How Chronic Fatigue Syndrome Is Treated

There is no standard treatment for chronic fatigue syndrome, clinically known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 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.

treating chronic fatigue syndrome

Verywell / Brianna Gilmartin

Home Remedies and Lifestyle

Making lifestyle changes may greatly impact how you feel, and the specific changes you need can depend on the severity of your illness and whether certain activities exacerbate your symptoms. While some people may see the tremendous benefit just from making changes to the way they eat, for example, others may find that more sweeping changes—such as a job change—may be necessary.

Pacing Activities

Pushing yourself on your good days can result in crashing for the next few days, which is known as the "push-crash cycle." Learning to pace your activities may help you avoid this. 

First, get to know your body and keep a journal or symptom log so you know how much physical or mental activity you can handle, which kinds have the most impact, and any early warning signs that you are nearing your limit.

Tips that can help:

  • Keep your activity periods short and take scheduled rests
  • Establish routines so your important activities get done, but you don't do too much in one day
  • Switch the types of tasks you do so you alternate sitting and standing, physical tasks, and mental tasks
  • Look for ways to modify tasks, such as sitting while working in the kitchen

Exercise

Exercise is especially difficult for people with ME/CFS since even small amounts of exertion can lead to post-exertional malaise. Graded exercise therapy (GET) is aimed at improving symptoms and overall health and is based on starting with low levels of exercise and gradually increasing the amount and intensity.

Studies have shown some benefits, but some of the research has been criticized for being of low quality, making GET a highly controversial subject.

Improving Sleep Habits

Unrefreshing sleep and sleep disturbances are some of the hallmark symptoms of ME/CFS.

You can improve your sleep environment by:

  • Setting a regular bedtime and wake-up time
  • Planning a period of quiet activity before going to bed, avoiding exercise or mentally stimulating activities
  • Avoiding caffeine from the afternoon onward, and limiting alcohol and large meals in the evening
  • Only use your bedroom for sleep; banishing the computer, TV, and phone from the room
  • Keeping naps to no more than 30 minutes total throughout the day
  • Making your bedroom a calming place that is quiet, dark, and pleasant (in terms of temperature)

Breathing and Mindfulness

It may sound too simple, but breathing deeply may help relieve the anxiety that can come with this illness. A lot of people take short, shallow breaths, which can trigger a "fight-or-flight" response in your autonomic nervous system (ANS). When you consciously slow your breathing, it can have the opposite effect, allowing your body and mind to relax.

Mindfulness is the practice of observing your thoughts, feelings, and physical sensations in a non-judgmental way.

Diet

Often, simply eating healthier can make a significant difference. If you need help, you may want to talk to your healthcare provider and get a referral for a dietitian. There's no solid evidence that any one diet is helpful for everyone with ME/CFS, however, and health authorities say elimination diets should be avoided. That said, some people with the condition find that they feel better when they emphasize certain foods.

symptom journal that includes notations on what you eat can help you identify foods that are a problem for or especially helpful to you.

Heating and Cooling

Some people with chronic fatigue syndrome experience temperature sensitivity and have a tendency to overheat and have trouble cooling down. There are many cooling products available, as well as heating products. You can take a warm or cool bath or just soak your feet. Epsom salts added to bath water is a traditional folk remedy used by many.

Heat is a great option for relaxing tight muscles, especially for people who are frequently cold and may have a hard time warming up. You can use a heating pad, hot water bottle, rice bag, or heated socks or slippers.

Over-the-Counter Therapies

These products can help you manage some of your symptoms, but be sure to tell your healthcare provider if you are reaching for them often.

Sleep Aids

If you have improved your sleep habits and environment but still have difficulty with sleep, over-the-counter sleep aids may be helpful. Your healthcare provider may recommend short-term use products such as Nytol (diphenhydramine), Unisom (doxylamine), or melatonin.

Topical Pain Relievers

Many pain-relief rubs and patches that are on the market may help relieve some of your aches and pains. Some of the common ones are Capzasin (capsaicin), Tiger Balm (camphor and menthol), Aspercreme (trolamine salicylate), BiOFREEZE (menthol USP), and Salonpas patches (camphor, menthol, and methyl salicylate).

Because they only work where you put them, rubs and patches are best used for localized pain. Always use them as directed. If you have sensitive skin, it's best to start with small doses to check for reactions.

NSAIDS

These drugs are sometimes used to relieve the pain and fever associated with ME/CFS. Several are available over-the-counter, including:

  • Advil, Bayer Select, Motrin, Nuprin (ibuprofen)
  • Aleve, Anaprox, Naprosyn (naproxen)

Prescriptions

While healthcare providers prescribe medications for chronic fatigue syndrome, none of them is FDA-approved for treating the condition. Usually, these drugs are intended to manage symptoms.

