Summary
Chronic fatigue syndrome (CFS) is an illness characterised by incapacitating fatigue and a pattern of somatic complaints without known cause. It is a controversial illness in that symptoms are subjective and overlap with symptoms of primary emotional disturbance.
The natural history of this illness is often characterised by spontaneous improvement, and a significant placebo response is frequently present. Therefore, results from poorly controlled trials may be misleading. Few adequate treatment trials have been done in patients with CFS, due to difficulties in case definition and the lack of definitive biological markers. However, numerous treatment regimens have been proposed over the last 30 years, the majority emphasising either psychotropic, immunological or antimicrobial therapy. While no single agent has been curative, benefit has been claimed for many agents. These include tricyclic antidepressants, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors fluoxetine and sertraline, amfebutamone (bupropion), immunoglobulin G, mismatched double-stranded RNA [Poly(I):Poly(C12U); ‘ampligen’] and essential fatty acids.
Similar content being viewed by others
References
Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome. Rev Inf Dis 1991; 13 Suppl. 1: S9–12
Krupp LB, Mendelson WB, Friedman R. An overview of chronic fatigue syndrome. J Clin Psychiatry 1991; 52: 403–10
Shafran S. The chronic fatigue syndrome. Am J Med 1991, 90: 730–9
Bell DS. Chronic fatigue syndrome: recent advances in diagnosis and treatment. Postgrad Med 1992; 91: 245–52
Henderson DA, Shelokov A. Epidemic neuromyasthenia-clinical syndrome. N Eng J Med 1959; 260: 757–64
Acheson ED. The clinical syndrome variously called benign myalgic encephalomyelitis, Iceland disease, and epidemic neuromyasthenia. Am J Med 1959; 26: 569–95
Holmes GP, Kaplan JE, Stewart JA, et al. A cluster of patients with a chronic mononucleosis-like syndrome. Is Epstein-Barr virus the cause? JAMA 1987; 257: 2297–302
Bell EJ, McCartney RA, Riding MH. Coxsackie B viruses and myalgic encephalomyelitis. J R Soc Med 1988; 81: 329
Daugherty SA, Henry BE, Peterson DL, et al. Chronic fatigue syndrome in northern Nevada. Rev Inf Dis 1991; 13 Suppl 1.: S39–44
Klimas NG, Salvato FR, Morgan R, et al. Immunologic abnormalities in the chronic fatigue syndrome. J Clin Microbiol 1990; 28: 1403–10
Caligiuri M, Murray C, Buchwald D, et al. Phenotypic and functional deficiency of natural killer cells in patients with chronic fatigue syndrome. J Immunol 1987; 139: 3306–13
Gupta S, Vayuvegula B. Comprehensive immunological analysis in chronic fatigue syndrome. Scand J Immunol 1991; 33: 319–27
Landay AL, Jessop C, Lennette ET, et al. Chronic fatigue syndrome:- clinical condition associated with immune activation. Lancet 1991; 338: 707–12
Abbey S, Garfinkel PE. Neurasthenia and chronic fatigue syndrome: the role of culture in making of a diagnosis. Am J Psychiatry 1991; 148: 1638–46
Kruesi MJP, Dale J, Straus SE. Psychiatric diagnoses in patients who have chronic fatigue syndrome. J Clin Psychiatry 1989; 50: 253–6
Lane TJ, Manu P, Matthews DA. Depression and somatization in the chronic fatigue syndrome. Am J Med 1991; 91: 335–44
Hickie I, Lloyd A, Wakefield D. Immunological and psychological dysfunction in patients receiving immunotherapy for chronic fatigue syndrome. Aust NZ J Psychiatry 1992; 26: 249–56
Lloyd A, Hickie I, Hickie C, et al. Cell-mediated immunity in patients with chronic fatigue syndrome, healthy control subjects, and patients with major depression. Clin Exp Immunol 1992; 87: 76–9
Klimas NG, Morgan R, Van Riel F, et al. Observations regarding use of an antidepressant, fluoxetine, in chronic fatigue syndrome. In: Goodnick PJ, Klimas NG, editors. Chronic fatigue and related immune deficiency syndromes. Washington DC: American Psychiatric Press, 1993: 95–108
Goodnick P, Sandoval R. Psychotropic treatment of chronic fatigue syndrome and related disorders. J Clin Psychiatry 1993; 54: 13–20
Hench PK. Evaluation and differential diagnosis of fibromyalgia. Approach to diagnosis and management. Rheum Clin North Am 1989; 15: 19–29
Goldenberg DL. Fibromyalgia and other chronic fatigue syndromes: is there evidence for chronic viral disease? Sem Arthritis Rheum 1988; 18: 111–20
Wysenbeek J, Mor F, Lurie Y, et al. Imipramine for the treatment of fibrositis: a therapeutic trial. Ann Rheum Dis 1985; 44: 752–3
