Drugs For Chronic Fatigue Syndrome

Case Presentation: Case 1

A white British female, now aged 63 , developed viral meningitis with accompanying vomiting leading to severe dehydration in 1988 when aged 33. She had previously been well and working as a general practitioner. Viral meningitis was diagnosed by lumbar puncture and again 6 weeks later on repeat hospital admission. She remained extremely unwell, being bed bound and unable to self-care, with profound weakness and fatigue, general malaise, light and sound sensitivity, repeated dizziness causing collapse, persistent anxiety and widespread pain. Although she improved slowly over the next 5 years, she was only able to return to work on a limited basis, still suffering headaches, fatigue, postexertional malaise and frequent migraine attacks characterised by vomiting and visual disturbances.

Following gastroenteritis in 1999, she again became bed bound and unable to self-care. Improvement was slower than the initial illness, and after 5 years she was still dependent on carers and used a motorised wheelchair when outside. She developed multiple food intolerances, shown on blood tests and confirmed by repeated withdrawals and reintroductions of intolerant foods. She showed a more dramatic response to wheat, even small amounts, characterised by nausea, severe headache, rapid heart beat and collapse within 10min of consumption, followed by a week of reduced energy and absolute constipation.

Living With Chronic Fatigue Syndrome

Although experts have not yet found a cure for CFS/ME, many people who have the illness are able to make lifestyle changes and find treatments that allow them to reduce or manage their symptoms. Improvement is possible by living within your limits and working with a doctor to find treatments that help you. There are also many CFS/ME support groups both online and in-person. Meeting with such a group might prove to be helpful.

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Concluding Remarks And Future Directions

This review suggests that the beneficial effects of nutritional supplements are not random, but that their action is due to the removal of one of the causes of the CFS/ME. There is evidence that supplements may benefit CFS/ME patients therefore, nutritional supplements should be recommended, at least in CFS/ME patients with a biochemically proven deficiency. Studies investigating nutritional interventions in CFS/ME remain very limited most studies have had small sample sizes, and lacked long term followup . Despite the relative consistency in case definition, the studies differed with regard to inclusion and exclusion criteria and reporting participants’ sociodemographic characteristics and clinical features . This heterogeneity in study design makes the application of the findings to the clinical setting more difficult. Therefore, longerterm RCTs in homogeneous populations that use more specific case criteria are now warranted.

In agreement with several previous studies, pacing was consistently shown to be the most helpful treatment, CBT was useful for some patients but not all for all graded training may cause the condition to worsen. However, the results must be interpreted with care, as the participants are not a representative sample.

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Where Can I Get Support

ME/CFS can have a significant emotional and financial impact on your life. A lack of understanding and awareness about ME/CFS means patients can experience disbelief, and even discrimination, from friends, family, health and social care professionals and employers.

Information on entitlements to welfare benefits, accessing health and social care and others sources of support for patients and carers are available from Action for M.E. They also offer resources and services for children and young people affected by ME/CFS and their families.

How Is Cfs Treated

Theres currently no specific cure for CFS.

Each person has different symptoms and therefore may require different types of treatment to manage the disorder and relieve their symptoms.

Work with your team of healthcare providers to create the best treatment plan for you. They can go over the possible benefits and side effects of the therapies with you.

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Drug And Alternative Therapies

Specific chronic fatigue syndrome symptoms such as pain, depression, and poor sleep are treated.

Many different drugs and alternative therapies have been tried to relieve the chronic fatigue itself. Although many treatments, such as antidepressants and corticosteroids, seem to make a few people feel better, none are clearly effective for all. It can be hard for people and doctors to tell which treatments work because symptoms are different in different people and because symptoms may come and go on their own.

Controlled clinical trials The Science of Medicine Doctors have been treating people for many thousands of years. The earliest written description of medical treatment is from ancient Egypt and is over 3,500 years old. Even before that, healers… read more , which compare the benefits of a drug to those of a placebo , are the best way to test therapies, and no drug therapy has been shown to be effective for the treatment of chronic fatigue syndrome in controlled trials. A number of treatments directed at possible causes, including use of interferons, intravenous injections of immune globulin, and antiviral drugs, have been mostly disappointing and potentially dangerous. Dietary supplements, such as evening primrose oil, fish oil supplements, and high-dose vitamins, are commonly used, but their benefits remain unproved. Other alternative treatments have also been ineffective. Treatments that have no proven benefits are best avoided because they can have side effects.

Memory And Concentration Problems

Memory aids, like organizers and calendars, can help with memory problems. For people with ME/CFS who have concentration problems, some doctors have prescribed stimulant medications, like those typically used to treat Attention-Deficit / Hyperactivity Disorder . While stimulants might help improve concentration for some patients with ME/CFS, they might lead to the push-and-crash cycle and worsen symptoms. Push-and-crash cycles are when someone with ME/CFS is having a good day and tries to push to do more than they would normally attempt .

