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Drugs Used For Fatigue In Ms

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Common Symptoms Of Ms Caused Fatigue

Treating Fatigue in MS – National MS Society

Fatigue in MS patients is different from just feeling tired. It is usually overwhelming and may have no obvious cause.

Many wake up from a nights sleep feeling as tired and run-down as they were before going to bed, and feel extremely tired even with very little activity. Frequent complaints are that the limbs become heavy, and basic tasks such as writing or getting dressed become difficult.

With fatigue, some of the diseases other symptoms may worsen temporarily, such as difficulty seeing and concentrating, or with maintaining balance.

Finding Help And Taking Help That’s Offered

People might say to you ‘If theres anything you need…’ or ‘If there’s anything I can do…’, but it is not always easy to ask for help, even when it is offered.

It can be useful to prepare a list of tasks that youd like help with. That way, if someone does offer to help, you can easily tell them how they could help.

If you find it hard to take, or ask for help, our fatigue management course could help you!

Lessening Ms Fatigue Without Medications

The NMSS and the Cleveland Clinic both suggest fatigue-reducers such as exercise, physical therapy, and relaxation therapy. Multiple Sclerosis News Today patient columnist Jessie Ace shared some other ideas a few months ago. But I think most of us have tried nonmedicinal strategies and only turned to medications when those therapies didnt help enough.

I tried going without my 100 mg dose of Provigil in the morning yesterday, and I didnt feel much more tired in the late afternoon than I usually do. I think Ill try this unscientific experiment again, but over two or three days, to see what happens.

Has there been fatigue-relieving magic in the pill Ive been taking all these years, or has it all been in my head?

What has your experience been? Please share in the comments below. Youre also invited to visit my personal blog at

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What Are Symptoms Of Fatigue

There are two major types of fatigue in MS. These two types of fatigue are probably separate problems related to the MS.

The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.

A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.

What Causes Ms Fatigue


The causes of MS fatigue are not yet well understood. It is thought to result from a range of different factors, partly caused by MS itself and partly by other factors .

Primary MS fatigue is due to changes in the brain and damage to the central nervous system. The damage affects the nerves by interrupting messages from the brain and spinal cord to the rest of the body. As a result, your body has to work harder to function, which can lead to a build-up of MS fatigue. Muscle weakness and cognitive demands are also affected by the changes in the brain, so they too use more energy, which can lead to MS fatigue.

Secondary MS fatigue occurs from the effects of living with MS. For instance, MS symptoms such as depression, pain or sleep disturbance from spasms or incontinence can all make MS fatigue worse. MS fatigue may also occur as a side effect of some medications or from inactivity, stress, poor diet or an infection. Other medical conditions can also cause or worsen MS fatigue.

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Axonal Loss And Altered Cerebral Activation

As conventional measures of T2 lesion volume and atrophy have fallen short in providing a basis for fatigue in MS, many investigators have relied on non-conventional neuroimaging techniques to shed further insight. The demonstration on positron emission tomography of decreased regional glucose metabolism in the frontal cortex and basal ganglia of fatigued MS patients has suggested that neuronal dysfunction in these regions may play a role. Magnetic resonance spectroscopy studies have shown significant reductions in N-acetylaspartate/creatine ratios in multiple brain regions among fatigued MS patients in comparison to non-fatigued MS patients, suggesting axonal loss as a contributing factor., MS-related fatigue also may arise at least in part from compensatory reorganization and increased brain recruitment, as functional MRI studies that have demonstrated increased volumes and patterns of activation in the cingulate gyri and left primary sensory cortex in fatigued MS patients compared to non-fatigued patients.

There Is No Magic Pill For Ms Fatigue

Ive been tired all day, which is nothing new, as fatigue and multiple sclerosis go hand in hand. Its been one of my primary symptoms since I was diagnosed in 1980.

To counter it, Ive taken Provigil for many years. Initially, taking 100 mg in the morning helped me make it through the day. But as time went on, Provigils effectiveness waned.

The year before I retired eight years ago, Id occasionally start to doze off in my office, or worse, while driving home from work. Recently, I began to wonder if Provigil was working for me at all. Today, while visiting our young grandkids, I was dragging my eyes were open, but I had no energy, even though Id taken my medication less than two hours earlier.

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Cognitive And Psychological Interventions

Several studies have investigated cognitive training in pwMS aiming mainly to improve attentional deficits, communication, and memory . Overall evidence for beneficial effects of psychological interventions in management of fatigue in pwMS is scarce. A systematic review reported that cognitive behavioral approaches were beneficial in the treatment of depression and in helping people adjust to, and cope with having MS . However, the authors did not find any studies focusing on psychological approaches to managing fatigue in pwMS. Findings from a few studies evaluating fatigue as a secondary outcome showed inconclusive and/or non-significant improvements in fatigue management .

