An open study of the efficacy & adverse effects of moclobemide in patients with Chronic Fatigue Syndrome (CFS)

There is a strong association between the chronic fatigue

syndrome and both depressive illness and sleep disturbance,

but the efficacy of antidepressants is uncertain. We studied

the efficacy and adverse effects of moclobemide in patients

with chronic fatigue syndrome, stratifying the sample both by

co-morbid major depressive illness and by sleep disturbance.

Forty-nine patients with chronic fatigue syndrome were

recruited. Patients were given moclobemide up to 600 mg a day

for 6 weeks. Four (8%) patients dropped out, three because of

adverse effects. Adverse effects wee otherwise mild and

transient. On analysing the whole sample, there were

significant but small reductions in fatigue, depression,

anxiety and somatic amplification, as well as a modest overall

improvement. The greatest improvement occurred in those

individuals who had a co-morbid major depressive illness, with

seven out of 14 (50%) of such individuals rating themselves as

“much better” by 6 weeks, compared to six out of 31 (19%) of

those who were not depressed (31% difference, 95% CI 1-60%, P

= 0.04). Sleep disturbance had no effect on outcome.

Moclobemide may be indicated in patients with chronic fatigue

syndrome and a co-morbid major depressive disorder. A

randomized, placebo-controlled trial is needed to confirm

this. These results do not support moclobemide as an effective

treatment of chronic fatigue syndrome in the absence of a

major depressive disorder.

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