Chronic Fatigue Syndrome

January 26, 2015

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest. The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. The problem with CFS is that while physical fatigue symptoms are common with depressive and anxiety disorders, the CDC emphasizes that CFS be diagnosed in the absence of diagnostic criteria for mood disorder in the individual otherwise mood disorder should be considered as the primary diagnosis. The dilemma increases when research supports that CFS and Depression often coexist. This is reflected in its uncertain classification as neurasthenia in the psychiatric classification and myalgic encephalomyelitis (ME) under neurological diseases.

According to CDC, a clinician should consider a diagnosis of CFS if these three criteria are met:

1. The individual has unexplained, persistent fatigue for 6 months or longer that is not due to ongoing exertion, is not substantially relieved by rest, has begun recently (is not lifelong)
2. The fatigue significantly interferes with daily activities and work.
3. The individual has had 4 or more of the following 8 symptoms:

i. Post-exertion malaise lasting more than 24 hours.
ii. Non-refreshing sleep.
iii. Significant impairment of short-term memory or concentration
iv. Muscle pain.
v. Pain in the joints without swelling or redness
vi. A sore throat that is frequent or recurring
vii. Tender lymph nodes in the neck or armpit
viii. Headaches of a new type, pattern, or severity

Effects on Quality of Life / Disability

Whatever the controversies, the noteworthy issue is that CFS can be quite debilitating. The confusion surrounding its nosology puts the patient at risk of not getting diagnosed and adequately treated. The condition also results in negative emotions of guilt, fatigue and victimization due to stigma as the symptoms, despite being real, are invalidated as psychological. Its comorbidity with depression and anxiety therefore can be both a source as well as the consequence of disability.

Management

There is no specific drug treatment for this condition. A multimodal approach with integration of medical and psychiatric strategies is recommended.

Symptom-based approach i.e treating disability causing symptoms

• Fatigue and sleep problems.
• Pain.
• Memory and concentration problems.
• Depression and anxiety.
• Dizziness and light-headedness.

Monitoring the use of OTC medicines and supplements

• Over-the-counter and prescription medicines.
• Nutritional and herbal supplements.

Lifestyle modification approach

• Avoiding extremes
• Developing an activity program
• Modifying exercises for extremely ill patients

Improving quality of life

• Cognitive behavioral therapy (CBT).
• Support groups.
• Professional counseling.