Chronic Fatigue Syndrome (ME/CFS)

Finding The Right Treatment

Treatment for Chronic Fatigue Syndrome

There are no FDA-approved medications to treat chronic fatigue syndrome; however, physicians may order medications off-label that can improve symptoms. Some researchers, such as psychiatrist Joel Young, MD, have found that stimulants can improve the symptoms of chronic fatigue syndrome. These may include stimulants that are commonly used to treat people with attention deficit/hyperactivity disorder (ADHD), such as Vyvanse, Adderall, and other drugs. However, these drugs can have more risks than wakefulness drugs. As a result, it may be best for individuals with chronic fatigue syndrome to try a wakefulness medication first and see if it helps alleviate some or most of the symptoms.

One medication, available since 1999, is a central nervous stimulant known as modafinil (Provigil). This drug, also known as a “wakefulness” medication, has few side effects and improves daytime sleepiness and alertness. Another wakefulness medication, armodafinil (Nuvigil) has also been used off-label to treat chronic fatigue syndrome.

More recently, several other wakefulness drugs were approved by the FDA for the treatment of narcolepsy, and they may be used off-label to treat chronic fatigue syndrome. These drugs include solriamfetol (Sunosi) and pitolisant (Wakix). Sunosi inhibits the reuptake of dopamine and norepinephrine, two important brain chemicals. This inhibition results in an improved alertness. Pitolisant blocks key histamine receptors, resulting in an increased level of wakefulness.

Wakefulness medications may not only improve alertness but it may also alleviate the problem of “brain fog” that many people with chronic fatigue syndrome experience. As with all medications, it’s best to start low (at a low dosage) and go slow (increase the dosage only slowly and under the direction of your doctor).

Some people report that a wakefulness drug also seems to improve their pain levels, although this is not always true. It is possible that increased alertness makes individuals more aware of their environment and more open to new experiences.

If a wakefulness medication is not effective, then a stimulant drug may be considered to treat the symptoms of chronic fatigue syndrome. Dr. Young’s research found that Vyvanse was effective in alleviating symptoms of chronic fatigue syndrome.

Note that if chronic pain is present and persists, it is best for the person with chronic fatigue syndrome to avoid strong analgesics such as opioids because such drugs will increase their sedation levels. In addition, individuals who take opioids will develop a tolerance to the drug such that they will eventually need higher doses, which is problematic. Acetaminophen, naproxen, or aspirin may provide basic pain relief for many people.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN.

Non-medication treatment

Insomnia and unrefreshed sleep are common problems for people with chronic fatigue syndrome. There are non-medication options for insomnia that could be a beneficial addition to a treatment regimen for narcolepsy. CBT (Cognitive Behavioral Therapy) has been endorsed by the National Institutes of Health as an effective method for treating insomnia. CBT for Insomnia addresses the underlying causes of insomnia including insomnia-driven thoughts and behaviors.

Techniques covered in CBT-I include changing sleep thoughts and behaviors, applying lifestyle habits that improve sleep, and practicing relaxation techniques. Typically, the CBT-I program is led by a therapist and includes an initial individual assessment and five individual treatment sessions over a six-week period.

The decision to start therapy

Many people try to cope with their distress on their own, then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.