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Suggest Treatment For Chronic Fatigue Syndrome
Question: Doctor, I was diagnosed with chronic fatigue syndrome (CFS) one year ago and have seen several doctors to rule out everything else. My psychiatrist, who treats my depression, has tried provigil, ritalin, and then he did gene testing on me. For the last three weeks I have been on rexulti and deplin with just a little success so far. When I look up CFS online it lists 5 or 6 meds used to treat it. How would you begin treating someone with this problem? XXXXXXX
Brief Answer:
Consultation
Detailed Answer:
Hello, and thanks for your question.
I have a few thoughts. First, it appears you have tried many medications (lithium, Remeron, Seroquel, Ritalin, Provigil, Rexulti) with limited results. This suggests to me that medication may not be the solution here. Rexulti is as good a choice as any, and it may take a few more weeks to kick in, as you have only been taking it for 3 weeks. You can also consider Trintellix or Vryalar. However, I believe the more fruitful option for you would be cognitive behavioral therapy (CBT). CBT is as effective as medications, if not more effective, as treatment for both bipolar depression and CFS. This modality of psychotherapy would be likely to provide benefit where medication has limited utility for you. This would be my primary suggestion.
Please remember to rate and close this answer thread when you are finished and satisfied.
Consultation
Detailed Answer:
Hello, and thanks for your question.
I have a few thoughts. First, it appears you have tried many medications (lithium, Remeron, Seroquel, Ritalin, Provigil, Rexulti) with limited results. This suggests to me that medication may not be the solution here. Rexulti is as good a choice as any, and it may take a few more weeks to kick in, as you have only been taking it for 3 weeks. You can also consider Trintellix or Vryalar. However, I believe the more fruitful option for you would be cognitive behavioral therapy (CBT). CBT is as effective as medications, if not more effective, as treatment for both bipolar depression and CFS. This modality of psychotherapy would be likely to provide benefit where medication has limited utility for you. This would be my primary suggestion.
Please remember to rate and close this answer thread when you are finished and satisfied.
Above answer was peer-reviewed by :
Dr. Prasad
hi Dr. Sheppe, and thank you for your response. The meds that you refer to are helping me with my depression, not my CFS. Aside from provigil, rexulti and deplin are the only meds prescribed for my CFS and that was only 3 weeks ago, so it's too early to say that meds haven't worked. The CFS has been severe for over 4 years. My primary care doctor said that I'd have to live with it and my therapist said it was all in my head. These are two answers that I would not accept. When I look online I find other meds that are used for CFS: lisdexamfetamine, armodafinil, and duloxetine. I do the best that I can considering that I am extremely tired all of the time. I try to walk, go to group therapy at the hospital, and lay across the bed alot of the time. Shouldn't I give meds more of a chance? XXXXXXX
Brief Answer:
Followup
Detailed Answer:
CFS is not a well-demarcated illness that is not well understood. Many symptoms are shared with depression, which is why antidepressants and antidepressant-neuroleptics (Rexulti, duloxetine) are often the medication treatment of choice for CFS. I agree with your primary care doctor insofar as treatment with medicine for CFS is not good and medication often is of marginal benefit. I don't agree with your therapist that it's "all in your head" -- chronic pain and depression are also in a sense "all in the head," but cause significant distress and real illness -- but I do agree that therapy is the most likely treatment to help you. I would continue with the Rexulti for another few weeks and if not helpful consider a trial of duloxetine, but overall my suggestion is to take CBT and therapy seriously as it is likely to be of the most benefit.
Please remember to rate and close this answer thread when you are finished and satisfied.
Followup
Detailed Answer:
CFS is not a well-demarcated illness that is not well understood. Many symptoms are shared with depression, which is why antidepressants and antidepressant-neuroleptics (Rexulti, duloxetine) are often the medication treatment of choice for CFS. I agree with your primary care doctor insofar as treatment with medicine for CFS is not good and medication often is of marginal benefit. I don't agree with your therapist that it's "all in your head" -- chronic pain and depression are also in a sense "all in the head," but cause significant distress and real illness -- but I do agree that therapy is the most likely treatment to help you. I would continue with the Rexulti for another few weeks and if not helpful consider a trial of duloxetine, but overall my suggestion is to take CBT and therapy seriously as it is likely to be of the most benefit.
Please remember to rate and close this answer thread when you are finished and satisfied.
Above answer was peer-reviewed by :
Dr. Raju A.T
hello Dr. Sheppe, and thank you for your information. My primary care physician did not say that CFS treatment with medication is not good or of marginal benefit. He just wasn't the one to prescribe something------he wanted my psychiatrist to do that. That's why I'm currently on Rexulti and Deplin------and I have noticed some difference in three weeks. As far as CBT, I have been doing group therapy three times a week for 4 years. It teaches me coping skills, etc but it does NOT lessen the debilitating fatigue and body aches. Only a person with CFS can understand this and I've read quite a few testimonies. I also have one on one therapy with my therapist whenever I need it. What has been missing is an effective med that will bring at least partial relief. Again, therapy keeps me headed in the right direction but it will not eliminate being just as tired in the morning as I was the previous night. Does this make sense? XXXXXXX
Brief Answer:
Followup
Detailed Answer:
Unfortunately, group therapy and talk therapy are not the same as CBT, and research does not suggest that therapies other than CBT are of any real benefit in CFS. CBT is a very specific manualized and well-studied therapy that involves a specific regimen designed to treat CFS. We know from studies that CBT is of equal and often of much greater benefit than medications for CFS. Medications can rarely offer some benefit, so you should give Rexulti a chance for a bit longer, but I strongly suggest seeking out a CBT therapist specifically for targeted CFS treatment.
Please remember to rate and close this answer thread when you are finished and satisfied.
Followup
Detailed Answer:
Unfortunately, group therapy and talk therapy are not the same as CBT, and research does not suggest that therapies other than CBT are of any real benefit in CFS. CBT is a very specific manualized and well-studied therapy that involves a specific regimen designed to treat CFS. We know from studies that CBT is of equal and often of much greater benefit than medications for CFS. Medications can rarely offer some benefit, so you should give Rexulti a chance for a bit longer, but I strongly suggest seeking out a CBT therapist specifically for targeted CFS treatment.
Please remember to rate and close this answer thread when you are finished and satisfied.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for the suggestion, Dr. Sheppe, to locate a CBT therapist. Before I do that, I want to read about it. Can you recommend a book so I can learn about CBT? I now know that it's different than other therapies. I hope that you're not suggesting that I discard all of my meds as I think that it would take a combination of meds and therapy to feel better. I've noticed a little difference right now on the rexulti and deplin. My life is on hold until I get rid of some of my fatigue. XXXXXXX
Brief Answer:
Followup
Detailed Answer:
I completely agree that a combination of medications and CBT will likely produce the best effects for treating CFS. I recommend reading "Cognitive Behavior Therapy, Second Edition" by XXXXXXX Beck to learn more about it.
Please remember to rate and close this answer thread when you are finished and satisfied.
Followup
Detailed Answer:
I completely agree that a combination of medications and CBT will likely produce the best effects for treating CFS. I recommend reading "Cognitive Behavior Therapy, Second Edition" by XXXXXXX Beck to learn more about it.
Please remember to rate and close this answer thread when you are finished and satisfied.
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Above answer was peer-reviewed by :
Dr. Nagamani Ng
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