Many healthcare providers prescribe medication to make the condition less severe by addressing possible persistent infections or other processes that could keep the immune system working overtime.

In addition to the below, some healthcare providers also prescribe ADD/ADHD medications for treating ME/CFS.

Antimicrobials

"Antimicrobial" refers to a variety of drug types, including antivirals, antibiotics, antifungals, and antiprotozoals. Some researchers theorize that chronic fatigue syndrome makes your body constantly act as if it's fighting an infection. While no specific virus or bacteria has been linked conclusively to ME/CFS, some possibilities that have been considered include Epstein-Barr virus (which causes mononucleosis), human herpesvirus 6 (HHV-6, which causes roseola), and enteroviruses.

Healthcare providers usually only prescribe antimicrobials when you have an active infection.

Some drugs are being studied for the treatment of ME/CFS:

  • Ampligen (rintatolimod): This experimental drug was rejected by the FDA and is not on the market for any use. Ampligen is thought to work by jump-starting the body's natural anti-viral pathway. The manufacturer is continuing trials to work towards approval.
  • Valcyte (valganciclovir): The antiviral valganciclovir has been proposed as a treatment for ME/CFS. Small studies have had encouraging results, but experts agree that larger and better-designed studies need to be done before they can draw reliable conclusions.

Antidepressants

While antidepressants are a common treatment, it doesn't mean all people taking them are depressed or have a psychiatric condition. Many people with chronic fatigue syndrome are clinically depressed, but that's generally considered a result of the symptoms and change in lifestyle and not a cause of the illness itself. The most common types of antidepressants prescribed for treating ME/CFS are SSRI/SNRIs and tricyclic agents.

Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) raise levels of important neurotransmitters that are low in some people with ME/CFS. Serotonin helps process pain signals and is also important to your sleep-wake cycle, while norepinephrine (a type of adrenaline) is involved in the stress response and bursts of energy.

Examples of SSRIs and SNRIs are:

Low doses of tricyclic antidepressants sometimes improve sleep and relieve mild, widespread pain in people with ME/CFS.

Some examples are:

  • Adapin, Sinequan (doxepin)
  • Elavil (amitriptyline)
  • Norpramin (desipramine)
  • Pamelor (nortriptyline)

Be sure you're familiar with the side effects of any antidepressants that you're taking, especially since many of these drugs come with a warning of a heightened risk of suicidal thoughts and behaviors.

If you would like to stop taking an antidepressant, talk to your healthcare provider first about how to properly wean yourself from it. Going cold turkey can lead to what's known as antidepressant discontinuation syndrome.

Anti-Anxiety Drugs

Healthcare providers sometimes prescribe anti-anxiety drugs for those ME/CFS patients with co-occurring anxiety disorders.

They include:

  • Xanax (alprazolam)
  • Klonopin (clonazepam)
  • Ativan (lorazepam)

Common side effects of anti-anxiety drugs include sedation and cognitive effects. Stopping them abruptly can lead to potentially serious withdrawal symptoms.

NSAIDS

Pain that can't be managed with OTC options or other measures may prompt your healthcare provider to prescribe NSAIDs that are stronger than off-the-shelf medications. It's important not to combine different drugs in this class. This can put you at risk of developing dangerous side effects, including kidney damage and gastrointestinal bleeding.

Blood Pressure Medications

A form of low blood pressure called orthostatic intolerance is common in people with chronic fatigue syndrome. It's caused by an abnormal interaction between the heart and the brain, even when both organs are normal and healthy.

Although often managed non-pharmacologically, some people diagnosed with this symptom take Florinef (fludrocortisone) to increase blood volume or other medications that can impact blood vessels or stress hormones.

Sleep Medications

If you continue to have sleep problems, your healthcare provider may start you on prescription sleep medication at a low dose or for a short time period. Klonopin (clonazepam), Lunesta (eszopiclone), Rozerem (ramelteon), Sonata (zaleplon), or Ambien (zolpidem) may be considered.

Therapy

It can be hard to accept health-imposed changes to your life. Many find psychological counseling and therapy helpful in addressing the impacts of chronic fatigue—not just mentally, but physically too.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a short-term psychological treatment used to address both psychological and physiological conditions. It is aimed at modifying thoughts and actions to help you find healthier approaches to things and eliminate bad habits that may be worsening your symptoms. You learn to change your thoughts toward certain things, as well as your behaviors toward them.

For example, your healthcare provider may recommend graded exercise therapy, but you may harbor the fear of getting active due to a history of post-exertional malaise. Therapy aims to reduce that trepidation.

