Psychostimulants. Psychostimulants may be helpful for a subgroup of patients with CFS who have cognitive problems such as difficulty concentrating, memory problems, and other attention deficit disorder (ADD)-like characteristics. Imbalances in norepinephrine and dopamine have been demonstrated in imaging studies of CFS patients, and are thought to be responsible for such symptoms. Although such imaging tests are not available to most patients, experts postulate that the benefit of psychostimulants offers proof that some CFS patients in fact have measurable chemical imbalances. It is not clear whether such imbalances may contribute to causing CFS, or whether the disease underlying CFS causes such changes in neurochemical structures in the brain.
Psychostimulants include Dexamphetamine, Adderal, Ritalin and Ritalin-like drugs such as Focalin, Concerta, Ritalin LA, and Metadate, as well as Strattera and Provigil.
Ampligen. The drug Ampligen is a form of genetic material called double-stranded (ds) RNA, which increases the body's defense against disease. In studies, Ampligen has been shown to improve exercise ability by increasing oxygen utilization. No serious adverse effects have been seen to date. Phase 3 studies are now complete, and the developer has applied for a New Drug Application from the FDA. At this time Ampligen must be administered intravenously twice per week.
D-ribose. D-ribose is another drug targeting cellular energy metabolism. It has been shown to increase cellular energy synthesis in heart and skeletal muscle. In a small study of 41 patients with CFS and or fibromyalgia, D-ribose caused significant improvement in energy, sleep, mental clarity, pain intensity, and well-being. Energy increased an average of 45% and well-being an average of 30%.
Antibiotics. Some patients with CFS exhibit a chronic state of immune activation. Azithromycin has been used to modulate the immune system. In one study, azithromycin reduced symptoms in 58 of 99 participants. Blood tests showed lower levels of plasma acetylcarnitine, likely reflecting lower levels of oxidative stress.
Alternative Remedies
Because of the difficulties in treating chronic fatigue syndrome, many patients seek alternative therapies. Some, such as acupuncture, yoga, and relaxation techniques, may be helpful and are not dangerous. No scientific evidence exists that vitamin and mineral supplements will relieve CFS, but taken in moderation, they are usually not harmful.
Herbal and Supplements. Popular herbal and dietary supplement remedies for CFS include coenzyme Q10, DHEA, ginseng, and acetylcarnitine. None have been rigorously tested. Some herbs, such as St. John’s wort, ginkgo, and comfrey, may cause serious side effects and drug interactions. [See Box: Herbs and Supplements.]
Herbs and SupplementsHerbal remedies and dietary supplements are not regulated by the FDA. This means that manufacturers and distributors do not need FDA approval to sell their products. In addition, any substance that can affect the body's chemistry can, like any drug, produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Some so-called natural remedies have been found to contain standard prescription medication. Of specific concern are studies suggesting that up to 30% of herbal patent remedies imported from China having been laced with potent pharmaceuticals, such as phenacetin and steroids. Most reported problems occur in herbal remedies imported from Asia, with one study reporting a significant percentage of such remedies containing toxic metals. CFS patients should be wary of those that promise a cure or urge the purchase of expensive but useless and sometimes potentially dangerous treatments, such as the following:
Of particular note for CFS patients are products containing the ingredient Ma Huang, which contains the stimulants ephedrine and kola nut, a caffeine source. Serious adverse reactions, including seizures, psychosis, and several deaths, have been reported in people taking this supplement for increased energy or weight loss. Products that have only one of these ingredients appear not to have the same effect, but people should take so-called energy boosting supplements only with the knowledge and recommendation of their doctor. Other alternative remedies with no proven benefit and possible toxic and dangerous effects include the following:
|
Previous Section
