CFS/ME and Stimulants

Can Caffeine, ADHD Medications or Provigil Lift the Fatigue?

Oct 6, 2009 Maija Haavisto

Can stimulants help chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? In some cases the answer is yes - and they can help more than just the fatigue.

Many people assume that chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is just about being tired, making stimulant drugs the "logical" treatment. Everyone with the illness knows it is far from that simple, but could stimulants still help?

Caffeine

Caffeine is the most familiar stimulant to most of us, found in coffee and tea. Some people find it helpful for CFS/ME fatigue, but others find it makes them too restless. Caffeine also causes tolerance very quickly and many people are merely feeding their addiction by drinking their morning coffee.

Contrary to common misconception chocolate does not contain much caffeine, but instead theobromine. Theobromine also has stimulant effects, but unlike caffeine it is a vasodilator (dilates blood vessels) instead of a vasoconstrictor and is also not thought to be as "edgy".

Many people with CFS/ME tolerate tea better than coffee, because tea also contains the relaxing amino acid L-theanine which counteracts the edginess from caffeine. L-theanine may also have positive effects on cognition and immune system.

ADHD Drugs

Methylphenidate (better known as Ritalin and Concerta) is an ADHD drug used by several CFS/ME experts such as Lucinda Bateman and Charles Lapp. A placebo-controlled study found that methylphenidate substantially reduced fatigue in a subset of CFS/ME patients - though only in 17% of them.

Amphetamine (Adderall) and its derivatives dexamphetamine or dextroamphetamine (Dexedrine) and lisdexamphetamine (Vyvanse) are also used in ADHD treatment. A very small placebo-controlled study found dexamphetamine useful for the majority of CFS/ME patients.

Modafinil

The exact mode of action of modafinil (Provigil) and its derivatives armodafinil (Nuvigil) and adrafinil (Olmifon) is still debated, but they are different from "traditional" stimulants. Provigil is commonly used in the treatment of chronic fatigue, sometimes also in CFS/ME and fibromyalgia. Several studies have evaluated this use, with mixed results.

Other Stimulants

Many antidepressant medications could be counted as stimulants, including protriptyline (Vivactil), reboxetine (Edronax), atomoxetine (Strattera), which have also been used in ADHD. Another example is bupropion, used for depression as Wellbutrin and for smoking cessation as Zyban. Besides its stimulating effects bupropion also has anti-inflammatory properties.

Nicotine is a stimulant drug and some doctors have used it to treat CFS/ME in the form of patches. This treatment is obviously very controversial and nicotine has the same problem as caffeine: it forms tolerance very quickly.

Problems with Stimulants

The problem in CFS/ME usually isn't so much tiredness but lack of stamina and muscle weakness. Sometimes stimulants can help that, but many people feel they just provide false energy and when it runs out, they "crash". Stimulants can cause insomnia and often also headaches and palpitations.

People with CFS/ME are often not "sleepy tired", but agitated or restless despite the crushing fatigue. Some CFS/ME doctors believe this is because the nervous system is overstimulated and thus sedative drugs would be more appropriate. Many patients do feel that low doses of tranquilizers like clonazepam (Klonopin) actually give them more energy.

Not Just for Fatigue

However, some people with CFS/ME clearly benefit from stimulants. Besides fatigue and tiredness, they can help depression and cognitive dysfunction ("brain fog"). Interestingly many stimulants (like amphetamines and methylphenidate) also have pain-relieving properties and they tend to boost pain relief from opiates while reducing the sedation caused by them.

There are case reports of dexamphetamine helping refractory interstitial cystitis (a painful condition of the bladder) and intractable pain from rheumatoid arthritis. They've even been suggested to help headaches, chronic urticaria and even carpal tunnel syndrome.

References

Blockmans D, Persoons P, Van Houdenhove B, et al. Does methylphenidate reduce the symptoms of chronic fatigue syndrome? Am J Med. 2006 Feb;119(2):167.e23-30.

Olson LG, Ambrogetti A, Sutherland DC. A pilot randomized controlled trial of dexamphetamine in patients with chronic fatigue syndrome. Psychosomatics. 2003 Jan-Feb;44(1):38-43.

Dalal S, Melzack R. Potentiation of opioid analgesia by psychostimulant drugs: a review. J Pain Symptom Manage. 1998 Oct;16(4):245-53.

Haavisto, Maija. Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia. 2008.

The copyright of the article CFS/ME and Stimulants in General Medicine is owned by Maija Haavisto. Permission to republish CFS/ME and Stimulants in print or online must be granted by the author in writing.

Coffee is the most popular stimulant

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