Chronic Fatigue Treatment Overview

When to see a healthcare provider

Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), should be treated by a healthcare provider. CFS usually requires long-term treatment that includes medication and therapy. Many people with CFS get some improvement in symptoms, though most do not fully recover.

Getting diagnosed

There is no test that confirms a diagnosis of CFS. Your healthcare provider will likely make the diagnosis after ruling out other conditions that can cause fatigue. Tests may include:

• A blood test to check for conditions like hypothyroidism and anemia
• A sleep study to make sure you don’t have a sleep disorder like narcolepsy or obstructive sleep apnea
• Mental health screening to see if depression or anxiety is causing your fatigue

What to expect from your doctor visit

• If you have depression, you may be treated with an antidepressant like sertraline (Zoloft) or with psychotherapy (talk therapy).
• If you have chronic pain caused by CFS, your provider may recommend a prescription medication like amitriptyline (Elavil) or gabapentin (Neurontin).
• Your provider may discuss cognitive behavioral therapy (CBT) with you. CBT can help you understand how your thoughts about activities lead to behaviors that ultimately make you feel more tired. But the research is mixed, showing that CBT may help some people but make symptoms worse in others.
• You may be prescribed low-dose sleep medication if you have trouble getting restful sleep. Examples include amitriptyline (Elavil), zolpidem (Ambien), and clonazepam (Klonopin).
• It’s important to try to remain active at a level that improves your health but does not trigger post-exertional malaise (feeling worse after you exercise).
• Avoid treatments that are not supported by evidence, including antivirals, immunosuppressants, stimulants, elimination diets, and amalgam extractions. These may have side effects and minimal benefits.

Prescription medications for chronic fatigue syndrome

• Prescription pain relievers: amitriptyline (Elavil), gabapentin (Neurontin), pregabalin (Lyrica), cyclobenzaprine (Flexeril)
• Antidepressants: duloxetine (Cymbalta), venlafaxine, (Effexor), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft)
• Sleep medication: zolpidem (Ambien), clonazepam (Klonopin), eszopiclone (Lunesta), ramelteon (Rozerem), zaleplon (Sunesta), amitriptyline (Elavil)

Types of chronic fatigue syndrome providers

• Your primary care provider can refer you to a specialist.
• A psychiatrist is a medical doctor who specializes in psychiatric conditions. They can prescribe medication if you have CFS and depression or anxiety.
• A sleep medicine physician can rule out sleep disorders and may treat CFS.
• You may be referred to a rheumatologist, who specializes in treating inflammatory conditions. Some rheumatologists treat CFS.

Treating chronic fatigue syndrome at home

Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is usually treated with medication and therapy.

But OTC pain relievers like ibuprofen (Advil, Motrin) can help manage mild to moderate pain—like headaches and joint and muscle pain. There are also lifestyle changes that your provider may discuss with you. These include:

• Getting quality sleep every night. It’s important to have good sleep habits (sleep hygiene) to improve your sleep.
• Regular physical activity may be helpful for some people with CFS. You may be given a low-intensity exercise program that can help you stay active without triggering post-exertional malaise (feeling overly tired after exercise).
• Eating a healthy, well-balanced diet. Avoid foods that can affect your energy levels, like alcohol, caffeine, and sugar.
• Pacing yourself. It’s tempting to try to do a lot on days when you have more energy, but over-exerting yourself can make symptoms worse.

OTC medications

• Acetaminophen (Tylenol)
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)