How Chronic Fatigue Syndrome Is Treated

Chronic fatigue syndrome (ME/CFS) has no standard treatment and cannot be cured, but options are available to help you manage symptoms and improve your quality of life. These are tailored to how the condition affects you personally and can include lifestyle changes, stress management, therapy, as well as medications. It's important for you to work with your doctor and other members of your health care team to come up with the regimen that's right for you. Finding one may take some trial and error, so be sure to be vocal about how you are feeling so adjustments if needed, can be made.

Home Remedies and Lifestyle

Making lifestyle changes may greatly impact how you feel, and the extent of them can depend on the severity of your illness and how your daily activities may 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. 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. Also 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. If you find you can tolerate exercise, you may want to try low-impact activities such as walking, yogaTai Chi, or Pilates.

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, which has gotten a lot of attention for this condition, involves deep breathing as well as other practices that may help you. Your shoulders shouldn't move upward when you take a deep breath. Instead, direct the breath lower, below your ribs, and inhale/exhale slowly. You can use this technique to try calming your body when you feel anxious, and you may want to practice it at other times as well.

Diet

Often, simply eating healthier can make a significant difference. If you need help, you may want to talk to your doctor 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. A 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 doctor 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 doctor may recommend products such as Nytol (diphenhydramine) or Unisom (doxylamine).

Topical Pain Relievers

Many pain-relief rubs and patches are on the market that may help relieve some of your aches and pains. Some of the common ones are Capzacin (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)
  • Feldene (piroxicam)

Prescriptions

While doctors prescribe medications for chronic fatigue syndrome, none of them is FDA-approved for the condition. Usually, these drugs are intended to manage symptoms. Some doctors, however, believe certain medications may make the condition less severe by addressing possible persistent infections or other processes that keep the immune system working overtime.

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

Antimicrobials

"Antimicrobial" refers to a variety of drug types, including antivirals, antibiotics, antifungals, and antiprotozoals. Some researchers theorize 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 of the suspects include Epstein-Barr virus (which causes mononucleosis), human herpesvirus 6 (HHV-6, which causes roseola, and enteroviruses

Doctors usually only prescribe antimicrobials when you have an active infection, and they do so even though they are uncertain as to if that infection is causing your chronic fatigue symptoms.

However, some drugs are being studied for use for the condition specifically:

  • Ampligen (rintatolimod): This experimental drug was rejected by the FDA and is not yet on the market for any use. Ampligen works by jump-starting your body's natural anti-viral pathway and regulating levels of RNase L (a substance in your cells that attacks viruses), which can be high in people with ME/CFS. The manufacturer is continuing trials, hoping to someday win approval.
  • Valcyte (valganciclovir): The antiviral valganciclovir treats HHV-6, which is found in a significant percentage of people with chronic fatigue syndrome. 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 psychological 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 ME/CFS are SSRI/SNRIs and tricyclic agents.

Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs or NSRIs) 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:

  • Cymbalta (duloxetine)
  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Paxil (paroxetine)
  • Effexor (venlafaxine)
  • Desyrel (trazodone)
  • Wellbutrin (bupropion)

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, Etrafon, Libitrol, Triavil (amitriptyline)
  • Norpramin (desipramine)
  • Pamelor (nortriptyline)

Be sure you're familiar with the side effects of any antidepressants you're taking, especially since many of these drugs come with a warning of a heightened risk of suicidal thoughts and behaviors. If you decide to stop taking an antidepressant, talk to your doctor about how to properly wean yourself. Stopping cold turkey can lead to some potentially serious problems.

Anti-Anxiety Drugs

Doctors sometimes prescribe anti-anxiety drugs for those ME/CFS patients with panic disorder. They include:

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

Common side effects of anxiety drugs include sedation, amnesia, insomnia, muscle cramps, and convulsions. Stopping them abruptly also can lead to withdrawal symptoms.

NSAIDS

Pain that can't be managed with OTC options or other measures may prompt your doctor 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 greater risk of developing dangerous side effects, including kidney damage and gastrointestinal bleeding.

Blood Pressure Medications

A form of low blood pressure called neurally mediated hypotension (NMH) is common in people with chronic fatigue syndrome. NMH is caused by an abnormal interaction between the heart and the brain, even though both organs are normal and healthy.

Some people with diagnosed NMH take a low-blood-pressure medication called Florinef (fludrocortisone), while others take the high blood-pressure medication Tenormin (atenolol). If you're on Tenormin, you'll probably need to be watched for low blood pressure and may be advised to increase your salt and water intake.

Sleep Medications

If you continue to have sleep problems, your doctor 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 how chronic fatigue impacts you not just mentally, but physically.

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 doctor 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 doctors favor using it as a front-line therapy, while others believe it's more appropriate as a complementary treatment, and still others 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 psychologist, 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 practitioner 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 doctor 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, either for these concerns or at all.

Before you start a supplement regimen, be sure to talk to your doctor 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 as well. 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 doctors and other healthcare providers, such as homeopaths and chiropractors, have developed experimental protocols for ME/CFS. While some of these protocols are based on established or emerging science, many are not. Be sure to thoroughly research any treatments you're considering and talk to your doctor about the possible benefits and risks.

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