Peopel with chronic fatigue syndrome (CFS) often feel so tired that they are unable to do even half of their normal daily activities -- and the feeling doesn't go away, even with more rest. Twice as many women as men are diagnosed with chronic fatigue syndrome. It may last a month, a couple of years, or many years. Sometimes symptoms may come and go.

• Severe fatigue that comes on suddenly, especially after you've had the flu
• Low-grade fever (100.4° F) and chills
• Sore throat and swollen lymph glands in the neck or armpits
• Muscle and joint aches, without any swelling
• Headaches
• Sleep that doesn't feel refreshing
• Feeling like you are in a fog and are unable to concentrate or remember

The cause of chronic fatigue syndrome is unknown, but a virus or an immune system reaction may be responsible. Risk factors include extreme stress or anxiety, flu-like illness that doesn't completely go away, and poor eating habits.

There is no laboratory test for chronic fatigue syndrome, but your doctor may use tests to rule out other illnesses. Your doctor will go over your symptoms, check your medical history, and do a physical examination. If you have CFS, your health care provider may prescribe drugs to treat your symptoms, or suggest herbs, vitamins, or dietary changes to help you. Your doctor may also suggest that you get plenty of rest, exercise regularly, and learn to pace your activity. Often these treatments and time will correct the problem.

If the usual treatments do not work, your doctor may check for other conditions, such as a psychiatric illness, muscle disease, or exposure to a toxic agent, that can cause symptoms similar to those of chronic fatigue syndrome.

Chronic fatigue syndrome is a stressful disease. It is important to get emotional support as well as treatment for your symptoms. Although there is no cure, symptoms can be treated with medications such as antidepressants and anti-anxiety drugs. Pain relievers and anti-inflammatory drugs help relieve muscle and joint aches. Support groups and stress-management techniques can help you cope with the disease.

Drug Therapies

Antidepressants -- In addition to relieving depression, these drugs can reduce fatigue and muscle tension, and improve sleep. Side effects vary. Antidepressants often prescribed for chronic fatigue include:

• Tricyclics: amitriptyline (Elavil), desipramine (Norpramin), notriptyline (Pamelor)
• Selective serotonin reuptake inhibitors (SSRIs): citalopram Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)

Anti-anxiety medications (benzodiazepines) -- Side effects vary. Alprazolam (Xanax) or lorazepam (Ativan) are among those prescribed.

Antihistamines -- relieve allergy-like symptoms. Side effects include drowsiness and headache.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- help relieve pain. These drugs include naproxen (Aleve) and ibuprofen (Advil, Motrin). Side effects can include gastrointestinal bleeding when used for a long period of time.

Acetaminophen (Tylenol) -- another pain reliever. Side effects can include kidney damage when large doses are taken.

Complementary and Alternative Therapies

Eating a healthy diet and using herbs and homeopathic remedies as recommended may help reduce the debilitating symptoms of CFS, and may improve overall energy. Counseling, support groups, meditation, yoga, and progressive muscle relaxation are stress-management techniques that may help as well.

Lifestyle

• Save your energy -- Your doctor may suggest that you learn to slow down and pace yourself, so that you don’t overdo it one day and pay for it the next with increased symptoms. The goal is to maintain a steady, moderate amount of activity that includes regular exercise.
• Get regular exercise -- Your doctor may suggest that you see a physical therapist to create an appropriate exercise program. At least one study shows that people with CFS who exercise have fewer symptoms than those who do not exercise.
• Reduce stress -- Stress can make CFS symptoms worse. Guided meditation or deep breathing may help you relax.

Nutrition and Supplements

Avoid refined foods, sugar, caffeine, alcohol, and saturated fats. Eat more fresh vegetables, legumes, whole grains, protein, and essential fatty acids (found in nuts, seeds, and cold-water fish).

The following supplements may help reduce symptoms of CFS.

• Magnesium (300 - 1,000 mg per day) may help reduce fatigue, but studies show mixed results. Too much magnesium causes diarrhea. To correct this problem, gradually reduce the amount you were taking. It is sometimes combined with malic acid (600 mg twice per day) to boost energy.
• Essential fatty acids, such as those found in fish oil (1,000 mg 3 times per day with meals) and evening primrose oil (3,000 - 6,000 mg per day) may also help reduce fatigue.
• NADH, a naturally occurring chemical involved in energy production in the body (5 - 20 mg per day).
• Coenzyme Q10, which helps cells function and produce energy (60 - 100 mg per day).
• DHEA, a hormone produced by the body that may improve energy levels (50 - 200 mg per day). DHEA is a precursor to testosterone and estrogen. It is truly a hormone rather than a supplement, and should never be taken without a doctor's prescription. Do not use DHEA if you have or are at risk for breast cancer, prostate cancer, or any other hormonally influenced illness. Do not take DHEA if you are pregnant or breastfeeding.
• Vitamin B12 (2,500 - 5,000 mcg by injection every two or three days for several weeks) has been shown to improve energy in people who are deficient, but it’s not clear whether it will help in cases of chronic fatigue syndrome. Oral supplements do not work as well because the body cannot absorb that much vitamin B12.
• Beta-carotene (50,000 IU per day) to strengthen immune function.
• Vitamin C (250- 500 mg two times per day) to increase endurance and immune function. Many alternative health care providers recommend higher doses. Talk to your health care provider to determine the proper dose for you.
• B-complex (50- 100 mg per day or 2 ml by injection one to two times per week) with additional B6 (100 mg per day) and B5 (100 - 250 mg per day) to reduce the effects of stress.
• Pantothenic acid, or vitamin B5 (250 mg twice per day).
• L-carnitine (500 - 1,000mg 3 times per day for 8 weeks) to support energy production in the cells.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Herbs that may help with symptoms of chronic fatigue include:

