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Chronic Fatigue Syndrome: Causes, Symptoms, and Treatment

Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a condition that many people don’t understand well and often get wrongly diagnosed. It affects millions globally and can affect how you live, causing both physical and mental difficulties. Here, I’ll talk about different things related to CFS, like its symptoms, possible reasons, how it’s diagnosed, treatment choices, and ways to handle it.

Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME)

Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME) is a complex disorder characterized by persistent fatigue and exhaustion that lasts for six months or longer and cannot be attributed to any other medical condition. It is more than just feeling tired; individuals with CFS experience a profound and overwhelming lack of energy that is not improved by rest or sleep.

CFS/ME Symptoms

CFS/ME is characterized by prolonged fatigue that does not get better with rest. But, chronic fatigue syndrome is often associated with other signs and symptoms. Here are the main chronic fatigue syndrome symptoms:
  • Fatigue – fatigue is the primary symptom of chronic fatigue syndrome. It can stop the person from doing normal activities of daily living. It can be so severe that even going to the toilet can be an exhausting exercise. Rest or any other intervention does not improve fatigue. Some medications help fatigue but are usually a temporary relief.
  • Sore Throat – a sore throat is one of the most common chronic fatigue syndrome symptoms. The sore throat is possibly due to dysfunction in the thyroid caused by chronic fatigue syndrome and immune dysfunction.
  • Myalgia – myalgia is general muscle pain that occurs throughout the body. It is not usually specific to one area. In some sufferers of chronic fatigue, the muscle pain is constant and can be very severe causing a lot of suffering.
  • Headaches – headaches are very common with chronic fatigue. Usually, the headaches are more severe than usual when suffering from chronic fatigue. It is sometimes uncharacteristic of a normal headache and can feel sometimes like a migraine.
  • Memory Loss – People suffering from CFS suffer from short-term and long-term memory loss. It is possibly due to the lack of sleep, pain, and fatigue which contributes to memory issues. Usually the more severe the symptoms of pain and sleep, the more severe the memory loss.
  • Lack of concentration – Sufferers of CFS have trouble focusing on a task and therefore have trouble concentrating.
  • Pain in joints without inflammation – Sufferers will feel pain in their joints which can move from one joint to another. Usually, the pain feels like an ache deep inside the joint and there is no redness or swelling in the joint.
  • Enlarged Lymph Nodes in the Neck and Axilla – Due to the lack of exercise, movement, and immune dysfunction, CFS will have enlarged lymph nodes in the neck and armpits.
  • Disturbed and Unrefreshing Sleep – Disturbed and unrefreshing sleep is common with CFS. Hence CFS people will feel tired, weak, and unmotivated in the morning and during the day.
  • Exhaustion and Malaise – extreme exhaustion and malaise that lasts for 24 hours or more with any mental or physical exertion.
  • Nausea – at times, CFS can be severe such that sufferers complain of nausea and vomiting.

Possible Causes and Triggers of CFS/ME

The exact causes of CFS/ME are still unknown, but several factors may contribute to its development. These include:
  • Viral infections
  • Immune system dysfunction
  • Hormonal imbalances
  • Genetic predisposition
  • Environmental factors
  • Psychological stress
While these factors are considered potential triggers, more research is needed to fully understand the underlying mechanisms of the condition.

CFS/ME Diagnosis

Diagnosis of chronic fatigue syndrome is based on the exclusion of other diseases and symptoms. Unfortunately, there is no concrete scientific test to diagnose chronic fatigue syndrome hence it is based on the elimination of other diseases and conditions.

Nevertheless, there are certain characteristics of people having chronic fatigue syndrome. Here are some steps used by doctors for a chronic fatigue syndrome diagnosis.

The guidelines used by the CDC (Centers for Disease Control) specify certain characteristics for chronic fatigue.

