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Treatments and drugs
By Mayo Clinic staffThere's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:
- Moderating daily activity. Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.
- Gradual but steady exercise. With the help of a physical therapist, you may be advised to begin an exercise program that slowly becomes more challenging. Research has proved that gradually increasing exercise can improve the symptoms of chronic fatigue syndrome.
- Cognitive behavior therapy. This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health provider to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.
- Treatment of depression. If you're depressed, medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help. Antidepressants may also help improve sleep and relieve pain. Commonly prescribed antidepressants include amitriptyline (Amitid, Amitril), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil) and sertraline (Zoloft).
- Treatment of existing pain. Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) may be helpful to reduce pain and fever.
- Treatment of sleep problems. Changing your sleep habits may be enough to help you start getting restorative nighttime sleep. But if techniques such as sticking with a regular bedtime, skipping daytime naps, and avoiding substances such as caffeine and alcohol don't help, your doctor may prescribe a short course of sleep medication.
- Treatment of allergy-like symptoms. Antihistamines such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.
- Treatment of low blood pressure (hypotension). The drugs fludrocortisone (Florinef) and atenolol (Tenormin) may be useful for certain people with chronic fatigue syndrome.
- Treatment for problems of the nervous system. Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.
Experimental therapies
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following medications:
- Methylphenidate (Ritalin, Concerta, others). This psychostimulant appears to boost and balance levels of the brain chemicals called neurotransmitters. It's commonly used to treat attention-deficit/hyperactivity disorder (ADHD). One study found that methylphenidate lessened fatigue and improved concentration in some people with chronic fatigue syndrome.
- Corticosteroids. Some studies have found that oral hydrocortisone may improve symptoms of chronic fatigue syndrome, while other studies have found no benefit.
- Immune globulins and interferons. These medications are used to boost your immune system's ability to fight infection. Studies have not found them to be consistently effective in treating chronic fatigue syndrome, and some participants have experienced severe side effects.
- Antiviral drugs, such as acyclovir. The possible connection between chronic fatigue syndrome and Epstein-Barr virus led researchers to test whether powerful antiviral medications could improve the symptoms of chronic fatigue syndrome. This approach has not been found effective, and the connection between Epstein-Barr virus and chronic fatigue syndrome has since been disproved.
- Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as galantamine. These drugs improve the effectiveness of acetylcholine, a chemical messenger that is believed to be important for memory, thought and judgment. Galantamine is used in the treatment of Alzheimer's disease, but it has not been found beneficial for chronic fatigue syndrome.
References
- Bennett RM. Fibromyalgia and chronic fatigue syndrome. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/133386890-3/833235176/1492/1050.html#4-u1.0-B978-1-4160-2805-5..50300-1_13277. Accessed April 22, 2009.
- Engleberg CN. Chronic fatigue syndrome. In: Mandell, GL, et al. Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2005. http://www.mdconsult.com/das/book/body/133386890-5/833235546/1259/1004.html#4-u1.0-B0-443-06643-4..50130-6_4604. Accessed April 22, 2009.
- Chronic fatigue syndrome: Symptoms. Centers for Disease Control and Prevention. http://www.cdc.gov/cfs/cfssymptomsHCP.htm. Accessed April 22, 2009.
- Chronic fatigue syndrome: Possible causes. Centers for Disease Control and Prevention. http://www.cdc.gov/cfs/cfscauses.htm. Accessed April 22, 2009.
- Chronic fatigue syndrome: Who's at risk. Centers for Disease Control and Prevention. http://www.cdc.gov/cfs/cfsatrisk.htm. Accessed April 22, 2009.
- Marshall GS, et al. Chronic fatigue syndrome.. In: Long SS, et al., eds. Long: Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/das/book/body/133386890-6/0/1679/204.html#4-u1.0-B978-0-443-06687-0..50203-4--chapter1. Accessed April 22, 2009.
- Gluckman SJ. Treatment of chronic fatigue syndrome. http://www.uptodate.com/home/index.html. Accessed April 22, 2009.
- Teitelbaum J. Chronic fatigue syndrome. In: Rakel RE. Integrative Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/133386890-7/833236431/1494/94.html#4-u1.0-B978-1-4160-2954-0..50051-X_2429. Accessed April 22, 2009.
- Chronic fatigue syndrome: Treatment options. Centers for Disease Control and Prevention. http://www.cdc.gov/cfs/cfstreatmentHCP.htm. Accessed April 22, 2009.
- Chronic fatigue syndrome: Support groups. Centers for Disease Control and Prevention. http://www.cdc.gov/cfs/cfssupport.htm. Accessed April 22, 2009.
- Patel G, et al. Complementary and alternative medicine for noncancer pain. Medical Clinics of North America. 2007;91:141.
