Tiredwise · BETA
Tiredwise
Maps for symptoms that don't come with an easy answer: tiredness, brain fog, pain, headache, gut and bladder. Common causes are big bubbles, rare ones small. Tap a bubble for clues, mechanisms, tests and what trials have shown.
Symptom maps
Look behind the label
A diagnosis can be the end of the story or a waypoint. Someone labelled with depression may be depressed because they're exhausted, and exhausted because of sleep apnoea, low iron or a thyroid problem. "Anxiety" can be a racing heart from POTS. "IBS" can be coeliac disease or bile acid diarrhoea. Tap any bubble to see dashed arrows from the hidden drivers to the label they can sit behind.
These links are clinical reasoning, not proof. Many labels are correct, and treating them helps. The point is to check the drivers once, especially when standard treatment isn't working.
Tiredness: the evidence
Bottom line
- Mood, sleep and life load dominate. Depression alone is found in about 18.5% of tired GP patients (pooled, 26 studies).
- Blood tests find little. Only 8% of tired patients had a somatic illness detectable by bloods. A 17-test panel added almost nothing over 4 tests but more than doubled the false positives (38 → 96).
- Serious disease is rare but real. Pooled serious somatic disease is about 4.3%; cancer about 0.6%. In a UK cohort of 285,382, 9-month cancer risk after a fatigue visit was 2.2% in men and 1.1% in women aged 30+, rising above 3% in older men with weight loss or abdominal pain.
- Large unexplained group. In one Dutch study about 43% ended with no diagnosis beyond "tiredness". That's a lot of people with real symptoms and no answer yet.
- For the unexplained group, the best-supported leads are features you can measure: post-exertional malaise, orthostatic intolerance, small fibre neuropathy, iron deficiency without anaemia, sleep disorders.
- The immune/autoantibody story is promising but repeatedly fails in proper trials (rituximab, IVIG, efgartigimod, BC007). Open-label wins keep shrinking under placebo control. Subgrouping by biomarker looks like the way forward.
Ranked causes, common to rare
Bars only for figures measured in tired primary care patients. GP data = measured in tired GP patients. population = how common in everyone (not a fatigue-specific rate). clinic = specialist clinic data, inflated by referral. no data = clinically common, no good fatigue-specific number.
How to read the map
Each layer leads to the next: from the symptom to the likely causes, the clues that point to each one, why it might happen, and what has been tested.
Tired
Duration, onset (sudden after infection?), what makes it worse.
Ranked bubbles
Common first. Red flags pinned. "Tests normal" filter.
Measurable clues
Crash after effort, worse upright, burning feet, flushing episodes, snoring.
Why it might happen
Low preload, small fibre loss, autoantibodies, mast cell mediators, iron stores.
What's been tested
Honest results, then studies recruiting now (Research hub feed).
Treatment trials for the unexplained group
Green = positive randomised result · amber = mixed, small or uncontrolled · red = negative randomised trial.
The pattern: small open-label studies look good, then larger placebo-controlled trials don't. Placebo and volume effects are big here (in the IVIG trial, both arms improved). The next generation of trials targets biomarker-defined subgroups, such as people with high NK cells for daratumumab, or confirmed antibody positivity.
Sources
Journal articles are linked by DOI where available. Prevalence figures marked "population" or "clinic" aren't rates in tired GP patients.
Beta. General education, not a diagnosis or personal medical advice. Always see your GP about ongoing tiredness. In an emergency, call 000; to talk now, Lifeline 13 11 14.