Exclude other conditions and diseases

The first step is to rule out any chronic infections, particularly to the nervous system such as mononucleosis, Lyme disease, or tuberculosis. Then another test is to exclude autoimmune system diseases (a condition where the body’s immune system attacks itself) such as lupus or multiple sclerosis. The test involves blood tests and investigations such as MRI scans to rule out these diseases.

The reason why these tests are done is because chronic fatigue syndrome has similar signs and symptoms to these neurological and infectious conditions and also there is no specific medical test for chronic fatigue.

Unexplained persistent fatigue

The next step for chronic fatigue syndrome diagnosis is unexplained persistent fatigue that is not due to physical stress or exertion which is not relieved by rest. The person experiences fatigue for no particular reason and is not treated by any means. It can appear suddenly and can last for an unidentified amount of time. This results in a decline or difficulty in performing daily activities of living.

Symptoms that are present for more than 6 months

If four of these symptoms are present for more than 6 months or more, then they are categorized as having chronic fatigue syndrome. The symptoms that the person may present are:

Myalgia – or general muscle pain in the body. The person may experience chronic achiness in the body all over and usually cannot be specified in one area.

Interrupted or unrefreshing sleep – The person may experience interrupted or unrefreshing sleep in which they wake up in the morning feeling tired, weak, or unmotivated.

Sore throat – The person experiences frequent sore throats or intermittently experiences sore throats very often in the past 6 months or more.

Post-exertional Mailase – The person experiences prolonged exhaustion and sickness following any mental or physical activity.

Short/Long-term memory loss and impaired Concentration – With chronic fatigue syndrome, the person will usually feel that they have short or long-term memory loss. It is also associated with the inability to sustain a task for a certain period.

Tender Axillary or Cervical Lymph nodes – If you feel tender underneath your armpits or around your neck.

Headaches – With chronic fatigue, headaches tend to be more severe than usual.

Joint pain without inflammation – If you feel pain in the joints without swelling or redness.

Your doctor should go through this procedure for a chronic fatigue syndrome diagnosis.

CFS/ME Treatment

As there are many causes for CFS/ME, there are several types of chronic fatigue syndrome treatment. Here are the main chronic fatigue syndrome treatment options.

Steroid injections

Steroid injections using hydrocortisone are useful for chronic fatigue syndrome treatment. Steroid or cortisone treatment is useful to treat CFS because it helps to increase the body’s metabolic system and helps reduce any inflammatory disorder that is affecting the body system.


Antidepressants are used to treat CFS as it helps to stop mood swings and stress. It also allows the person with CFS to sleep better so people can get more refreshing sleep during the night. This allows the person to have more energy during the day and will fatigue less.

Anti-viral treatment

Since some cases of Chronic Fatigue Syndrome (CFS) are caused by viruses, antiviral treatments can be effective. Some antiviral treatments that have been found to be effective in treating CFS include Valacyclovir, Ampligen, Interferon, and IGG. Among these, Interferon has been shown to be the most effective in treating chronic fatigue syndrome in randomized controlled studies.

Depression Treatment for CFS/ME

One of the most common conditions often associated with chronic fatigue syndrome is depression. Due to fatigue, lack of energy, and weakness people will tend to become depressed because of the lack or inability to perform activities of daily living and physical exercise.

Depression with chronic fatigue syndrome is a deadly mix that can spiral down to suicidal tendencies and physical health-related issues. Hence, treatment for depression must be managed straight away to minimize further depression and a faster recovery.

Depression Treatment

There are three effective main ways of depression treatment. They are psychotherapy, medication, and exercise. People with chronic fatigue syndrome have variable results with each treatment.


Psychotherapy treats depression in non-pharmaceutical ways primarily by counseling (but psychotherapy can be combined with pharmaceutical therapy to assist with treatment).

Psychotherapy treatment is divided into three parts. The first is to provide support and acknowledgment of having depression which helps to minimize existing pain.

The second part of the therapy uses cognitive behavioral therapy techniques such as hypnosis or strategies to make the person feel positive about them.

The third part is to identify the stressors or keys that make them feel depressed by managing, eliminating, or coping with the stressors or triggers of depression.