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A Trial Of Solriamfetol In The Treatment Of Myalgic Encephalomyelitis/chronic Fatigue Syndrome

This will be an 8-week single center, randomized, double-blind, placebo-controlled, flexible titration trial evaluating the efficacy of solriamfetol in the treatment of fatigue symptoms in adult patients with a diagnosis of ME/CFS. Subjects will be randomized to a solriamfetol group or placebo group . The investigators will utilize an intent to treat model and impute data, if statistically feasible, from dropouts utilizing a MNAR approach.

The trial involves primary, secondary, exploratory and safety/tolerability objectives.

Primary objective: Evaluate IMP efficacy in treating ME/CFS fatigue symptoms

Primary endpoint: Difference in means at week 8 between treatment and control groups as measured by the Fatigue Symptom Inventory.

Who Is At Risk For Chronic Fatigue Syndrome

Because the cause of CFS is not known, its hard to know what might put someone at risk for getting the condition. However, certain factors are seen more often in people with CFS. These factors include:

• Gender. CFS happens up to 4 times more often in women than in men.
• Age. CFS commonly affects middle-aged people, but people of any age can get it.

• The Many Faces of Chronic Fatigue Syndrome

There is no standard treatment for chronic fatigue syndrome, clinically known as myalgic encephalomyelitis/chronic fatigue syndrome . However, there are many options for managing symptoms and improving quality of life, including lifestyle changes, stress management, therapy, and medications. With the help of your healthcare provider and other caregivers, these can be tailored to your specific symptoms.

Verywell / Brianna Gilmartin

• Step 4: Build Peace and Relax

Chronic Fatigue Syndrome is a chronic illness characterized by extreme fatigue that lasts for more than six months. This fatigue cannot be explained away by an underlying medical condition. In fact, one of the diseases principle challenges is that its impossible to diagnose with laboratory tests. However, some professionals believe it is closely related to adrenal fatigue or system wide inflammation of the body.

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Sleep Rest And Relaxation

You may have sleep problems that make your ME/CFS symptoms worse. For example, you may:

• have problems getting to sleep
• have unrefreshing or restless sleep
• need an excessive amount of sleep
• sleep during the day and be awake at night

You should be given advice about how to establish a normal sleeping pattern. Having too much sleep does not usually improve the symptoms of ME/CFS, and sleeping during the day can stop you sleeping at night.

You should change your sleep pattern gradually, and your doctor should review how it’s going regularly. If your sleep does not improve after making changes, you may have an underlying sleep problem that will need to be addressed.

It’s likely you’ll need to rest during the day, and your doctor should advise you about the best way to do this. For example, they may suggest limiting each rest period to 30 minutes and teach you relaxation techniques, such as breathing exercises.

If you have severe ME/CFS and need to spend much of your time in bed, it can cause problems, including pressure sores and blood clots. These problems, and how to avoid them, should be explained to you and your carers.

Causes Of Chronic Fatigue Syndrome

Despite considerable research, the cause of chronic fatigue syndrome remains unknown. Controversy exists as to whether there is a single cause or many causes and whether the cause is physical or mental, but either way the symptoms are very real to the person.

Some researchers believe the syndrome ultimately will prove to have several causes, including genetic predisposition and exposure to microbes, toxins, and other physical and emotional factors.

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Keep Track Of Your Symptoms And Their Onset

Tracking the frequency, timing, and severity of your symptoms might help your doctor better understand what youre experiencing. Tracking your activity level and symptoms can also help you draw connections and learn your limits so that you can reduce flare-ups.

When tracking your symptoms, remember to write down everything ailing you, not just fatigue. People with CFS/ME often also have issues with pain, cognition, such as memory and concentration, and sleep. You might also consider keeping a sleep diary, so your doctor can see how well youre sleeping and determine if sleep might play a role in your symptoms.

What Is Chronic Fatigue Syndrome

Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a complicated illness characterized by at least six months of extreme fatigue that is not relieved by rest, and a group of additional symptoms that also are constant for at least six months. In many people with chronic fatigue syndrome, the disorder begins suddenly, often following a flulike infection or an episode of physical or psychological trauma, such as surgery, a traumatic accident or the death of a loved one. In other cases, chronic fatigue syndrome develops gradually. The illness lasts for many months or years, and only a small percentage of people recover full health.

Many people feel tired a lot of the time, and many seek help from their doctors. Most people who experience chronic fatigue are not suffering from chronic fatigue syndrome. Depression and overwork are much more common causes of chronic fatigue.

Several parts of the immune system remain activated for long periods in people with chronic fatigue syndrome. There is growing evidence that some patients with chronic fatigue syndrome have an autoimmune condition: their immune system is attacking particular tissues in the body.

Patients with chronic fatigue syndrome have defects in the ability of cells in their bodies to make energy. Some studies indicate that certain genes are built differently, and that the activity of genes in white blood cells is different, in patients with chronic fatigue syndrome.