Carette S, McCain GA, Bell DA. Evaluation of amitriptyline in primary fibrositis. Arthritis Rheum 1986; 29: 655–9
Goldenberg DL, Felson DT, Dinerman H. A randomized trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum 1986; 29: 1371–7
Scudds RA, McCain GA, Rollman GB, et al. Improvements in pain responsiveness in patients with fibrositis after successful treatment with amitriptyline. J Rheumatol 1989; 16 Suppl.: S98–103
Jones JF. Chronic Epstein-Barr virus infection. Ann Rev Med 1987; 38: 195–209
Caruso I, Sarzi Puttini PC, Boccassini L, et al. Double blind study of dothiepin versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1987; 15: 154–9
Gracious B, Wisner KL. Nortriptyline in chronic fatigue syndrome: a double-blind, placebo-controlled single case study. Biol Psychiatry 1991; 30: 405–8
Geller SA. Treatment of fibrositis with fluoxetine hydrochloride. Am J Med 1989; 87: 594–5
Finestone DH, Ober SK. Fluoxetine and fibromyalgia. JAMA 1990; 264: 2869–70
Goodnick PJ, Sandoval R. Treatment of chronic fatigue syndrome and related disorders: psychotropic agents. In: Goodnick PJ, Klimas NG, editors. Chronic fatigue and related immune deficiency syndromes. Washington DC: American Psychiatric Press, 1993; 131–60
Pepper CM, Krupp LB, Friedberg F, et al. A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression. J Neuropsychiat Clin Neurosci 1993; 5: 200–5
Goodnick PJ. Bupropion in chronic fatigue syndrome [letter]. Am J Psychiatry 1990; 147: 1091
Bakheit AMO, Behan PO, Dinan TG, et al. Possible upregulation of hypothalamic 5-hydroxy-tryptamine receptors in patients with postviral fatigue syndrome. BMJ 1992; 304: 1010–2
Yunus MB, Dailey JW, Aldag JW, et al. Plasma tryptophan and other amino acids in primary fibromyalgia: a controlled study. J Rheumatol 1992; 19: 90–4
Russell IJ, Vaeroy H, Javors M, et al. Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis. Arthritis Rheum 1992; 35: 550–6
Demitrack M, Gold PW, Dale JK, et al. Plasma and cerebrospinal fluid monoamine metabolism in patients with CFS. Biol Psychiatry 1992; 32: 1065–77
Lloyd A, Hickie I, Brockman A, et al. Immunologic and psychologic therapy for patients with chronic fatigue syndrome: a double blind, placebo-controlled trial. Am J Med 1993; 94: 197–203
Butler S, Chalder T, Ron M, et al. Cognitive behaviour therapy in chronic fatigue syndrome. J Neurol Neurosurg Psychiatry 1991; 54: 153–8
Goodnick PJ, Sandoval R. Treatment of chronic fatigue syndrome and related disorders: immunological approaches. In: Goodnick PJ, Klimas NG, editors. Chronic fatigue and related immune deficiency syndromes. Washington DC: American Psychiatric Press, 1993; 109–30
DuBois RE. Gamma globulin therapy for chronic mononucleosis syndrome. AIDS Res 1986; 1 Suppl.: S191–5
Peterson PK, Shepard J, Macres M, et al. A controlled trial of intravenous immunoglobulin G in chronic fatigue syndrome. Am J Med 1990; 89: 554–60
Lloyd A, Hickie I, Wakefield D, et al. A double-blind, placebo controlled trial of intravenous immunoglobulin therapy in patients with chronic fatigue syndrome. Am J Med 1990; 89: 561–8
Straus SE. Intravenous gammaglobulin treatment for the chronic fatigue syndrome. Am J Med 1990; 89: 551–3
Strayer D, Gillespie D, Peterson D, et al. Treatment of chronic fatigue immune dysfunction syndrome with Poly(I): Poly (C12U). Presented at the 31st ICAAC Meetings, Chicago, Illinois, October 1, 1990
Cotton P. Treatment proposed for chronic fatigue syndrome; research continues to compile data on disorder. JAMA 266; 2667
Behan PO, Behan WMH. Essential fatty acids in the treatment of postviral fatigue syndrome. Omega-6 essential fatty acids: pathophysiology and roles in clinical medicine. London: Alan R. Liss, Inc, 1990; 275–82
Straus SE, Dale JK, Tobi M, et al. Acyclovir treatment of the chronic fatigue syndrome. N Eng J Med 1988; 319: 1692–8
Kaslow JE, Rucker L, Onishi R. Liver extract-folic acid-cyanocobalamin vs placebo for chronic fatigue syndrome. Arch Int Med 1989; 149: 2501–3
Blondell-Hill E, Shafran D. Treatment of the chronic fatigue syndrome. Areview and practical guide. Drugs 1993; 46: 639–51
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bell, D.S., Concemi, P.T. & Khan, A. Chronic Fatigue Syndrome. CNS Drugs 1, 348–355 (1994). https://doi.org/10.2165/00023210-199401050-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00023210-199401050-00005