Treatment and Prevention
Although there are no recommended or proven treatments to date, management of CFS includes reassurance and support of the condition and how things will improve with time. It is difficult to predict when and how much someone with CFS will improve, since this varies a great deal between individuals.
Cognitive behavioral therapy and exercise (starting slow and increasing over time) appear to produce the most benefit. A doctor will likely combine a number of different treatments aimed at addressing your specific symptoms, including:
- medical intervention and medications
- alternative therapies
- psychotherapy (cognitive behavioral therapy)
- physical and lifestyle adjustments
Since no medication has been specifically proven to cure CFS, medications are used to treat some of the symptoms that are seen with CFS. For depression, antidepressants such as selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine*, sertraline) or tricyclic antidepressants (TCAs; e.g., amitriptyline, imipramine) may be used. Antianxiety medications such as lorazepam may be used to treat anxiety. Sleeping pills, such as zopiclone, may be used to treat certain sleep disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for headaches, fever, and general aches and pains.
CFS can sometimes go away on its own. Medications should therefore be tried for short periods and then stopped, and the person's status should be reassessed before continuing with medication treatment.
Some people seek alternative therapies, including massage, acupuncture, herbal products, and dietary supplements. Herbal preparations that have been used by some people with CFS include astragalus, borage seed oil, bromelain, comfrey, echinacea, garlic, ginkgo biloba, ginseng, primrose oil, quercetin, St. John's wort, and shiitake mushroom extract.
The value of alternative remedies is questionable. With few exceptions, most of these remedies haven't been shown to be effective for treating CFS patients. Many people believe that just because herbal products are "natural" they're also safe, which is not always true. Besides containing an active compound that may have medicinal properties, unrefined plant preparations also have other substances that can harm you. In addition, many dietary supplements are not regulated by the Food and Drug Administration (FDA), meaning there may be inconsistencies with dosing of the active component. Comfrey and high doses of ginseng, for example, are known to have harmful effects. As well, herbal preparations and dietary supplements can interfere with other medications you may be taking or cause side effects.
Before taking alternative remedies, talk to a doctor or pharmacist about what's safe and appropriate for your specific situation.
Psychotherapy is another strategy that can help people with CFS and their families cope with the symptoms of CFS. Cognitive behavioral therapy may help alleviate some of the distress and concerns about CFS and its affects on your work and personal life.
Physical and lifestyle changes may also be recommended. Prolonged lack of exercise can exacerbate physical weakness. A graded exercise regimen can be a means of restoring some of the loss of energy and stamina. "Graded" exercise means starting exercise slowly and gradually increasing the amount and intensity over time.
Learning ways to manage energy levels is important; for instance, overexertion during periods of good health can lead to a return of symptoms. Finding ways to cope and deal with physical and emotional stresses can help prevent a return of CFS symptoms.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Jeffrey Heit, MD, Internist with special emphasis on preventive health, fitness and nutrition, Philadelphia VA Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.