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Popular Medications For Chronic Fatigue Syndrome

Chronic fatigue syndrome can have a devastating effect on a woman’s life and relationships. Unlike normal tiredness and fatigue, chronic fatigue syndrome is a long-term, incurable form of intense fatigue that does not improve with rest or sleep. While there is no cure for this condition, there are medications for chronic fatigue syndrome that may help manage symptoms. A doctor can help you decide which of these five popular chronic fatigue medications is right for you.

Case Presentation: Case 3

A white British male sustained a head injury when 7 years old and was diagnosed with glandular fever when 10 years old. He developed severe tonsillitis in 1996 when 14 years old. His symptoms gradually worsened and he became bedridden and unable to self-care, suffering profound fatigue, headaches, excessive day and night sleeping and light and sound sensitivity. He was diagnosed with chronic fatigue syndrome by a hospital paediatrician in 1997. He gradually improved over the next 3 years with increased energy. By his mid-20s, he was able to work full time although with persistent tiredness and recurrent infections. He improved further by practising pacing, listening to body symptoms to control his activity and by changing jobs to one with flexible working hours, which he continues to this date. He continued to experience difficulty sleeping and recurrent colds, at least four per year, accompanied by energy dips and subsequent depression. He was diagnosed with nasal polyps, sinusitis and seasonal allergic rhinitis.

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Diagnosis Of Chronic Fatigue Syndrome

• Laboratory tests to exclude other causes of symptoms

At least one of the following manifestations is also required:

• Difficulty thinking

• Feeling of light-headedness or dizziness when standing up that is relieved by lying down

The frequency and severity of the symptoms should be assessed by a doctor. If people do not have these symptoms at least half of the time with moderate, substantial, or severe intensity, doctors reconsider the diagnosis of chronic fatigue syndrome .

Criteria for diagnosis are important mainly because they help doctors communicate clearly with each other when they study a problem. However, when treating a specific individual, doctors focus more on that person’s symptoms rather than the criteria.

How Is Chronic Fatigue Syndrome Treated

Treatment is determined by your healthcare provider and based on:

• Your overall health and medical history
• Extent of the condition
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

• Medicine, including corticosteroids, antidepressants, and others
• Light-intensity aerobic exercise
• Dietary supplements and herbal preparations
• Psychotherapy and supportive counseling

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Prescription Stimulants For Me/cfs

Some healthcare providers prescribe attention deficit disorder/attention deficit hyperactivity disorder drugs for their patients with ME/CFS and say they’ve seen positive results. There is a growing body of evidence to back this up, although more research is needed.

These drugs are classified as neurostimulators, which means that they stimulate brain activity. They’re used for ADD/ADHD because, paradoxically, they have a calming effect on ADD/ADHD brains. Given that, it makes more sense that they’d be helpful in a condition defined by fatigue.

The most popular stimulants prescribed for chronic fatigue syndrome include:

• Ritalin and Concerta, which contain methylphenidate
• Dexedrine, which contains dextroamphetamine
• Adderall, which contains amphetamine and dextroamphetamine
• Vyvanse, which contains lisdexamfetamine

Depression Stress And Anxiety

Adjusting to a chronic, debilitating illness sometimes leads to other problems, including depression, stress, and anxiety. Many patients with ME/CFS develop depression during their illness. When present, depression or anxiety should be treated. Although treating depression or anxiety can be helpful, it is not a cure for ME/CFS.

Some people with ME/CFS might benefit from antidepressants and anti-anxiety medications. However, doctors should use caution in prescribing these medications. Some drugs used to treat depression have other effects that might worsen other ME/CFS symptoms and cause side effects. When healthcare providers are concerned about patients psychological condition, they may recommend seeing a mental health professional.

Some people with ME/CFS might benefit from trying techniques like deep breathing and muscle relaxation, massage, and movement therapies . These can reduce stress and anxiety, and promote a sense of well-being.

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Pragmatic Rehabilitation: The Fine Trial

Pragmatic rehabilitation is a programme involving gradually increasing activity designed collaboratively by the patient and the therapist. In response to an earlier successful trial, a larger trial was conducted. In this trial, patients fulfilling 1991 Oxford CFS criteria who were allocated to pragmatic rehabilitation reported a statistically significant though clinically modest improvement in fatigue compared with patients allocated to either supportive listening or treatment as usual, but after 12 months followup the differences were no longer statistically significant nor was there was any significant improvement in physical functioning at any time. About 10% of the trial participants were nonambulatory and about 30% met 1994 London criteria for ME, but separate results for these groups were not published . An accompanying editorial gave some possible reasons for the failure to replicate the earlier success in this trial, and called for further research. The patients in this trial had higher comorbidity and disability than patients in the earlier trial and in most other trials, and received fewer sessions than most successful trials of CBT and GET. The editorial also raised the question of whether generalists are as successful as specialists in offering behavioural interventions .