Medication is often used alongside psychotherapy. The most common group of medications for the treatment of depression is antidepressants.

Antidepressants help to alleviate depression symptoms like anxiety, stress, and mood changes. Antidepressants work by changing the chemicals or neurotransmitters in the brain that will trigger depression. There are many types of antidepressants. The most common types are:
  • Tricyclic Antidepressants (TCA) – Work by increasing Serotonin and norepinephrine (which includes drugs such as Aventyl, Pamelor, Sinequan, and Vivactil).
  • Monoamine Oxidase Inhibitors (MAOI) – increase norepinephrine and serotonin. Drugs found in this class are Nardil, Marplan, and Parnate.
  • Selective Serotonin Reuptake Inhibitors (SSRI) – increase serotonin and uptake of serotonin in the brain. Zoloft, Prozac, Paxil, Celexa
  • Welbutrin – increases norepinephrine and dopamine in the brain.
  • Effexor – increases serotonin and norepinephrine in the brain as above.
  • Trazodone – this drug blocks certain neurotransmitters in the brain that trigger depression
All these medications have side effects and must be prescribed by a psychiatrist or doctor for the correct dosage.

Diet and Exercise

Diet or exercise regimen for CFS, and maintaining a healthy lifestyle can positively impact symptom management. Balanced nutrition, including a variety of whole foods, can support overall well-being.

Exercise is often effective for the management of depression. When people exercise, they increase the natural neurotransmitter called endorphins which is a natural pain killer. It also helps to block neurotransmitters that trigger depression.

With chronic fatigue syndrome, graded exercises tend to be the most effective in the treatment of depression. This is best prescribed by a health professional such as a physical therapist.

Gentle forms of exercise, such as walking or stretching, may also help improve physical function. However, it is crucial to tailor dietary choices and exercise routines to individual capabilities and consult with healthcare professionals before making any significant changes.

Patients are often also advised to slow down, cut down physical exertion, and try to avoid mental stress as it may cause a decrease in their immune system.

Alternative Therapies and Complementary Medicine

Alongside conventional medical treatments, some people with CFS find relief by incorporating complementary and alternative therapies into their management plan. These can include practices like acupuncture, massage therapy, herbal supplements, and mind-body techniques such as meditation or yoga.

Important: Consult with your doctor before trying any alternative therapies. While some studies suggest potential benefits for certain therapies,  research is ongoing, and effectiveness can vary.  Your doctor can help you weigh the potential risks and benefits of these approaches and ensure they don't interfere with any existing medications you're taking.

FAQs (Frequently Asked Questions)

What is the difference between Chronic Fatigue Syndrome and regular fatigue?

Chronic Fatigue Syndrome is characterized by persistent fatigue that lasts for six months or longer and is not relieved by rest. It is more severe and debilitating than regular fatigue.

Is Chronic Fatigue Syndrome the same as being tired all the time?

No, Chronic Fatigue Syndrome is a chronic illness characterized by severe fatigue that does not improve with rest. It is not the same as temporary tiredness or lack of sleep.

Are there any specific tests to diagnose Chronic Fatigue Syndrome?

Currently, there are no specific tests available to diagnose CFS. Healthcare professionals rely on a combination of medical history, symptom assessment, and ruling out other potential causes of fatigue.

Can Chronic Fatigue Syndrome be cured?

Currently, there is no known cure for Chronic Fatigue Syndrome. However, various treatment options can help manage symptoms and improve quality of life.

Can lifestyle changes help manage Chronic Fatigue Syndrome?

Yes, certain lifestyle changes such as prioritizing rest, practicing good sleep hygiene, and managing stress can help manage CFS symptoms and improve overall well-being.

Where can individuals with CFS find support and resources?

There are several support networks available, including CFS advocacy organizations, online communities, support groups, and healthcare providers specializing in CFS. These resources can provide valuable information, support, and a sense of community for individuals with CFS.


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