Monoamine Oxidase Inhibitors (MAOIs). Monoamine oxidase inhibitors (MAOIs) block the enzyme monoamine oxidase, which has negative effects on many of the neurotransmitters that are important for well-being. In one study moclobemide, a newer MAOI, was associated with improved energy levels in CFS patients regardless of whether they are depressed or not. Other MAOIs are likely to have similar effects. The most serious side effect of MAOIs is severe hypertension, which can be brought on by eating certain foods having a high tyramine content. Such foods include aged cheeses, most red wines, sauerkraut, vermouth, chicken livers, dried meats and fish, canned figs, fava beans, and concentrated yeast products. They also have serious interactions with a number of medications and should not be taken by pregnant women.
Designer Antidepressants. Newer, so-called designer SSRIs, including bupropion (Wellbutrin), nefazodone (Serzone), or mirtazapine (Remeron), affect combinations of different neurotransmitters, and some may have moderate benefits for CFS patients. For example, in one study, nefazodone improved mood, fatigue, and sleep disturbances.
SSRIs. The popular antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) may be helpful for the subgroup of CFS patients who experience significant depression. They include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Cymbalta (duloxetine) is a new antidepressant that is classified as a selective serotonin and norepinephrine reuptake inhibitor (SSNRI). Doctors are hopeful that it will be more effective because the drug targets two key neurotransmitters, serotonin and norepinephrine, in contrast to the SSRIs, which target only serotonin.
In a 2006 UK study of 275 CFS patients, those treated with antidepressants recovered faster than those who did not receive the medication. SSRIs were found to be more effective than tricyclic antidepressants, producing improvements that included a reduction in fatigue that were maintained at the 3-year followup.
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