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Chronic Fatigue Syndrome (CFS)

A Summary

by: George Pararas-Carayannis, Ph.D.

(Excerpts 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 uncommon

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 somewhat lower.

CFS is a real illness

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.

Symptoms of CFS

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;
* depression;
* "swollen glands", sore throat; swollen lymph nodes;
* intermittent pains in different parts of the body, muscle, joint pains;
* fevers and chills;
* headaches;

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 system.

Diagnosing 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 ruled out.

Other causes of chronic fatigue (not related to CFS)

Organic Disorders: 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.

CFS and Depression

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 depression.

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.

Possible 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).

Conventional Treatment of CFS

Physical examinations 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.

Prescribed Medications: 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.

As discussed 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.

Miscellaneous Summaries on Chronic Illnesses

heart disease | | stroke | diabetes | | high blood pressure | | high cholesterol | | Alzheimer's | | Parkinson's | | arthritis | | chronic fatigue | | poor circulation | | brain injury | | multiple sclerosis | | cerebral palsy | | life extension | | memory loss |

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