abnormalities like pallor, edema, or altered mental status that may point to systemic issues.^[41] Common accompanying symptoms, such as persistent headaches or unexplained weight loss, can further guide the direction of subsequent testing.^[42] Laboratory tests are essential for ruling out common physiological contributors to lethargy. A complete blood count (CBC) assesses for anemia by measuring hemoglobin and red blood cell indices, while thyroid-stimulating hormone (TSH) levels evaluate thyroid dysfunction, a frequent cause of fatigue-like symptoms.^[16] Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) help identify infections or chronic inflammation, and urinalysis detects dehydration or metabolic disturbances like elevated glucose or ketones.^[40] Additional panels, including electrolyte and liver function tests, provide a broad screen for imbalances that could manifest as lethargy.^[43] If neurological or structural causes are suspected based on history and exam, imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain may be ordered to evaluate for abnormalities like tumors or strokes.^[44] Specialized tests, including polysomnography for sleep disorders like obstructive sleep apnea, are recommended when sleep-related issues are implicated, as these can significantly contribute to daytime lethargy.^[45] To quantify the severity of lethargy and differentiate it from mimics like depression or hypersomnia, validated scales such as the Epworth Sleepiness Scale (ESS) are employed; this self-reported tool rates the likelihood of dozing in various situations, with scores above 10 indicating excessive daytime sleepiness warranting further investigation.^[46] These differential tools aid in prioritizing tests and ensuring a targeted approach to diagnosis.^[43]

Treatment and Management

Addressing Underlying Causes

Addressing the underlying causes of lethargy is essential for effective treatment, as it targets the root etiology rather than merely alleviating symptoms.^[43] Once diagnosed, interventions focus on resolving the primary condition, such as infections, hormonal imbalances, nutritional deficiencies, neurological disorders, or iatrogenic factors, often leading to significant improvement in energy levels. For physiological causes, bacterial infections contributing to lethargy are typically managed with appropriate antibiotics, which resolve the infection and thereby reduce associated fatigue.^[47] In cases of hypothyroidism, where low thyroid hormone levels induce profound tiredness, levothyroxine replacement therapy restores normal hormone function and alleviates fatigue within 1-2 weeks of initiation, with ongoing monitoring to maintain euthyroid status.^[48] Similarly, iron deficiency anemia, a common culprit for lethargy due to impaired oxygen transport, responds well to oral iron supplementation, with most patients reporting reduced tiredness within one week, though full hematologic recovery may take months.^[49] Neurological conditions underlying lethargy require specialized interventions to mitigate disease progression or aid recovery. In multiple sclerosis (MS), disease-modifying therapies (DMTs) such as glatiramer acetate, natalizumab, and ponesimod have demonstrated efficacy in reducing fatigue by modulating immune activity and slowing neurodegeneration.^[50]^[51] The OPTIMUM Phase 3 extension study, as of June 2025, further confirmed sustained efficacy and safety of ponesimod in reducing MS-related fatigue.^[52] Following neurological injuries like traumatic brain injury, rehabilitation programs incorporating targeted exercises and self-management strategies help address post-injury fatigue by improving functional capacity.^[53]^[54] When medications induce lethargy as a side effect—such as certain antidepressants, antihistamines, or opioids—adjustments under medical supervision are recommended, including dose reduction, switching to alternative agents, or discontinuation to restore energy without compromising therapeutic benefits.^[55]^[56] A multidisciplinary approach is often employed, involving specialists like endocrinologists for metabolic disorders, neurologists for central nervous system issues, and pharmacologists for drug-related causes, ensuring comprehensive evaluation and tailored interventions based on the specific diagnosis.^[43] This coordinated care model enhances outcomes by addressing interconnected factors contributing to lethargy.^[57]

