Chronic Fatigue Syndrome: Medication & Treatment Options

Myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS), is a complex and debilitating illness that can be challenging to diagnose and treat. It predominantly occurs in young to middle-aged individuals. CFS diagnosis is more common in women. However, it may be because the symptoms are more likely to be reported to healthcare providers by women than men. Certain medical problems are also risk factors contributing to chronic fatigue syndrome. Please continue reading to find out treatment options for chronic fatigue syndrome.

What are the symptoms of chronic fatigue syndrome?

Symptoms of chronic fatigue syndrome include:

Extreme fatigue lasting for six months or longer
Severe fatigue and exhaustion associated with chronic fatigue syndrome following physical activity or mental exertion
Fatigue that is exacerbated by activities but not significantly relieved after resting
Cognitive dysfunction (problems with focusing, concentration, and memory)
Dizziness that is made worse by going from a lying or sitting position to standing (this is called orthostatic intolerance)

Besides severe fatigue, CFS can also disrupt sleep and cause muscle or joint pain.

A diagnosis of chronic fatigue syndrome is made when symptoms are present for at least 6 months and are moderate to severe in intensity at least half of the time.

How do doctors diagnose chronic fatigue syndrome?

There is no single test that can confirm a diagnosis of chronic fatigue syndrome. If you have symptoms of fatigue for more than 6 months, your doctor will perform a physical examination and order tests to rule out other conditions that could cause chronic fatigue.

What makes diagnosing CFS very challenging is that CFS symptoms can be similar to those of other medical conditions, such as sleep disorders (obstructive sleep apnea, insomnia, restless leg syndrome), anemia, diabetes, hypothyroidism (underactive thyroid gland), an autoimmune disease such as rheumatoid arthritis, or mental health conditions such as anxiety and depression. For example, depression is often the cause of fatigue and sleep problems. However, for patients with bipolar disorder, fatigue is very common during manic episodes where agitation, insomnia, and restlessness are present.

Many people with chronic fatigue syndrome have other disorders, such as irritable bowel syndrome and obstructive sleep apnea. Fibromyalgia is a very similar condition and has many overlapping symptoms with chronic fatigue syndrome. Therefore, CFS and fibromyalgia are sometimes considered to be different facets of the same medical condition.

How is chronic fatigue syndrome treated?

Chronic fatigue syndrome cannot be cured. Even though there were very few randomized controlled trials evaluating the treatments for CFS/ME, various medications and non-drug approaches were used to alleviate symptoms and improve quality of life. Healthcare providers develop individualized treatment plans based on a person’s symptoms.

Medications for chronic fatigue syndrome

Medications to relieve pain: Over-the-counter pain relievers such as NSAIDs (nonsteroidal anti-inflammatory drugs) can be helpful or some people; examples are ibuprofen (Advil, Motrin) and naproxen sodium (Naprosyn, Aleve). Doctors may also use prescription drugs used for fibromyalgia such as gabapentin (Neurontin) or pregabalin (Lyrica) can result in significant improvements in chronic pain if OTC pain relievers are not effective.
Medications to regulate heart rhythm and blood pressure: If your CFS symptoms include feeling faint, nauseated, or dizzy when going from a lying or sitting position to standing, your doctor may give you prescription medications to relieve symptoms of orthostatic intolerance.
Medications to treat depression: It is common for people with chronic illnesses such as chronic fatigue syndrome to develop depression. Antidepressant and anti-anxiety medications such as selective serotonin reuptake inhibitors (SSRIs) can make a significant difference in these symptoms as well as reduce pain and trouble sleeping.
Antiviral medications: There is a longstanding hypothesis that chronic fatigue syndrome is caused by a viral infection, although no specific virus has been identified. The use of antiviral drugs such as acyclovir, valacyclovir, and rintatolimod (Ampligen) has met with varying degrees of success during clinical trials on patients with myalgic encephalomyelitis (chronic fatigue syndrome).

