What’s The Treatment Plan For Chronic Fatigue Syndrome? – Part I

According to the CDC, there is no cure nor approved treatment plan for chronic fatigue syndrome. (1)

So what should you do to overcome this debilitating illness?

Most readers of my blog will have a strong bias towards alternative/natural medicine over conventional/Western medicine. I’m of the mind that this should not be an either-or debate. Instead, alternative and conventional medicine should work together. They fill in each other’s deficiencies very well. In the treatment of chronic fatigue syndrome, you’re going to want a diverse point of view. Combining alternative and conventional therapies will be your best option.

In this post, I’ll describe the most beneficial treatment options from a conventional perspective – the treatments you need to try and the ones you should absolutely avoid. And in the second post of this series, I’ll describe the most beneficial therapies from a functional or natural medicine perspective. I believe the ideal treatment plan for chronic fatigue syndrome involves a combination of therapies. In all likelihood, chronic fatigue syndrome describes many different conditions.

For you, fatigue could be caused by a viral infection like mono. Your friend’s fatigue could be caused by her hormones, her genetics, or even her gut. Exploring a multitude of treatment options is your best bet to regaining your energy.

The best conventional treatments for chronic fatigue syndrome

The inherent problem with pharmaceutical treatments is that they serve only to address your symptoms. I’m not saying that’s not important – symptom management is incredibly important. But I don’t think any of you want to be dependent on medication for the remainder of your life. This is where alternative medicine fills in the gap. Use conventional medicine to make your symptoms tolerable. Once you can better tolerate your symptoms, use alternative medicine to investigate and treat the underlying or root cause of your fatigue.

Some of the more commonly proposed chronic fatigue syndrome treatment plans via conventional medicine include: (2)

• Antivirals
• Pain killers (analgesics)
• Antidepressants
• Steroids

Antivirals

It has long been thought that a previous viral infection leads to chronic fatigue syndrome. And there’s a decent amount of evidence to support this hypothesis. (3, 4) Herpesvirus, enterovirus, and the Epstein-Barr virus have all been implicated in causing CFS. Should you have a lingering viral infection, treating it with antivirals can be an effective treatment option – but only if your fatigue is caused by a viral infection.

Some studies have found that antivirals do not improve fatigue symptoms at all. (5) But more recent studies have shown that antivirals are, in fact, effective treatment for chronic fatigue syndrome. (6, 7) Now let’s bear in mind that all three of these studies using antivirals were very small. Each was around 25 participants. With a sample size that small, you cannot draw firm conclusions.

Remember, in all likelihood chronic fatigue syndrome has multiple potential causes. If your fatigue is caused by a virus, you’ll likely respond to antivirals. But if your fatigue is being maintained by something other than a virus, no amount of antivirals is going to improve your symptoms. I suspect this is the reason you see conflicting reports in the research on antivirals and chronic fatigue – only some patients have a viral infection!

Before signing up for antiviral therapy, ensure your practitioner takes a detailed health history. If your fatigue began after a flu-like infection, antivirals may be a worthwhile treatment option. But if you cannot remember an infection occurring before your fatigue, skip the antivirals. They probably won’t improve your symptoms.

Pain killers (analgesics)

Out of all the medications used in treating chronic fatigue, none are more popular than pain killers. (8) The most common which included acetaminophen and NSAIDs such as ibuprofen, and aspirin. Opiate-based pain killers like morphine and/or naloxone have not been shown to be effective in treating pain levels in CFS patients. (9) If your doctor starts recommending opiates to control your pain, politely decline.

Pain killers work by decreasing levels of something called cyclooxygenase. You may know this term as a COX inhibitor. Taking medication to inhibit COX will often provide relief from inflammation and pain.

Specific pain killers are known as COX-2 inhibitors. Cox-2 has been shown to be elevated during viral infections. (10, 11) If your chronic fatigue has a viral origin, taking a COX-2 inhibitor should improve your symptoms of both pain and fatigue. There are no current studies examining the effect COX-2 inhibitors have on CFS. But given what we know about COX-2 inhibitors effect on viral infections, they might be the perfect medication to help you better manage your symptoms.

Antidepressants

Using antidepressants as a treatment option is a controversial topic – and it should be. Doctors and researchers are still unclear whether depression is an associated symptom of chronic fatigue syndrome or merely a secondary effect brought on by having to cope with a chronic, debilitating illness. (12, 13) To further complicated matters, depression in the context of chronic fatigue could be both a symptom of the disease and an effect brought on by the restrictions caused by chronically high levels of fatigue.

Depression aside, there is some preliminary research to suggest antidepressants may also have a positive effect on your mitochondrial function. (14) Using antidepressants in the context of improving mitochondrial function for chronic fatigue patients is absolutely something I can get behind! But at the time of this writing, there just isn’t much research to support its efficacy.

That lack of research extends even further. There’s really no good evidence suggesting antidepressants are effective in treating CFS. And it’s why I don’t often agree with doctors prescribing antidepressants as first-line therapy for chronic fatigue syndrome. The research that has been done is – at best – conflicted. One study of ninety-six participants using Prozac (fluoxetine) found the antidepressant to have no effect on symptoms. (15)

Two studies have shown modest improvements in patients symptoms with the use of antidepressants. (16, 17) Though neither of these studies was double-blinded. So, we should view their results with some skepticism. What’s needed is a large scale, double-blind research trials. These types of studies will draw clearer conclusions about the effects antidepressants have on chronic fatigue syndrome.