A recent RCT showed that an internet-based cognitive behavior therapy program MS Invigor8 was an effective treatment for MS-related fatigue . The CBT included eight tailored, interactive sessions with a clinical psychologist over 810 weeks. The treatment group reported significantly greater improvements in fatigue severity and impact as well as in anxiety, depression and quality-adjusted life years . Another RCT showed significantly greater improvements in fatigue in pwMS after eight weekly sessions of CBT compared to relaxation therapy . However, both groups showed clinically significant decreases in fatigue. ESs for reduction in fatigue from baseline to the end of treatment were 3.03 for the CBT group across the 8 months compared with the relaxation therapy group .


Q: Are There Any Medications For Ms Fatigue

Fatigue as a Side Effect from Medications for People with MS – National MS Society

A: Symptomatic medications can be considered concurrently with other interventions. There are no medications approved by the FDA for the treatment of MS fatigue. The most commonly used off-label symptomatic medications are amantadine and modafinil. Clinical trials have shown conflicting evidence regarding their efficacy.

Amantadine is indicated as an antiviral and in Parkinsons disease and has dopaminergic effects. Usual doses are between 100 and 200 mg per day taken in am and midday if necessary. Side effects are mostly mild and reversible. The most frequently reported side effects are: anxiety, insomnia, nightmares, and livedo reticularis.

Modafinil was initially approved for narcolepsy. The starting dose is usually 100 mg daily. The dose can be titrated up to 400 mg per day, with an average dose of 200 mg per day. The most frequent side effects are headaches, nervousness, irritability, anxiety, and nausea. Modafinil is a controlled substance. More recently armodafinil has been proposed off label to treat MS fatigue, but there is no published data on its efficacy.

Antidepressants, particularly selective serotonin reuptake inhibitors, may help with fatigue. This effect could be mainly related to the improvement of depression and associated sleep disturbance. Activating antidepressants, such as fluoxetine, venlafaxine, and bupropion can also be helpful.

Results of one clinical trial suggested that two 325 mg aspirin twice a day can be effective on MS fatigue.

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Finding Help And Taking Help Thats Offered

People might say to you If theres anything you need or If theres anything I can do, but it is not always easy to ask for help, even when it is offered.

It can be useful to prepare a list of tasks that youd like help with. That way, if someone does offer to help, you can easily tell them how they could help.

If you find it hard to take, or ask for help, our fatigue management course could help you!

Are Stimulants Effective For Ms Fatigue

Psychostimulants work by speeding up the CNS and increasing the amount of two important neurochemicals: norepinephrine and dopamine. For most people struggling with MS fatigue, stimulants on their own are not very effective. In some cases, stimulants can help MS fatigue in combination with other fatigue management interventions. Clinical trials on how well various stimulants treat MS fatigue thus far have been limited.

Current evidence shows contradictory or conflicting results about how well psychostimulants work against MS fatigue. For example, one small study published in the journal Multiple Sclerosis found that methylphenidate was likely less effective at alleviating MS fatigue than placebo.

The TRIUMPHANT-MS study by Johns Hopkins University compared how well modafinil, methylphenidate, amantadine, and placebo helped with MS fatigue. This clinical trial compared each drug to find out whether they worked better than no treatment at all. TRIUMPHANT-MS determined that modafinil and methylphenidate were not more effective at reducing MS fatigue than placebo.

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Take Rest When You Need It

For some people, rest helps relieve fatigue and is an important part of fatigue management. Resting can prevent you getting to a point of complete exhaustion and coming to a sudden halt, mid task.

A few small breaks are best for some people or you might feel better after just one longer rest at a particular time.

For example:

  • try taking a few short rests or power naps,
  • through the day try just one longer rest,
  • at the same time each day take a break between coming home from work and getting ready for an evening out

When you rest, try to make your rest as complete as possible. Doing smaller jobs around the house, talking to the family or watching TV might be more relaxing than work or chores, but it is not really resting. It can be tricky, but the aim should be to switch off both the mind and the body.

You might want to have a short sleep, or use relaxing music to help you clear your mind. Some people find yoga, mindfulness or meditation useful.

If worries disturb time set aside for rest, try writing down these concerns and shelving them while you are resting. You will have more energy to tackle them once your energy levels are up again.

If resting helps you manage your fatigue, it is important that other people realise how valuable this quiet, undisturbed time is.

Above all dont feel guilty about taking rest when you need it. If this is something you find challenging our online fatigue management course can help you think it through.

Get Help For Depression

Medicare and multiple sclerosis: Coverage, options, and costs

If you are feeling down and hopeless, or if things that used to be enjoyable dont interest you anymore, you may be depressed. Depression is one of the most common symptoms of MS, and left untreated, it can make your fatigue worse.

Depression is treatable, so if you think you might be depressed, tell your healthcare provider right away.

