The fatigue of depression may not be recognized by the MS person. Depression presents with poor sleeping, eating, and feelings. Fatigue often results and must be managed by appropriate medications and counseling. Lassitude is the most common fatigue in MS and can occur without depression. It presents as an overwhelming sleepiness that may be quite disabling.
Management is with stimulating antidepressants, cerebral stimulants, and amantidine.
The occupational therapist helps the fatigue management by teaching more efficient ways to dress, eat, groom, bathroom, and live. This is an important management strategy to conserve energy. With more progressive MS the goal is to have control of the bowel by having a bowel movement on a non-rigid schedule. It is natural to have a bowel movement after a meal. This is due to the gastrocolic reflex.