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|Clinicians Digest Jan/Feb 2007 - Page 5|
What Works with Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS) exists in a hazy, difficult to treat niche, with little consensus on the best approach to use to curb its intermittently debilitating fatigue, muscle pain, headaches, insomnia, depression, anxiety, impaired work and social life, and deteriorating memory and concentration. Medications, vitamin or herbal supplements, psychotherapy, or a combination of approaches have been tried with varying success.
Now better guidance is on the way. Britain's National Institute for Health and Clinical Excellence (NICE), which develops treatment guidelines for the government's National Health Service, will issue its official CFS treatment guidelines in April, and the study it commissioned finds that cognitive-behavioral therapy (CBT) and a careful exercise program are the most effective treatments. The study also finds that the adverse side effects of the most commonly used medications outweigh their limited efficacy. That's important news, because most people go to physicians for relief of CFS, rather than to a therapist.
Through the years, NICE's decisions on treatment guidelines have been characteristically free of pharmaceutical-industry influence. Its revised guidelines for treating depression in young people, for example, recommended therapy as the primary treatment and warned about the links between certain SSRI antidepressants and youngsters' suicidal thoughts. These guidelines helped influence the U.S. Food and Drug Administration to finally place stronger warnings on some antidepressants.
The CFS study in the October Journal of the Royal Society of Medicine reviews nearly 70 CFS treatment studies and finds "disappointing results" across the board for medications. For instance, cortisone injections alleviate fatigue, but have no positive effect on anxiety, depression, or sense of well-being and, given the side effects, don't appear to be a good choice. Nasal cortisone, which has fewer side effects, doesn't work, and neither do dexamphetamines or antidepressants. Melatonin improves sleep, vitality, and mood, but seems to worsen body pain, and so forth.
By contrast, CBT significantly improves people's moods and lessens pain and fatigue by teaching people such things as identifying early signs of discomfort and pacing themselves accordingly, adjusting their expectations of their capabilities, reducing perfectionism and self-criticism, learning relaxation techniques, and accepting that CFS isn't a character flaw but a genuine condition with physical and emotional components. For younger people, a combination of individual and family CBT also works well. For people with less severe cases of CFS, supervised exercise programs which gradually increased physical effort help improve energy far more than meds, though the study cautions against unstructured, vigorous exercise. The study also looks at vitamin supplements, such as B-3, essential fatty acids, and magnesium, and finds some evidence of efficacy, but calls for better designed research on them.
Because its physical symptoms usually bring people to physicians before therapists, people with CFS are likely to try treating it with meds before therapy. When the official NICE guidelines appear, that may change, at least in Britain, but perhaps in the United States as well.