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A Little More Strength To Carry The Weight

In my experience, it’s not like you take a pill and, just like that, no more fatigue until the pill wears off. When I take my medication, the fatigue is still there, but it becomes easier to work through it kind of like how cold medication doesn’t eliminate a cold, but it may help reduce the symptoms of one. If you think of fatigue like the weight of a huge boulder on your back that you have to walk around with, I would say that these medications don’t really remove the weight of the boulder but instead give you a little more strength to carry it. The heaviness in my body caused by my fatigue is always there, but these medications make it a little less difficult to not be crushed by it. At least that how it feels to me.

No Benefit Of Three Commonly Used Medications For Ms Fatigue

A new placebo-controlled trial has shown no benefit over placebo for three different drugs commonly used to treat fatigue in patients with multiple sclerosis . The TRIUMPHANT study found no difference between the effects of amantadine, modafinil, methylphenidate, and placebo in the Modified Fatigue Impact Scale in a study involving 141 patients with MS.

There was also no difference between any of the drugs and placebo in any of the preplanned subgroups which included different Expanded Disability Status Scale scores, depressive scores, use of disease-modifying therapy, or type of MS .

The research was presented online as part of the 2020 American Academy of Neurology Science Highlights.

These three drugs are used very commonly used for MS fatigue by neurologists, psychiatrists, and primary care doctors, but they dont seem to be any better than placebo. They were all associated with increased side effects compared with placebo even with short-term use, said lead investigator Bardia Nourbakhsh, MD, assistant professor of neurology at Johns Hopkins University, Baltimore.

Our recommendations are that as amantadine was not better than placebo in any subgroup its use should be discouraged in MS fatigue, Dr. Nourbakhsh commented. Modafinil and methylphenidate may possibly be considered for MS patients with excessive daytime sleepiness, but this should really be confirmed in further studies.

A version of this article originally appeared on

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I Take A Daily Morning Dose Of Coenzyme Q10 Capsules Supplements From Holland & Barrett As Recommended By My Ms Nurse And They Certainly Do Work For Me And Others I Have Passed The Recommendation On To They Somehow Raise My Energy Levels In The Morning They Are Still Not Fantastic But Better With Them Than Without Dont Take Too Many Or You May Not Sleep Well

Vitamin D and omega 3


Other therapies

AcupunctureOxygen therapyAction Potential Simulation Therapy

We asked the MS community to share their 10 top tips for managing fatigue, they are…

  • Healthy eating and regular resting
  • Meditation, relaxation and biofeedback.
  • Try to plan activities around the house carefully, remember there is always tomorrow, and ask others to help you
  • Being aware of the need to factor in rest time
  • Time to myself to do exactly what I want to do with my day
  • Being aware of limitations, having self-awareness
  • Break down tasks into small units and take breaks! Celebrate and be grateful for small successes
  • Regular daily patterns go to bed at the same time each day and get up at the same time each morning
  • Looking after your psychological wellbeing can have a positive effect on fatigue levels
  • Trying just to do what I can that day. I will not beat it so its pointless fighting. Learning about MS and how it affects me helps. And avoiding external stressors
  • How This Study Was Carried Out

    Depression’s Impact on Fatigue in MS – National MS Society

    Two MS clinics in the United States recruited 141 participants with MS who were affected by fatigue and had low to moderate disability.

    Participants were assigned to take the medications in one of four sequences. They started taking one medicine and took it for six weeks, followed by a two-week washout period and repeated this process for all three medicines and the placebo. Neither participants nor the researchers knew which medication they were currently taking.

    Methylphenidate, also known as Ritalin, is a central nervous system stimulant used to treat narcolepsy and attention deficit hyperactivity disorder. In the States it is sometimes used to treat MS fatigue, but is rarely used for this purpose in the UK.

    Fatigue was measured at the beginning of the study using the Modified Fatigue Impact Scale and again during week 5 of each treatment period. MFIS is a questionnaire which you complete yourself. It assesses the impact of fatigue on different aspects of daily life: physical activity, thinking processes and taking part in social activities. People were included in the study if their MFIS was 33 or greater. Read more about the MFIS and test yourself.

    Participants also completed the Epworth Sleepiness Scale which measures daytime sleepiness and a questionnaire which assessed the impact of fatigue on quality of life.

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    What Was The Research About

    Multiple sclerosis, or MS, is an illness that affects the central nervous system. Fatigue is a common and disabling symptom of MS.

    In this study, the research team wanted to learn how well three commonly used medicines work to help patients with MS feel less fatigued and improve quality of life. The medicines were amantadine, methylphenidate, and modafinil. The team compared these medicines with a placebo. A placebo is a pill with no active ingredients. Using a placebo helps researchers learn if results are due to a medicine or chance.

    Patients took each of the medicines and the placebo in a specific order over seven to eight months.

    The research team also looked at whether patients took the medicines as prescribed and if they had adverse events. An adverse event is when a medicine causes harm an example is an allergic reaction.

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