CBT is controversial because some healthcare providers favor using it as front-line therapy, while others believe it's more appropriate as a complementary treatment. And although there's evidence to show its effectiveness for treating ME/CFS, some patients believe it can be damaging.

Emotional Support and Counseling

You may benefit by seeking psychological counseling to help address the emotions and stress that come with having a chronic illness that greatly impacts your lifestyle. In addition to seeing a therapist, you may find attending a support group beneficial.

Complementary Medicine (CAM)

Most complementary/alternative treatment methods aren't well researched for ME/CFS. Some people report success with them, while others do not.

These treatments include:

  • Acupuncture: Various forms of acupuncture may help some people with pain management. People also use it to attempt to reduce fatigue and increase energy.
  • Massage, Reiki, and other bodywork: Gentle massage may help with relaxation, lowering anxiety, and improving sleep.
  • Qigong: This is a traditional Chinese practice to improve the movement of energy (qi or chi) through the body. Tai chi is the form that uses gentle exercise. Other forms combine breathing exercises with meditation and movement. A trained healthcare provider may perform energy work, similar to Reiki. Some studies have found beneficial effects for fatigue and anxiety when using qigong with meditation.
  • Hypnotherapy and biofeedback: These therapies may be aimed at achieving relaxation and lowering stress.

Supplements

Your healthcare provider may recommend a nutritional supplement to address a deficiency and its related symptoms, but there is little solid evidence that supplements help alleviate symptoms of ME/CFS. Self-reported results are highly mixed, with different supplements working for different people. Some supplements have gone through double-blind, placebo-controlled clinical trials and have had mixed results, while others haven't been scientifically tested at all.

Before you start a supplement regimen, be sure to talk to your healthcare provider to make sure the options you are interested in are safe for you.

Your pharmacist is a great resource for spotting possible negative interactions between supplements and your medications. Keep in mind that just because a product is natural, that doesn't ensure that it's safe.

When considering supplements, think about what symptoms impact you most and then look for the ones that help with those specific symptoms. The following lists break commonly used supplements into categories related to common chronic fatigue syndrome concerns. Note that some supplements fall into more than one category. This may help you decide which ones to try.

Some healthcare providers and other healthcare providers, such as homeopaths and chiropractors, have developed experimental protocols for ME/CFS. Two of the better-known include the Pall protocol and Glutathione protocol. While some of these treatments are based on established or emerging science, many are not. Be sure to thoroughly research any treatments you're considering and talk to your medical professional about the possible benefits and risks.

Chronic Fatigue Syndrome Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Old Woman

Frequently Asked Questions

  • What type of healthcare provider treats chronic fatigue syndrome?

    If you suspect you may have chronic fatigue syndrome, see your regular general practitioner or family healthcare provider. They may send you to see a specialist who can evaluate your symptoms to either help diagnose ME/CFS or to rule it out in favor of another condition that's causing your symptoms. You may be referred to see a sleep specialist, rheumatologist, or neurologist, for example.

  • What should I eat if I have chronic fatigue syndrome?

    Overall, it's important to eat a diverse diet that's rich in nutrients and low in saturated fats and empty calories if you have ME/CFS (and even if you don't). Beyond that, there's little evidence to support eating certain foods or avoiding others to manage ME/CFS. That said, you may want to make sure your diet includes ample quantities of vitamin A (a good source is lean protein) and vitamin E (found in vegetable oils, eggs meat and poultry). In some research, both vitamins have shown potential for alleviating symptoms.

  • Can I exercise if I have chronic fatigue syndrome?

    You can, but it's important to choose your activities carefully. According to the Centers for Disease Control and Prevention (CDC), "patients with ME/CFS do not tolerate" vigorous aerobic exercise. The CDC emphasizes the importance of working with your healthcare provider to formulate any sort of exercise routine and not to overdo physical activity even on days when you're feeling especially energetic.

  • Can armodafinil help treat chronic fatigue syndrome?

    Armodafinil, the generic name for the prescription medication Nuvigil, is approved to treat a number of conditions associated with sleepiness‚ narcolepsy, shift work sleep disorder, and sleep apnea. It sometimes is prescribed off-label for chronic fatigue, but there is no research to show that it's effective. You should discuss with your healthcare provider whether armodafinil might be helpful for you.

  • Is there a cure for chronic fatigue syndrome?

    There's no cure for ME/CFS. If you have this disorder, it may be disheartening to learn you will have to live with it. But even though you can't make it go away, you can manage your symptoms by eating well, being careful not to overexert yourself, working with a counselor for support, and incorporating relaxation techniques into your daily life, such as meditation and deep breathing.

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