Treatment of Chronic Fatigue Syndrome

Evidence-Based Treatment Approach

• The American College of Physicians and other guideline societies recommend avoiding stimulants, corticosteroids, antivirals, and antibiotics for patients with chronic fatigue syndrome (CFS/ME), and instead offer cognitive behavioral therapy (CBT) and graded exercise therapy (GET) as first-line treatments, while recognizing that these rehabilitative approaches remain controversial and must be delivered cautiously with close patient collaboration 1, 2
• The 2021 VA/DoD guidelines explicitly distinguish ME/CFS as a separate entity requiring different management, emphasizing the critical distinction between CFS/ME and cancer-related or inflammatory disease fatigue 1, 2
• For cancer-related fatigue, methylphenidate and corticosteroids may have limited roles, in contrast to CFS/ME where these pharmacological interventions should be avoided 3

Pharmacological Interventions to Avoid

• Do not use stimulants (e.g. methylphenidate) for fatigue symptoms in CFS/ME patients, as recommended by the Mayo Clinic Proceedings 1, 2
• Do not use corticosteroids for CFS/ME, as stated in the Mayo Clinic Proceedings 1, 2
• Do not use antivirals for CFS/ME, according to the Mayo Clinic Proceedings 1, 2
• Do not use antibiotics for CFS/ME, as recommended by the Mayo Clinic Proceedings 1, 2