Fatigue Syndrome (CFS)
George Pararas-Carayannis, Ph.D.
from summary prepared under contract for the ReGenesis Medical
Center/ Dec 2000)
The Center for Disease
Control and Prevention (CDC) defines Chronic Fatigue Syndrome
(CFS) to be a truly debilitating fatigue with symptoms which
vary in severity. CFS has a sudden onset, is not alleviated by
rest, and can last for at least 6 months or more. It is not clear
that this definition of CFS identifies a uniform group of individuals
with this distinct disorder.
CFS is relatively
Although the complaint
of debilitating chronic fatigue is very common, the illness CFS
is relatively uncommon. Only, about 1 in 1,000 US adults meet
the Center for Disease Control and Prevention (CDC) criteria
for the syndrome. Chronic fatigue syndrome occurs in both men
and women, in all age groups, and in all ethnic, racial, and
socioeconomic groups. Among adolescents, the prevalence may be
CFS is a
CFS is not an imaginary
illness, however the resulting of body sensations can be intensified
as a result of a patient's anxiety. The medical literature indicates
that certain biological abnormalities can be found more often
in patients with CFS. A majority of patients complain of symptoms
that could reflect involvement of the central nervous system:
for example, difficulty with memory, concentration, and balance
or sensitivity to light.
A variety of symptoms
have been reported. CFS symptoms may include:
* extraordinary weakness,
intense fatigue, lack of energy;
* discomfort and exhaustion after exertion;
* sleeping difficulties, unrefreshing sleep;
* impaired memory or concentration;
* "swollen glands", sore throat; swollen lymph nodes;
* intermittent pains in different parts of the body, muscle,
* fevers and chills;
and just a general
feeling of sickness. Many patients with CFS also frequently report
decreased appetite, nausea, night sweats, dizziness, and intolerance
of alcohol and pharmaceuticals that affect the central nervous
the Chronic Fatigue Syndrome (CFS)
Most of the symptoms
of CFS are experienced in other illnesses, and there is not yet
a good diagnostic test. Therefore, when diagnosing CFS, medical
and psychiatric conditions that can produce fatigue must be first
of chronic fatigue (not related to CFS)
Patients with CFS
constitute only a small fraction (2% to 5%) of patients presenting
with chronic fatigue. Another equally small fraction has a well
recognized organic disorder -- for example, anemia, hypothyroidism,
or a malignancy.
Depression and Anxiety:
Depression and anxiety
appear to be the most common causes of chronic fatigue. One complication
for the physician is that some depressed patients find the diagnosis
of depression to be stigmatizing. When they read about CFS in
the media, they may self diagnose themselves as having CFS to
avoid the stigma.
Overwork: Another common cause of chronic
fatigue is overwork. The length and intensity of the workweek
for US citizens has increased progressively during the past 30
years, in contrast to that of most other developed nations of
the world. This is particularly true for women, when both work
in the workplace and at home are measured.
Some patients with
CFS develop an accompanying depression. The interaction between
depression and CFS is not known. Many patients report that they
experience periodic episodes of severe depression after the onset
of the illness, but not before. Because of such reports, CFS
is often mischaracterized as a psychiatric illness. However,
symptoms of patients with CFS reflect only an underlying major
Although CFS and depression
share some symptoms, several of the symptoms of CFS are not characteristic
of psychiatric illnesses; for example, symptoms such as sore
throat, swollen lymph nodes, and discomfort and exhaustion after
exertion. Also, patients with CFS typically lack such depressive
symptoms as guilt, lack of motivation, and lack of interest in
activities they used to enjoy.
Some CFS patients
report feeling somewhat better with antidepressant therapy. However,
a controlled study failed to demonstrate an improvement in fatigue
from treatment with the antidepressant fluoxetine in patients
with CFS, even in those with an accompanying major depression.
In fact, even the depression did not improve in these patients.
Finally, studies found no evidence of major depression in many
(25% to 60%) patients with CFS, either before or after the onset
of CFS. Thus, major depression and other neurotic disorders do
not appear to explain CFS, although the presence of psychiatric
disorders cannot be excluded in any patient with the presenting
complaint of fatigue.
causes of CFS
The causes of the
chronic fatigue syndrome (CFS) are not fully understood. Some
researchers view CFS as a syndrome that probably has many triggering
factors. Most studies have shown objective evidence of abnormalities
in the central nervous system. However, the reported findings
do not yet come together to clearly define how the illness develops.
The cause of these abnormalities and their relationship to the
symptoms of CFS remain obscure.
Many patients have
reported that their CFS began with a flu like illness. Moreover,
some of the symptoms of CFS suggest a chronic infection. There
is currently no convincing evidence that most cases of CFS are
caused by an infectious agent.
Some researchers studying
CFS believe that infectious agents may trigger and even perpetuate
the symptoms of CFS. Chronic fatigue syndrome can follow acute
infectious mononucleosis (which is typically caused by Epstein-Barr
virus), properly diagnosed and treated Lyme disease, and Q fever
(a rare parasitic infection with flu like symptoms).
Treatment of CFS
and laboratory tests over the course of CFS may not show specific
cause for the variety of symptoms. Therefore, many sufferers
of CFS often seek psychiatric care. Their doctors often prescribe
antidepressant medications which do not prove helpful. The symptoms
of CFS persist.
Also, the course of
CFS may be complicated by the use of a lot of medications that
treat the fatigue and the depression that goes with it. It has
always been difficult to distinguish the side effects of the
medications from the underlying process, that is so poorly understood.
No controlled studies
have provided convincing evidence that any conventional treatment
for CFS is effective. Some of the treatment options include very
low doses of tricyclic drugs, such as amitriptyline, which may
improve the quality of sleep and reduce the symptoms of CFS.
Beneficial effects are reported within 48 hours of initiating
treatment. This rapid effect and the low dose used are not consistent
with an effect on an underlying depression. Studies of low dose
tricyclics have demonstrated benefit in a very similar syndrome,
fibromyalgia. There are many similarities between fibromyalgia
and CFS, and some observers believe they may be the same illness,
with different labels.
previously, the only controlled study of antidepressant use in
patients with CFS did not demonstrate a benefit. Some patients
do improve while undergoing this therapy. However, not all patients
have success with these types of antidepressants.
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