Supportive Interventions

Supportive interventions for lethargy encompass a range of non-pharmacological and pharmacological strategies aimed at alleviating symptoms such as persistent tiredness and low energy, independent of the underlying etiology. These approaches can provide symptomatic relief while more targeted treatments are pursued.^[58] Lifestyle modifications form the foundation of supportive care for lethargy. Regular exercise, particularly aerobic activities like walking or cycling, has been shown to boost endorphin levels, thereby enhancing mood and reducing feelings of fatigue over time.^[59] A balanced diet rich in nutrients, including fruits, vegetables, whole grains, and lean proteins, supports sustained energy by preventing deficiencies that exacerbate tiredness.^[60] Optimizing sleep hygiene to achieve 7-9 hours of quality rest nightly is essential, as inadequate sleep directly contributes to daytime lethargy and can be improved through consistent routines and a conducive sleep environment.^[61] Behavioral therapies offer structured ways to address motivational deficits and stress associated with lethargy. Cognitive behavioral therapy (CBT) helps individuals reframe negative thought patterns that perpetuate low motivation, leading to improved energy management and reduced fatigue severity in conditions like chronic fatigue syndrome.^[62] Stress reduction techniques, such as mindfulness-based practices, promote relaxation and have demonstrated effectiveness in mitigating exhaustion by lowering cortisol levels and enhancing overall resilience to daily demands.^[63] Pharmacological aids may be considered for more pronounced lethargy, under medical supervision. Stimulants like modafinil, prescribed for conditions such as narcolepsy with excessive daytime sleepiness or fatigue in traumatic brain injury, can improve alertness, though efficacy varies across neurological disorders and long-term use requires monitoring for side effects like insomnia.^[64]^[65] Modafinil may produce fewer jittery effects than traditional stimulants like amphetamines.^[65] Over-the-counter options like caffeine provide temporary relief from mild lethargy by blocking adenosine receptors to promote wakefulness, but excessive intake risks dependency, tolerance, and withdrawal symptoms including heightened fatigue.^[66] Alternative approaches, including acupuncture and light therapy, offer additional avenues for symptom management. Acupuncture has evidence from clinical trials showing it reduces fatigue scores in patients with chronic conditions, possibly through modulation of the nervous system and improved circulation.^[67] Light therapy, particularly for seasonal-related lethargy as seen in seasonal affective disorder, involves exposure to bright light to regulate circadian rhythms, with studies indicating significant improvements in energy levels and mood after consistent use.^[68]

Prognosis and Prevention

Prognosis

The prognosis of lethargy, a common symptom characterized by profound tiredness and reduced energy, largely depends on its underlying etiology and the promptness of intervention. In cases stemming from acute causes such as infections, prompt treatment of the primary condition often leads to resolution of symptoms within weeks to months for most individuals, though approximately 20% may experience prolonged fatigue.^[69] In chronic scenarios, lethargy often persists when associated with untreatable or progressive conditions, such as advanced neurodegenerative diseases like Parkinson's or Alzheimer's, where symptom management shifts toward maintaining quality of life through supportive care rather than cure.^[70] Key factors influencing outcomes include the timing of diagnosis, with early detection enabling more effective addressing of reversible causes and thereby enhancing recovery prospects; conversely, comorbidities like obesity can exacerbate lethargy by contributing to metabolic strain and sleep disturbances, leading to poorer overall prognosis.^[58]^[71] Studies on fatigue linked to lifestyle factors like poor diet or inactivity, as well as chronic conditions, indicate that many individuals experience significant symptom improvement with targeted interventions such as exercise and behavioral modifications, highlighting the potential for positive outcomes when modifiable contributors are addressed.^[72]^[73]

Prevention Strategies

Preventing lethargy involves proactive measures to address potential underlying physiological and lifestyle factors that contribute to its development. Routine medical check-ups play a crucial role in early detection of conditions such as anemia and thyroid disorders, which are common causes of lethargy; blood tests during these visits can identify low hemoglobin levels indicative of anemia or abnormal thyroid function tests for hypothyroidism or hyperthyroidism.^[74]^[75] Staying up to date with recommended vaccinations, such as those for influenza and pneumococcal disease, helps prevent infections that can lead to prolonged fatigue by reducing the incidence of severe respiratory illnesses.^[76]^[77] Adopting consistent daily habits significantly lowers the risk of lethargy. Engaging in at least 150 minutes of moderate-intensity aerobic physical activity per week, as recommended by global health guidelines, enhances energy levels and combats fatigue by improving cardiovascular health and sleep quality.^[78]^[79] A nutrient-dense diet rich in iron, found in foods like lean meats, spinach, and beans, helps maintain adequate iron stores to prevent anemia-related lethargy; pairing these with vitamin C sources boosts absorption.^[80] Implementing stress management techniques, such as mindfulness meditation practiced for 10-20 minutes daily, reduces psychological stress that can manifest as lethargy by lowering cortisol levels and improving emotional regulation.^[81]^[82] Environmental adjustments can mitigate factors like seasonal variations that exacerbate lethargy. Optimizing the sleep environment by maintaining a cool, dark, and quiet bedroom—using blackout curtains and avoiding screens two hours before bed—supports consistent 7-9 hours of restorative sleep, countering disruptions from reduced daylight.^[58]^[83] Increasing morning light exposure, either through outdoor time or light therapy devices delivering 10,000 lux for 30 minutes, helps regulate circadian rhythms and prevents seasonal affective disorder-related fatigue during shorter days.^[84] For at-risk groups like the elderly, targeted strategies are essential to avert lethargy. Regular medication reviews during check-ups can identify and deprescribe polypharmacy issues, where multiple drugs cause side effects like drowsiness and fatigue, thereby reducing the risk of drug-induced lethargy.^[85]^[86] Promoting social engagement through community activities or regular interactions combats isolation, which contributes to depression and subsequent lethargy in older adults, by fostering emotional well-being and motivation.^[87]

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