How do you approach antidepressant selection in patients with prominent fatigue but minimal mood symptoms?

I'm puzzled by this question, in that prominent fatigue without mood symptoms warrants a proper medical workup before assuming it is depression related. This would include a full set of labs, a sleep study to rule out sleep apnea or other causes of fatigue (and with daytime MSLT to rule out narcolep...

I tend to favor starting the pt on a trial of dopaminergic Wellbutrin, if the patient is not overly anxious, irritable, or agitated, and especially if they present with some common fatigue coexisting symptoms such as apathy, anhedonia, etc. Might even add an SNRI if only partial response on max dose...

Tend to favor antidepressants that include a noradrenergic component for this type of situation.

Although a patient might not present with clear subjective mood symptoms, fatigue itself can be considered a mood symptom that involves withdrawal and isolation. I find that SSRIs and antidepressants of all classes might also effectively treat the depression that underlies fatigue, without attemptin...

Provigil, Nuvigil, and stimulants.

Certainly, it's one first-line agent. Other factors to be considered as contributory to fatigue may prompt consideration of other agents, such as armodafinil.