Treatment of the Chronic Fatigue Syndrome (CFS). A review & practical guide

The chronic fatigue syndrome (CFS) was formally defined in

1988 to describe a syndrome of severe and disabling fatigue of

uncertain aetiology associated with a variable number of

somatic and/or psychological symptoms. CFS has been reported

in most industrialised countries and is most prevalent in

women aged between 20 and 50 years. Despite occasional claims

to the contrary, the aetiology of CFS remains elusive.

Although abnormalities in tests of immune function and

cerebral imaging have been described in variable numbers of

CFS patients, such findings have been inconsistent and cannot

be relied upon, either to establish or exclude the diagnosis.

Thus, diagnosis rests on fulfillment of the Centers for

Disease Control case definition which was revised in 1992.

This case definition remains somewhat controversial, largely

due to its subjectiveness. The mainstay of treatment is

establishing the diagnosis and educating the patient about the

illness. An empathetic clinician can stop further

consultations elsewhere (‘doctor shopping’) and subsequent

excessive investigations, which frequently occur in such

patients. Most patients should undertake a trial of

antidepressant therapy, even if major depression is not

present. The choice of antidepressant drug should tailor the

tolerability profile to relief of particular CFS symptoms,

such as insomnia or hypersomnia. Failure to improve within 12

weeks warrants an alternative antidepressant agent of another

class. Many other drugs have been reported anecdotally to be

beneficial, but no therapy has been demonstrated to be

reproducibly useful in double-blind, placebo-controlled

clinical trials with an adequate duration of follow-up.

Blondel-Hill E, Shafran SD

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