Treatment

There is no cure for chronic fatigue syndrome. Treatment focuses on symptom relief. The most disruptive or disabling symptoms should be addressed first.

Medications

Some problems associated with chronic fatigue syndrome can be improved with either prescription or over-the-counter medications. Examples include:

• Depression. Many people with long-term health problems, such as chronic fatigue syndrome, are also depressed. Treating your depression can make it easier for you to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants can also help improve sleep and relieve pain.
• Orthostatic intolerance. Some people with chronic fatigue syndrome, particularly adolescents, feel faint or nauseated when they stand or sit upright. Medications to regulate blood pressure or heart rhythms may be helpful.
• Pain. If over-the-counter medications such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) don't help enough, prescription drugs sometimes used to treat fibromyalgia might be options for you. These include pregabalin (Lyrica), duloxetine (Cymbalta), amitriptyline or gabapentin (Neurontin).

Therapy

Many people with chronic fatigue syndrome benefit from:

• Counseling. Talking with a counselor can help build coping skills to deal with chronic illness, address limitations at work or school, and improve family dynamics. It can also be helpful for managing depression.
• Addressing sleep problems. Sleep deprivation can make other symptoms more difficult to deal with. Your doctor might suggest avoiding caffeine or changing your bedtime routine. Sleep apnea can be treated by using a machine that delivers air pressure through a mask while you sleep.
• Exercise. Aggressive exercise regimens often lead to worsened symptoms, but maintaining activities that are tolerated is important to prevent deconditioning. Exercise regimens that start at a very low intensity and increase very gradually over time may be helpful in improving long-term function.

Post-exertional malaise

People with chronic fatigue syndrome have a worsening of their symptoms after physical, mental or emotional effort. This is called post-exertional malaise and it can last for days or weeks after the exertion.

People who experience post-exertional malaise often struggle to find a good balance between activity and rest. The goal is to remain active without overdoing it.

You may want to keep a daily diary of your activities and symptoms, so you can track how much activity is too much for you. This may help you avoid pushing too hard on the days you feel good, which can result in a "crash" where you feel much worse later.