Treatment for post-exertional malaise

Chronic fatigue syndrome is frequently associated with worsening symptoms after physical, emotional, or mental exertion. This is called post-exertional malaise (PEM). It typically starts 12 to 48 hours after an activity and lasts for a few days to weeks.

If you have chronic fatigue syndrome, it is important to find a balance between staying active without triggering post-exertional malaise. Healthcare providers suggest pacing where you are active, but you should not overdo it.

This could involve graded exercise therapy, where you gradually increase the intensity of your activity to avoid triggering post-exertional malaise. It may be useful to keep a journal of your daily activities and CFS symptoms so you can identify and track the type and intensity of activities that cause post-exertional malaise. This way, you can find your individual limits for physical and mental activity and stay within this “energy envelope.”

It is important to keep in mind that though physical therapy plays a critical role in a person’ overall wellness, it is different for people with ME/CFS. Therefore, exercise must be individualized for ME/CFS patients by their healthcare team to prevent post-exertional malaise.

Treatment for sleep problems

Not getting enough sleep can make chronic fatigue syndrome symptoms worse. Your healthcare team may recommend avoiding caffeine or fine-tuning your bedtime routine. Your provider will also prescribe treatment for conditions such as obstructive sleep apnea or other sleep disorders that can lead to disruption of sleep.

Relaxation techniques

Emotional and mental stress are known risk factors for chronic fatigue syndrome flares. Deep breathing, yoga, guided meditation, and other relaxation techniques can help you reduce stress and prevent flare-ups.

Counseling and support groups

Some people with chronic fatigue syndrome find counseling, therapy modalities like cognitive behaviour therapy (CBT), and emotional support groups helpful in dealing with the restrictions, uncertainties, and chronic fatigue caused by myalgic encephalomyelitis (chronic fatigue syndrome). For example, counseling can help you learn coping strategies and build resilience to deal with a chronic illness. Support groups can offer useful information on working within your limitations or improving interpersonal relationships.

Alternative treatments for chronic fatigue syndrome

There are no alternative therapies that are proven to treat CFS or benefit symptoms of chronic fatigue syndrome. Always check with your healthcare provider before taking any herbal products or supplements or trying alternative treatments for fatigue or other symptoms because they can cause serious adverse effects and be potentially harmful.

What is the best anti-inflammatory for CFS?

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen sodium (Aleve, Naprosyn) can result in significant improvements in muscle pain and joint pain associated with chronic fatigue syndrome. COX inhibitors such as celecoxib and meloxicam are also sometimes used as anti-inflammatory medications for chronic fatigue syndrome.

However, if you have kidney failure or chronic kidney disease, NSAIDs are not a safe option for you. Discuss other pain management approaches if you have any type of kidney insufficiency.

Is there any other treatment for chronic fatigue syndrome?

Interestingly, ME/CFS is found to be associated with B-cell dysfunction. As a result, rituximab attracted interest due to its ability to deplete nearly all peripheral B cells in the body. However, the positive response produced by rituximab was only found in two-thirds of 28 patients. In addition, the mechanism of action of rituximab remains unclear in the context of ME/CFS.

Therefore, further clinical trials are essential to evaluate the relationship between regulating the endocrine and immune systems and the effects on ME/MCF. Currently, monoclonal antibodies, including rituximab, do not have a positive role in the ME/CFS treatment approach.

How do you stop chronic fatigue flares?

The following lifestyle changes can help you cope with chronic fatigue syndrome in your daily life and prevent flares:

Identify and track triggers for flares, such as extreme stress, and avoid them.
A dietary intervention such as eating a healthy Mediterranean diet may be of benefit.
Eating 3 to 4 small meals a day can help keep energy levels up.
Taking regular breaks during work can reduce mental fatigue.
Taking frequent breaks during physical activities and not overdoing it can help prevent post-exertional malaise.
Seeing a sleep specialist for trouble sleeping or symptoms of sleep apnea can improve sleep.
Psychotherapy modalities like cognitive behavior therapy can help you learn coping mechanisms.
Work with your healthcare team to establish the best approach, including medication and non-pharmacological approaches, to best manage your CFS symptoms.