TREATMENT OF THE CHRONIC FATIGUE SYNDROME - A REVIEW AND PRACTICAL GUIDE

The chronic fatigue syndrome (CFS) was formally defined in 1988 to des cribe a syndrome of severe and disabling fatigue of uncertain aetiolog y associated with a variable number of somatic and/or psychological sy mptoms. CFS has been reported in most industrialised countries and is most prevalent in women aged between 20 and 50 years. Despite occasion al claims to the contrary, the aetiology of CFS remains elusive. Altho ugh abnormalities in tests of immune function and cerebral imaging hav e been described in variable numbers of CFS patients, such findings ha ve been inconsistent and cannot be relied upon, either to establish or exclude the diagnosis. Thus, diagnosis rests on fulfilment of the Cen ters for Disease Control case definition which was revised in 1992. Th is case definition remains somewhat controversial, largely due to its subjectiveness. The mainstay of treatment is establishing the diagnosi s and educating the patient about the illness. An empathetic clinician can stop further consultations elsewhere ('doctor shopping') and subs equent excessive investigations, which frequently occur in such patien ts. Most patients should undertake a trial of antidepressant therapy, even if major depression is not present. The choice of antidepressant drug should tailor the tolerability profile to relief of particular CF S symptoms, such as insomnia or hypersomnia. Failure to improve within 12 weeks warrants an alternative antidepressant agent of another clas s. Many other drugs have been reported anecdotally to be beneficial, b ut no therapy has been demonstrated to be reproducibly useful in doubl e-blind, placebo-controlled clinical trials with an adequate duration of follow-up.