Question and Answer Forum

Is it OK to judiciously use stimulants during CFS relapses?

By David S. Bell, MD, FAAP

Published in Lyndonville News, September 1999

Question: I am a 24-year-old postgraduate student with CFS. I have had moderate CFS for 5 years now. I have kept up my studies part time. I am wondering whether it would be considered good or bad medical practice to use central nervous system stimulants (judiciously and under medical supervision) during periods of relapse. For example the weeks of debility that follows an episode of the common cold, not during the infection but afterwards when the lassitude and debility set in. The lassitude after a cold is very distressing as well as incapacitating. I would classify this situation differently than a relapse precipitated by overexertion, where the use of CNS stimulants is probably highly inadvisable.

Answer: The use of stimulants in CFS is very appropriate when they work. The problem with very severe CFS is that they do not work and may make you feel worse. I have talked with three or four patients who felt that their CFS got worse because of stimulants. I tend to think that they were in a relapse that would have happened anyway and the stimulants made them feel worse, but did not necessarily cause their illness to be worse.

Healthy people use stimulants (coffee for example) judiciously. If they take too much they become frazzled and do not over do it the next time. CFS patients are very sensitive to stimulants in general, perhaps because of an increased adrenergic tone (The adrenaline system). That is the reason the heart rate is higher in CFS than healthy persons.

But if a stimulant helps, there is no harm to take it. (We are not talking of cocaine, by the way). Some CFS persons are helped by coffee, and they should use it judiciously. Amantadine, Ritalin, and other drugs may have a beneficial effect. CFS persons learn how to use stimulants quickly. For example, one person may take 1/2 teaspoon of amantadine twice a day, while another takes it once every three days. This is not a one-dose-fits-all medication.

The drawback to stimulants is that they may worsen the agitation (being frazzled), and increase anxiety or interrupt sleep. But this can be overcome by starting with tiny doses. The main problem is that they do not create energy, so if there is a good response, it may be followed by a crash. I do not think this crash is dangerous. Common sense is the key. Find the middle ground with some increase in activity and not too bad of a crash.

By the way, cocaine is a very interesting cause of chronic fatigue, but not chronic fatigue syndrome. It is a tremendous stimulant, and causes severe chronic fatigue because it exhausts your norepinephrine stores (adrenergic). CFS is like cocaine addiction without the cocaine or the initial high. Doesn't seem fair.

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