special subjects
Chronic Fatigue Syndrome
Treatment of Chronic Fatigue Syndrome
Cognitive-behavioral therapy Graded exercise Medications for depression, sleep, or pain if indicated In most cases, symptoms of chronic fatigue syndrome lessen over time. However, it often takes years for symptoms to subside, and not all symptoms disappear. People may recover more fully if they focus more on what function they can recover than on how much function they have lost. Specific symptoms such as pain, depression, and poor sleep are treated. Cognitive-behavioral therapy and gradual graded exercise, which have helped some people, may be worth trying. Cognitive-behavioral therapy is usually a brief course of psychotherapy aimed at redirecting discouraging thoughts that could prevent the positive outlook that can help recovery. Excessive periods of prolonged rest cause deconditioning and may actually worsen symptoms of chronic fatigue syndrome. Gradual introduction of regular aerobic exercise, such as walking, swimming, cycling, or jogging, under close medical supervision (called a graded exercise program) may reduce fatigue and improve physical function. Formal, structured physical rehabilitation programs may be best. Specific chronic fatigue syndrome symptoms such as pain, depression, and poor sleep are treated. Many different medications and alternative therapies have been tried to relieve the chronic fatigue itself. Although many treatments, such as antidepressants and corticosteroids, seem to make a few people feel better, none are clearly effective for all. It can be hard for people and doctors to tell which treatments work because symptoms are different in different people and because symptoms may come and go on their own. Controlled clinical trials, which compare the benefits of a medication to those of a placebo (a substance that is made to resemble a medication but that does not contain an active ingredient), are the best way to test therapies, and no medication therapy has been shown to be effective for the treatment of chronic fatigue syndrome in controlled trials. A number of treatments directed at possible causes, including use of interferons, intravenous injections ofimmune globulin, and antiviral medications, have been mostly disappointing and potentially dangerous. Dietary supplements, such as evening primrose oil,fish oilsupplements, and high-dose vitamins, are commonly used, but their benefits remain unproved. Other alternative treatments (for example, essential fatty acids, animal liver extracts, exclusion diets, and removal of dental fillings) have also been ineffective. Treatments that have no proven benefits are best avoided because they can have side effects. 