Potential Drugs for Improving Chronic Fatigue Syndrome
Journal: J Neuropsychiatry Clin Neurosci 19:472, November 2007
doi: 10.1176/appi.neuropsych.19.4.472
Authors: Sayed Shahabuddin Hoseini, Faculty of Medicine, Medical
Sciences/Tehran University, Tehran, Iran and Shahriar Gharibzadeh,
Affiliation: Neuromuscular Systems Laboratory, Faculty of Biomedical
Engineering, Amirkabir University of Technology, Tehran, Iran
NLM Citation: PMID: 18070856
Chronic fatigue syndrome (CFS) is the current name for a disorder
Characterized by debilitating fatigue and several associated
physical, constitutional, and neuropsychological complaints. Specific
symptoms reported by CFS patients are fatigue, difficult
concentration, headache, sore throat, tender lymph node, muscle ache,
joint ache, feverishness, and allergies.
There are several hypotheses about its etiology, including
postinfectious, immunological, neuroendocrine, neurological, and
psychological ones. A CNS dysfunction brought about by abnormal
cytokine release in response to antigenic challenge has been
described.1 Substantial evidences show a pivotal role for
proinflammatory Cytokines (e.g., interleukin1, interleukin6, and
tumor necrosis factor-{alpha}) in induction of CNS mediated responses
such as fever, somnolence, and sickness behavior in acute infections.
A significant elevation in serum levels of interleukin-1, and tumor
necrosis factor-{alpha} in the patient with chronic fatigue syndrome
have been reported.2
Recently, biological agents that bind and neutralize the tumor
necrosis factor have become available:
1) Etanercept, a tumor necrosis factor type 2 receptor fused to IgG1,
is assessed to be effective in psoriasis.3
2) Infliximab, a chimeric mouse-human monoclonal antibody to the
tumor necrosis factor, has shown successful trials for treating
inflammatory bowel disease.
3) Adalimumab, a fully human antibody to the tumor necrosis factor,
is used in cutaneous sarcoidosis.
4) Thalidomide has immunomodulatory and anti-inflammatory effects
including inhibition of synthesis of the tumor necrosis factor
{alpha}. It is effective for treating Behçets syndrome.4
We suggest that these drugs, which are approved by FDA for some of
the aforementioned diseases, can be usefulin treating patients with
chronic fatigue syndrome. Even modest improvement in symptoms can
make an important difference in the patient's degree of
self-sufficiency and ability to appreciate life's pleasures.5 Surely,
clinical trials should be done to assess the efficacy versus side
effects of these drugs on affected patients.
REFERENCES
1. Mihrshahi R, Beirman R: Etiology and pathogenesis of chronic
fatigue syndrome: a review. N Z Med J 2005; 118:U1780
2. Tomoda A, Joudoi T, Rabab el-M, et al: Cytokine production and
modulation: comparison of patients with chronic fatigue syndrome and
normal controls. Psychiatry Res 2005; 134:101104[CrossRef][Medline]
3. Bos JD, de Korte J: Effects of etanercept on quality of life,
fatigue, and depression in psoriasis. Lancet 2006; 367:67[CrossRef][Medline]
4. Sayarlioglu M, Kotan MC, Topcu N, et al: Treatment of
recurrent perforating intestinal ulcers with thalidomide in Behcet's
disease. Ann Pharmacother 2004; 38:808811.[Abstract/Free Full Text]
5. Straus SE: Chronic fatigue syndrome, in Harrison's Textbook of
Internal Medicine, 16th ed. New York, McGraw-Hill, 2005, pp 2545-2547
© 2007 American Psychiatric Publishing, Inc.
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For some mildly-affected patients, as little as 10% improvement is enough to get them back to work. On the other end of the spectrum, a 10% gain might allow a bedridden patient to brush her own teeth and feed herself instead of being totally reliant on others.
Getting the right pills stopped me from deteriorating further. That alone was a big help; I was getting so bad that I was making calls to nursing homes. After finding something that helped me sleep more than 2 hours at a time, I was able to start doing some things I liked, instead of waking up every morning and going through a long list of "nope, not up to doing that" and finally winding up with the only option being my least favorite thing, to once again lie in bed watching TV all day.
A childhood friend commented a few months ago that she was starting to see the old me again. Some of the old sparkle was back because a couple days that week, I had been able to do what I really wanted to do, instead of settling for the only thing within my physical limitations and spending the day resenting this damn disease and incompetent doctors for sentencing me to a life without those little pleasures. After years of being denied the ability to leave home except for absolute essentials, I had finally been able to go out and do something enjoyable instead of just grocery/pharmacy/doctor. I still can't manage an excursion every day, but at least I've improved enough to occasionally go out to meet people, attend a free concert at the library, etc.
And although I still can't do a complete housecleaning by myself, I'm no longer having to set aside a full week to do a single load of laundry; on a really good day, I can manage start-to-finish in one day, though mostly it's a two-day project.
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