By Erica Verrillo*
The list of pharmaceuticals prescribed for patients with Chronic Fatigue Syndrome & Myalgic Encephalomyelitis (ME/CFS) is extensive, spanning a broad range of drugs – from over-the-counter medications, to narcotics and immune modulators.
The reason there is such a wide array is that treatments are aimed at both alleviating symptoms, which in ME/CFS are numerous, and at correcting secondary infections, which are found in the majority of ME/CFS patients. Physicians have found that by correcting secondary infections, while alleviating the most troubling symptoms, patients can make considerable improvement. Neither of these types of treatments directly address the immune system dysregulation that underlies the disease, however. (See experimental treatments)
The mostly commonly prescribed medications for Chronic Fatigue Syndrome & Myalgic Encephalomyelitis are antidepressants. In a survey on antidepressants conducted by ProHealth, of the 20 antidepressant medications listed, there wasn’t one that had not been tried by the respondents. In fact, each antidepressant listed had been taken by a significant portion of the respondents (range of 32% to 66%), with an average of 9 different prescription antidepressants per person.
A survey of over 4,000 ME/CFS patients conducted in Great Britain found that 35%- 40% of the respondents had taken antidepressants. The results of both surveys confirmed that while antidepressants were among the most commonly prescribed medications for ME/CFS, more than one-third of ME/CFS patients reported feeling worse after taking them.
Drugs Aimed at Symptom Relief
Physicians who treat Chronic Fatigue Syndrome & Myalgic Encephalomyelitis generally try to mitigate their patients’ most severe symptoms. Typically, they begin with sleep disorder, pain, orthostatic intolerance, and cognitive dysfunction. Some physicians treat cognitive problems with stimulants (e.g. Adderall), but most specialists recommend avoiding the use of stimulants because they cause an increase in fatigue.
Below are some prescription and over-the-counter drugs recommended by ME /CFS clinicians for four of the most commonly experienced symptoms. (In spite of the fact that all ME/CFS patients experience fatigue – of various sorts – there is no drug that will treat it. As Dr. Paul Cheney put it, “treating fatigue is treating the illness itself.”)
Note: Because patients with ME/CFS frequently have sensitivities and allergies, as well as paradoxical reactions to medications, all of these treatments must be supervised by a physician, regardless of whether a prescription is required. It is always best to begin with a very low dose.
Ambien, Sonata, Restoril, Rozerem
Antidepressants (doxepin, trazodone, etc.)
Muscle relaxers (Flexeril)
NSAIDs (Ibuprofen, etc.)
Anticonvulsants (Topamax, Zonegran)
Medications for Orthostatic Intolerance
Calcium Channel Blockers
Medications Aimed at Secondary Infections
When it comes to treating Chronic Fatigue Syndrome & Myalgic Encephalomyelitis, each doctor utilizes a different approach, depending on how they view the illness. Those physicians who prioritize treating secondary infections, such as Dr. Lucinda Bateman and Dr. Kenny De Meirleir, believe that concurrent infections must be eliminated in order to allow patients to recover. Treatments will depend on which secondary infections are found upon testing.
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Some physicians have reported dramatic success treating patients who have ongoing secondary infections. Dr. Carol Jessop, an internist in California, suspected that candidiasis played a major role in the development of ME/CFS. Dr. Jessop treated yeast infections in thousands of patients with ME/CFS with antifungals combined with an anti-candida therapy program for 3-12 months. The majority of these patients experienced a significant reduction of symptoms. (CFIDS Chronicle, Spring 1991).
Physicians using antivirals have also reported success. In a recent study conducted by Dr. Dan Peterson on the antiviral, Vistide, seventy percent of the patients were able to return to work or had significant increases in functionality.
The most common medications prescribed for secondary infections are below.
Type of Infection
|Bacterial infection (Borrelia, mycoplasma)||Antibiotics (wide-spectrum)|
|Candida, or yeast infection||Antifungals (Nystatin, Diflucan)|
|Viral reactivation||Antivirals (valacyclovir, Vistide)|
|Parasites (giardia)||Mebendazole and pyrantel pamoate|
|Small Intestine Bacterial Overgrowth||Xifaxan|
* Erica Verrillo is ProHealth’s expert editor for the ME/CFS HealthWatch and Natural Wellness newsletters. She is the author of Chronic Fatigue Syndrome: A Treatment Guide, 2nd Edition, available as an electronic book on Amazon,Barnes & Noble, Kobo and Payhip (PDF file). Her website,CFSTreatmentGuide.com, provides practical resources for patients with ME/CFS. She also writes a blog, Onward Through the Fog, with up-to-date news and information about the illness, as well as the full text of CFS: A Treatment Guide, 1st Edition (available in translation).
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