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Current Drug Treatment Trends in Chronic Fatigue Syndrome

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By By: Molly Holzschlag • • December 1, 1994

There are currently two exciting approaches to treating CFS with pharmaceutical drugs. The first is to approach dysregulation of the immune system with immune modulating medicines; the other is to address the neurological, or brain problems that are involved in the syndrome. Interestingly, many of these drugs are not especially new to the market, rather new in their application to this illness.

Our bodies are very complex, and each system interacts with other body systems. This interaction is what may very well be why CFS symptoms are so varied, and frequently change or fluctuate from hour to hour or year to year. Some physicians feel that whatever the initiating factors, once the illness is in place it disturbs multiple parts of our bodies.

One perspective held is that parts of the brain are affected, and changing the brain's chemistry, which includes chemicals known as neuro-transmitters, is very popular. Dr. Jay Goldstein, who specializes in treating CFS and Fibromyalgia (FM) patients, says "...the whole body has to be looked at as an interactive network that is controlled by transmitter substances. I think that all the symptoms can be explained on the basis of dysfunction of the brain regulatory mechanism."

One perspective held is that parts of the brain are effected, and changing the brain’s chemistry, which includes chemicals known as neuro-transmitters, is very popular.

Based on this ideal, Dr. Goldstein and other physicians treating CFS and FM look to drugs that affect brain chemistry. The most popular of these are from the class of drugs known as anti-depressants. Used first in the treatment of depression, such medications are now being shown to aid in helping the symptoms of a wide range of ailments, particularly those that reflect changes in brain chemicals such as serotonin and other neuro-transmitters. As Dr. Charles Lapp of the Cheney Clinic says, "we are not using this for depression, but to increase serotonin levels and modulate the immune system."

"The very best success" says Dr. Lapp of these medications, is with Prozac. "It's very safe in the way we use it, in doses of 5-10 milligrams," as opposed to the way it is used to treat depression, which starts at about 40 milligrams daily. Prozac belongs to a special sub-set of psychotropic medications, known as 'selective serotonin re-uptake inhibitors" or SSRI's. These medications are very particular in that they work directly on altering the level and action of serotonin.

Wellbutrin is also being used with good success, the general sensation being that it acts on the brain as well as the immune system. In fact, Dr. Paul J. Goodnick of the University of Miami reports very good results with this other like drugs, and feels strongly that such and anti-depressants work to help patients by both altering blood chemistry, improving mood and sleep disorders, and modulating the immunity to create better health.

Other medications being used to approach the action of the brain include nitroglycerin, a drug used mostly in heart conditions. Again, using doses lower than normally prescribed for other ailments, nitroglycerin seems to give the best relief to symptoms of fibromyalgic pain and tenderness, headaches, and as described by Dr. Goldstein in his book "Chronic Fatigue Syndromes: The Limbic Hypothesis," it can relieve the "idiopathic" chest pain which many CFS patients experience. Interestingly, this medication shows immediate results in some patients, by increasing energy, reducing fatigue, and clearing the famous ‘brainfog’ that so many CFS patients endure. Why nitroglycerin works may lie in the fact that it can alter the action of brain chemicals known as catecholamine, as well as other neuro-transmitters.

An ophthalmic drug, nephazaline, is also showing rapid results when used in certain individuals with CFS. These eye drops apparently work by stimulating the trigeminal nerve. The medication in the drops is quickly transmitted to the brain, which then results in better blood flow and thus a reduction in symptoms associated with that problem.

Research into the immune system is relatively new and discoveries are being made on a regular basis as to how it really works. Current investigation into CFS shows that in most people, there is evidence of immune problems, from irregularities of certain cells known as T-cells, to changes in a biochemical system known as the RNase-L pathway. There are certain popular medications that seek to treat CFS by altering the behavior of immunity. As discussed before, many of the neurological, or brain drugs, may be doing this as well, but their action is not thought to be as specific.

A medication originally used in dermatological conditions holds promise for certain CFS patients. Kutapressin is an extract of liver, and current physicians, including Dr. Charles Lapp, feel that it "has a place in the treatment of CFS...particularly if there is evidence of viral activation." In the test tube, kutapressin can suppress herpetic viruses, and even the so-called "spuma" virus in CFS.

The speculation is that it not only works as an anti-viral drug, but also as an immune modulator affecting the cytokines. Most patients require 60 to 80 doses of the drug before any improvement may be noted, according to a study by Dr.'s Thomas Steinbach and William Hermann. These physicians, says Dr. Lapp, "...have done a great service to bring this drug to our attention." Kutapressin, according to Dr. Lapp, "is the only available medication that has such a success rate in the treatment of CFS."

The one drug that reliably improves a significant majority of CFS patients is Ampligen. Tragically, this medication was not approved by the FDA and is not even available for clinical trials. Patients who were on it for years have been removed from it, and inevitably go through serious decline in their health. Ampligen addresses a part of the immunity known as the RNase-L pathway, and helps to regulate its action. The results from this drug were felt to be very profound. According to one patient, Jerry Crum, "My wife believes that without intervention with Ampligen, I would have died, or at the very least, I would have had to have been institutionalized. .. Ampligen therapy has improved the quality of my life considerably."

While the medications discussed herein may show promise in the treatment of CFS, they are by no means universally successful, or without problems and side effects. Furthermore, none of these therapies should be taken without the advice and supervision of a medical doctor. Current trends in medicine, and a better understanding of the causes and symptoms of CFS will certainly lead to new and more effective treatments for this serious and debilitating disease.

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