There is no proven treatment for chronic fatigue syndrome. Both gradual aerobic exercise programs and cognitive behavioral therapy — counseling designed to change beliefs about the condition — improve level of function, but neither cures the illness. In patients with a similar condition, fibromyalgia, low doses of tricyclic drugs have been shown to improve symptoms, probably by improving a sleep disorder that is part of the illness. No one approach is best for everyone with chronic fatigue syndrome, and the condition rarely is cured.
In general, doctors use a combination of the following:
Lifestyle changes. Patients are encouraged to slow down and to avoid physical and psychological stress. They learn to save their energy for essential activities at home or work and to cut back on less-important activities.
Resuming exercise gradually but steadily. With the help of a physical therapist, patients begin an exercise program in which aerobic physical activity begins very slowly, and is increased very gradually. Patients can expect occasionally to feel worse the day after aerobic exercise. If that happens, many experts recommend avoiding exercise for several days and then resuming a less-intensive program, and slowly increasing the pace.
Treating existing psychiatric problems. In the approximately 50% to 60% of people with chronic fatigue syndrome who develop depression, antidepressant treatment and talk therapy can be valuable in treating the depression; however, the chronic fatigue is rarely if ever cured by antidepressant therapy.
Treating existing pain. Aspirin, acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat headaches, muscle pain and joint pain. Antidepressant medications also may help to reduce chronic pain.
Treating existing allergy symptoms. Antihistamines and decongestants are used to treat allergy symptoms.
Experimental therapies. Some studies indicate that high doses of omega-3 fatty acids (such as fish oil capsules) may be helpful. Several anti-viral therapies are being tested. Stimulants are sometimes prescribed, but their value has not been carefully tested.