In the interim, I recommend being cautious before taking an antidepressant from your family doctor. They do not seem to be very helpful in treating CFS symptoms. And their side effects and withdrawal symptoms can be quite severe. What I recommend you do instead is visit a psychiatrist to see if you have depression in addition to chronic fatigue syndrome. True depressive disorders can respond well to antidepressants. And in these cases, I think the use of antidepressants is certainly warranted. If your symptoms are not related to depression (just to CFS) then I think avoiding antidepressants is wise.

Steroids

It’s long been thought that chronic fatigue syndrome results from improper functioning of your hypothalamic-pituitary-adrenal (HPA) axis. (18) You’re probably more familiar with HPA axis issues when they’re referenced as adrenal fatigue. Adrenal fatigue describes a condition of lowered cortisol levels. This is often brought about through maladaptation of the HPA axis. I’ve written at length about adrenal fatigue here, here, and here.

One proposed avenue of treatment for HPA axis abnormalities is hydrocortisone – a steroid that can be used to raise cortisol levels. An initial study done in the ’90s showed that hydrocortisone had minimal improvement on CFS symptoms. (19) And it lead to adrenal issues in a number of participants – not a side-effect you want! But other studies using small doses of the hydrocortisone have shown this steroid to have a beneficial effect. (20, 21) It’s worth noting that none of the studies included a long-term follow-up with patients. I feel this is a critical piece of information. If there’s no long-term improvement, then we can conclude that hydrocortisone alleviates some symptoms but not much else.

I suspect that the reason why steroids like hydrocortisone are only partially effective has to do with chronic fatigue having multiple causes. If a suppressed HPA axis (adrenal fatigue) is the cause of your fatigue, it should come as no surprise that hydrocortisone works. But if the HPA axis is not affected, hydrocortisone will not have much effect on your fatigue.

Summary

Ok, these are the best treatment options for CFS from a conventional medical standpoint. Try each of them – find out what works for you. But know that these treatment options are only dealing with your symptoms. They will not bring about complete resolution of your fatigue. That’s not to say they’re not important – symptom management is incredibly important!

My recommendation is to use conventional therapies to get your energy levels to a place where you’re able to make nutrition/lifestyle changes. Nutrition and lifestyle changes will help uncover the root cause of your fatigue. But they take a lot of energy. So, step one should be getting your energy up through conventional medical therapies. Once you’re done that, head on over to part two of this article where I’ll show you the best natural treatment plans for chronic fatigue syndrome.

But before you jump into the next article, make sure you read below where I share the conventional medical therapies you need to avoid!

The wrong way to treat chronic fatigue syndrome

Now you know the conventional medical therapies that are best suited to treat chronic fatigue syndrome. A lot of them don’t have great research to support their use. So, be sure to have an in-depth discussion with your doctor. Discuss whether the potential side effects of the medication are worth it for the potential benefits.

There are other treatments that are often prescribed in conventional medical settings that are known to not be effective. And they may even have dangerous side effects. Below, I detail the conventional treatments of chronic fatigue that need to be avoided. These include:

• Graded exercise therapy
• Sleeping pills

Graded exercise therapy

Graded exercise therapy or GET as it’s commonly referred to is an exercise plan specifically for those with chronic fatigue syndrome. Most patients with CFS report something known a post-exertional malaise – this is a feeling of exhaustion or tiredness following exercise/activity. GET was developed in hopes to improve CFS patient’s resilience to exercise programs.

Graded exercise therapy remains a common conventional treatment for chronic fatigue syndrome. Even though patients typically remark that GET makes their symptoms worse. Thankfully, new research confirmed what CFS sufferers had been saying all along – GET does not work. And it may actually make your fatigue worse.

Do not include GET in your chronic fatigue treatment. Instead, follow the recommendations I lay out for exercising with fatigue here, here, and here.

Sleeping pills 

What’s known as unrefreshing sleep is a common symptom in chronic fatigue syndrome. Some of the other sleep-related symptoms tied to CFS include difficulty falling or staying asleep, extreme sleepiness, intense and vivid dreaming, restless legs, and nighttime muscle spasms. (22) The conventional treatment for these symptoms is sleeping pills. Unfortunately, the side effects of sleeping pills, which includes constipation, diarrhea, dizziness, headaches, increased levels of fatigue, heartburn, stomach pain, and/or weakness, can often be worse than your symptoms without the medication. (23)

Sleep medications like Zoplicone have been shown to reduce the onset of REM sleep and decrease the amount of time you spend in REM sleep each night. (24, 25) This side-effect alone will likely increase your fatigue levels. And I haven’t even mentioned how challenging it is to wean yourself off of sleep medication. Withdrawal symptoms are common and can include: anxiety, shaking, sweating, headaches, and even hallucinations. (26)

Summary of the conventional treatment plan for chronic fatigue syndrome

Let’s assume the symptoms of your chronic fatigue include fatigue, sleep issues, pain, and depression/anxiety. With this symptom cluster, you may see four different doctors. A rheumatologist for your pain. A psychiatrist for your depression/anxiety. A sleep specialist for your insomnia. And your family physician. Each doctor will likely prescribe a different medication designed to address one of your symptoms. In this example, you may end up with prescription pain killers, sleeping pills, and an antidepressant.

There is no research done on either the long-term effects of taking those medications. Or, how those medications may interact with each other. And my greatest frustration is that there is no over-arching treatment plan. The treatment is to take these medications forever. This is not how you should treat chronic fatigue syndrome.

Take medications to improve your energy to the point where you have enough capacity to address the underlying or root cause of your fatigue. Then, head on over to part two of this article and start treating the root cause of your fatigue with natural or functional medicine!

Note: this is the first article in a series. Once you’re finished this article, be sure to check out part II – The best ways to treat chronic fatigue through an alternative or holistic medical framework.

Now, I want to hear from you!

What conventional therapies increased your energy? Leave your answers in the comments section below!