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Could Antidepressants Help Those with Chronic Fatigue Syndrome/ME?

  [ 216 votes ]   [ Discuss This Article ] • December 10, 2003

By Dr. James Le Fanu

It is always a pleasure to pass on readers' personal tips and remedies, but what follows is in a rather different league - with the potential to transform the lives of thousands. Chronic Fatigue Syndrome (also known as ME - Myalgic Encephalomyelitis) must be one of the most argued over medical conditions of all time.

Doctors in the past have been less than sympathetic, pointing out how the wide range and severity of symptoms complained of seems quite incompatible with the lack of objective evidence of impairment. Chronic Fatigue [Syndrome], it has been alleged, is either a psychological disorder such as hypochondriasis, or even a "malingerer's charter", an unprovable pseudo-scientific diagnosis much favoured by the indolent and work-shy.

Then, without apologising for the offence previously given, the medical profession changed its tune. Doctors conceded that there was clear evidence of some abnormality of brain functions: patients sleeping patterns were often chaotic and their "hypochondriac symptoms" were due to a disturbance of the autonomic nervous system, which controls such crucial things as blood pressure, body temperature and so on. But what to do about it?

It seemed logical to prescribe something that might improve the brain function, such as the anti-depressant drug Prozac which boosts the levels of the neurotransmitter serotonin in the brain. This did not mean that those with Chronic Fatigue [Syndrome] were depressed (surprisingly, in view of their misfortune, they tend not to be), but rather "just in case" boosting the serotonin levels might work for them as it does for those with depression.

Well, it did not, and quite unequivocally so. "Prozac has no beneficial effect on any characteristic of Chronic Fatigue [Syndrome]", concluded one of several groups of researchers, writing in The Lancet. And that was pretty much the end of that.

Thus doctors treating the condition had little alternative other than to fall back on one or other "coping strategy", such as cognitive therapy or graded exercises, which it was presumed must at least be better than doing nothing. And both do appear to help a little, although not to any great effect, and some patients quite rightly find such approaches onerous, as they do not address the underlying problem.

This preamble is the necessary background to appreciate the significance of a recent letter from Mrs. Cynthia Floud from Hampstead, north London - erstwhile director of an adoption agency, Justice of the Peace and wife of a polytechnic director. Her busy life was rudely interrupted when, following a walking holiday in Skye, she contracted 'flu from which she never fully recovered. As a result, she spent the best part of a decade "lying in bed listening to Radio 4, unable even to read novels as it tired me too much".

She knew all about this as, unfortunately, a couple of years earlier her daughter had also been struck down by Chronic Fatigue [Syndrome], forced to pack in her university course and return home. "We both had so little energy that if we got upset or, conversely, quite elated, we would have to pay for it with several days of feeling very ill."

They then read a piece in their local paper, The Ham and High, concerning D. Ian James from the Royal Free Hospital, who was seeking patients for a research project into their condition. Dr. James had become fascinated with the effects of drugs on the brain ever since he had earned the gratitude of legions of musicians by demonstrating the value of betablocker drugs in overcoming the effects of stage fright.

Dr. James's take on Chronic Fatigue [Syndrome] was straightforward: here was a disorder of brain function for which the best treatment must be some drug that could correct whatever was disordered. To be sure Prozac hadn't worked, but that did not mean that some similar drug, such as sertraline, might not do the trick if one got the dosage right. It was all a matter of fine-tuning.

Cynthia Floud and her daughter willingly volunteered to be his guinea-pigs, starting intially with a low dose and increasing gradually to 100mg daily. "Nothing happened for eight weeks. Then I woke one morning feeling I had slept heavily, just like I used to do before I was ill," Mrs Floud writes. "My daughter was a week behind me, and I had a worrying time fearing it might not also work for her."

Over the following weeks, as their energy levels surged, so their other symptoms resolved as well. They then seemed to reach a plateau, but continued to improve, albeit more slowly. It took five years in all before "that blissful day when once again I could ride my bike through Regent's Park hell for leather".

So why is this not common knowledge? Sadly, Dr. James died before he had the opportunity to write up his findings, which remain hidden from view, smothered by the blanket of the prevailing medical orthodoxy which holds that "antidepressant-type drugs do not work for Chronic Fatigue [Syndrome]".

Cynthia Floud, now firing on all cylinders, has been vigorously promoting his cause - but to no avail. Perhaps those intrigued by this story could persuade their family doctor to let them give sertraline a trial. If just half a dozen people echoed Mrs. Floud's experience, I could then summarise the results in a letter to the British Medical Journal - and who knows how many people around the world might be grateful?

© Copyright of Telegraph Group Limited 2003. Source: The Telegraph, online at

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