Neurasthenia is a type of neurotic disorder characterized by mental excitability and mental fatigue, often accompanied by emotional distress and psychophysiological symptoms. It is not secondary to physical or brain diseases, nor is it part of any other mental disorder. There may be a history of prolonged emotional tension and psychological stress prior to the onset of the condition.

bubble_chart Diagnosis

1. Medical history and symptoms:

This condition often presents with multiple mental and physical symptoms simultaneously, such as asthenic symptoms, excitatory symptoms, emotional symptoms, tension-type pain, sleep disorders, and other psychophysiological disturbances, including dizziness, blurred vision, tinnitus, palpitations, shortness of breath, chest tightness, abdominal distension and fullness, indigestion, frequent urination, profuse sweating, impotence, premature ejaculation, or menstrual irregularities. These symptoms are mostly nonspecific and may obscure the manifestations of neurasthenia.

2. Duration of illness:

Typically lasts for more than five months.

3. Differential diagnosis:

Needs to be distinguished from organic brain disorders and somatic diseases; major psychiatric disorders; other neuroses; chronic fatigue syndrome.

bubble_chart Treatment Measures

1. Psychotherapy is the fundamental treatment for this condition, commonly including:

(1) Group psychotherapy;

(2) Small-group psychotherapy;

(3) Individual psychotherapy;

(4) Morita therapy.

Psychotherapy involves doctors systematically explaining the medical knowledge of the disease to patients, enabling them to fully understand the condition, analyze the causes of their illness, seek solutions, eliminate hypochondriacal thoughts, reduce anxiety and distress, and break the vicious cycle. Additionally, treatment methods are explained to encourage active patient cooperation and maximize therapeutic effects. Individual psychotherapy provides targeted psychological counseling based on the specific circumstances of each patient, building upon group or small-group therapy. Morita therapy, which advocates acceptance of natural processes, is one of the effective methods for treating neurasthenia and can be adopted by hospitals with the necessary conditions.

(1) Anxiolytics: Options include diazepam 2.5–5.0 mg, estazolam 1–2 mg, alprazolam 0.4–0.8 mg, or lorazepam 1–2 mg, administered three times daily for 1–2 weeks.

(2) Sedative-hypnotics: For patients with significant sleep disturbances, triazolam 0.25–0.5 mg, nitrazepam 5–10 mg, or clonazepam 2–4 mg may be taken at bedtime for 1–2 weeks.

(3) For marked anxiety, depression, or early awakening, tricyclic antidepressants such as amitriptyline or doxepin 25–50 mg may be taken once at bedtime.

(4) Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or paroxetine, can also be used for patients with accompanying anxiety and depressive symptoms.

3. Other Therapies

Treatments such as insulin hypoglycemic therapy, physiotherapy, Chinese medicinals and acupuncture, biofeedback therapy, and music therapy may also be employed.