• Ginseng (Panax ginseng), to improve energy (100 - 300 mg two times per day).
• Echinacea (Echinacea species), to stimulate the immune system (200 mg 2 times per day). Alternate with astragalus.
• Astragalus (Astragalus membranaceus), or huang qi, to stimulate the immune system (add 1 tsp. of the root to 1 cup boiling water, strain and cool. Drink 3 times per day). Alternate with echinacea.
• Licorice (Glycyrrhiza glabra), is often recommended to stimulate the adrenal glands, though studies are lacking (200 - 400 mg 3 times per day for 6 - 8 weeks). Do not use licorice if you have high blood pressure, edema, or heart failure.
• Pau d'arco (Tabebuia avellanedae), to strengthen the immune system (1 tsp. liquid extract in 1 cup water, 2 - 3 times per day). Do not take pau d'arco if you are taking blood-thinning medication, and limit intake to 1 - 2 weeks.
• A tincture of Siberian ginseng (Eleutherococcus senticosus), schizandra berry (Schizandra chinensis), ashwaganda root (Withania somnifera), gotu kola (Centella asiatica), and astragalus root (Astragalus membranaceus). Take 20 - 30 drops two to three times per day. These herbs may need to be taken for 4 - 6 months for maximum benefit.

Essential oils of jasmine, peppermint, and rosemary are calming and restorative and may be used in aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.

Homeopathy

The appropriate homeopathic treatment for chronic fatigue syndrome depends on your constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual. Some remedies commonly used by professional homeopaths to treat CFS include:

• Arsenicum -- for restlessness and fatigue accompanied by chills and burning pains that are worse at night
• Gelsemium -- for mental exhaustion, including drowsiness and indifference, and physical weakness, such as heaviness of the limbs and eyelids
• Pulsatilla -- for people who are moody and emotional, although usually with a calm and gentle disposition
• Sulphur -- for people who feel fatigue but are usually not as emotionally sensitive as those requiring Pulsatilla

Acupuncture

Several studies in China have indicated acupuncture may help treat chronic fatigue syndrome. And some Western studies have found that acupuncture may help conditions with similar symptoms such as fibromyalgia, depression, headache, and irritable bowel syndrome. Some evidence also suggests that acupuncture may help boost your immune system. It may also help people with CFS get a more restful night's sleep, which is often key to turning the condition around.

Acupuncturists treat people with chronic fatigue syndrome based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of CFS, a qi deficiency is usually detected in the spleen or kidney meridians, but a deficiency may also be found in the lung or liver meridians.

Acupuncturists may use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) in addition to needling therapy, as it is thought moxibustion helps to provide a deeper and stronger treatment. Practitioners with herbal training may recommend specific herbal remedies as well as dietary changes.

Chiropractic

Although no well-designed trials have evaluated chiropractic treatment for CFS, some chiropractors suggest that spinal manipulation may boost energy and decrease pain in some people with the condition. In these cases, it is believed that spinal manipulation may have a stimulating effect on the nervous system.

Massage

Therapeutic massage can reduce stress-related symptoms, improve circulation, and increase your overall sense of well-being.

Your health care provider will do routine checkups while you are taking any drugs or following treatments for chronic fatigue syndrome. Contact your doctor if new symptoms develop.

The effects of herbs in pregnancy have not been fully investigated. They should be used only under the careful supervision of your doctor. Avoid high doses of vitamin C if you are pregnant. You should not take echinacea, licorice, and pau d'arco for long periods of time.

Behan PO, Behan WM, Horrobin D. Effect of high doses of essential fatty acids on the postviral fatigue syndrome. Acta Neurol Scand. 1990 Sep;82(3):209-16.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet. 1991;337:757-60.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 320, 327-328, 339-340, 345.

Edmonds M, McGuire H, Price J. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2004;(3):CD003200.

Forsyth LM, Preuss HG, MacDowell AL, et al. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy. 1999;82:185-191.

Fukuda K, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953-959.

Himmel PB, Seligman TM. A pilot study employing dehydroepiandrosterone (DHEA) in the treatment of chronic fatigue syndrome. J Clin Rheumatol. 1999;5:56–59.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Lapp CW, Cheney PR. The rationale for using high-dose cobalamin (vitamin B12). CFIDS Chronicle Physicians’ Forum 1993;Fall:19–20.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Plioplys AV, Plioplys S. Amantadine and L-carnitine treatment of chronic fatigue syndrome. Neuropsycholbiol 1997;35:16–23.

Santella ML, Font I, Disdier OM. Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome. J Clin Rheumatol. 1999;5:56-59.

Scalzo R. Naturopathic Handbook of Herbal Formulas. 2nd ed. Durango, Colo: Kivaki Press; 1994:S/A18-S/A19.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 275.

van Heukelom RO, Prins JB, Smits MG, Bleijenberg G. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol. 2006;13:55-60.

Wang O, Xiong JX. Clinical observation on effect of electro-acupuncture on back-shu points in treating chronic fatigue syndrome. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2005 Sep;25(9):834-6.

Warren G, McKendrick M, Peet M. The role of essential fatty acids in chronic fatigue syndrome. Acta Neurol Scand. 1999 Feb;99(2):112-6.

Wearden AJ, Morriss RK, Mullis R, et al. Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. Br J Psychiatry. 1998;172:485-490.

Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:418-421.

Williams G, Waterhouse J, Mugarza J, et al. Therapy of circadian rhythm disorders in chronic fatigue syndrome: no symptomatic improvement with melatonin or phototherapy. Eur J Clin Invest. 2002;32:831-7.