Chronic fatigue syndrome


People with chronic fatigue syndrome (CFS) often feel so tired that they can't 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.

Although researchers aren't sure what causes CFS, there are ways to manage symptoms so you can still do the things you enjoy doing.

Signs and Symptoms

  • 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 not ebing able to concentrate or remember
  • Mood changes

What Causes It?

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. Depression can make the condition worse and make it last longer.

What to Expect at Your Provider's Office

There is no laboratory test for chronic fatigue syndrome, but your health care provider may use tests to rule out other illnesses. Your health care provider 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 health care provider may also suggest that you get plenty of rest, exercise regularly, and learn to pace yourself. Often these treatments and time will help you get better.

If the usual treatments do not work, your health care provider may check for other conditions that can cause symptoms similar to those of chronic fatigue syndrome.

Treatment Options

Chronic fatigue syndrome is a stressful disease. It is important to get emotional support as well as treatment for your symptoms. Studies show that psychological support, including cognitive behavioral therapy, can help treat symptoms of chronic fatigue syndrome.

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 stomach 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.


  • 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. 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. Ask your doctor before taking a supplement and work with someone knowledgeable in complementary and alternative medicine therapies.

  • 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 are taking. It is sometimes combined with malic acid (600 mg twice per day) to boost energy. Magnesium can alter blood pressure and interfere with certain medications.
  • 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, although study results are mixed. Essential fatty acids may increase the risk of bleeding, especially if you also take blood-thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin.
  • NADH, a naturally occurring chemical involved in energy production in the body (5 - 20 mg per day). One small study showed it might help reduce symptoms of CFS, but more research needs to be done.
  • DHEA, a hormone produced by the body that may improve energy levels (50 - 200 mg per day). Your body uses DHEA to make 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. People with diabetes, high cholesterol, liver disease, or bipolar disorder should not take DHEA. DHEA interacts with many medications, including antidepressants and ant-anxiety medications.
  • Vitamin B12 (2,500 - 5,000 mcg by injection every 2 - 3 days for several weeks) has been shown to improve energy in people who are not getting enough B12, but it's not clear whether it will help in cases of chronic fatigue syndrome. Oral supplements do not work as well as injections.
  • Beta-carotene (50,000 IU per day) to strengthen immune function. Some studies suggest that smokers should not take beta-carotene. Beta-carotene may interact with some drugs used to treat high cholesterol.
  • L-carnitine (500 - 1,000mg 3 times per day for 8 weeks) may support energy production in the cells, although the scientific studies on this have not been of good quality. L-carnitine may alter blood pressure. Tell your doctor about any kidney issues you may have. People who take thyroid hormone or blood-thinners should ask their doctor before taking l-carnitine.
  • Vitamin D (600 - 1,000 IU daily) Although vitamin D isn't used specifically to treat CFS, not getting enough vitamin D may make symptoms worse.


The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.

Unless otherwise indicated, 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) may help improve energy (100 - 300 mg 2 times per day). One test tube study found that ginseng and echinacea increased the immune response in cells taken from people with CFS. But no studies have been done where people took ginseng for CFS. Ginseng can increase the risk of bleeding, especially if you already take blood-thinners such as clopidogrel (Plavix), warfarin (Coumadin), or aspirin. Ginseng also may interact with several drugs, including those taken for diabetes or to suppress the immune system. People with heart disease, schizophrenia, diabetes, or those with hormone-sensitive cancers -- including breast, uterine, ovarian, or prostate cancer -- should not take ginseng.
  • Echinacea (Echinacea species) may help boost the immune system (200 mg 2 times per day). No studies, however, have looked at echinacea as a treatment for CFS in people. People with autoimmune disease, such as lupus or rheumatoid arthritis, should not take echinacea.

Essential oils of jasmine, peppermint, and rosemary may help reduce stress when used in aromatherapy. Place several drops in a warm bath or atomizer, or on a cotton ball.


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


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.


Although no well-designed clinical trials have looked at chiropractic treatment for CFS, some chiropractors suggest that spinal manipulation may boost energy and reduce pain in some people with the condition.


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

Following Up

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.

Special Considerations

If you are pregnant, you should not use any herbs or supplements without your doctor's supervision. You should not take echinacea for long periods of time.

Supporting Research

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

Ferri: Ferri's Clinical Advisor 2010 1st ed. Philadelphia, PA: Mosby Elsevier. 2009.

Grinde B. Is chronic fatigue syndrome caused by a rare brain infection of a common, normally benign virus? Med Hypotheses. 2008;71(2):270-4.

Hadlandsmyth K, Vowles KE. Does depression mediate the relation between fatigue severity and disability in chronic fatigue syndrome. J Psychosom Res. 2009;66(1):31-5.

Hobday RA, Thomas S, O'Donovan A, Murphy M, Pinching AJ. Dietary intervention in chronic fatigue syndrome. J Hum Nutr Diet. 2008;21(2):141-9.

Lorusso L, Mikhaylova SV, Capelli E, Ferrari D, Ngonga GK, Ricevuti G. Immunological aspects of chronic fatigue syndrome. Autoimmune Rev. 2009;8(4):287-91.

Malouff JM, Thorsteinsson EB, Rooke SE, Bhullar N, Schutte NS. Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: a meta-analysis. Clin Psychol Rev. 2008;28(5):736-45.

Rakel: Integrative Medicine, 2nd ed. Philadelphia, PA: Saunders Elsevier. 2007.

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.

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.

Alternative Names

Version Info

  • Last reviewed on 1/15/2012
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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