Most of the pharmaceuticals used to increase energy in chronic fatigue syndrome (ME/CFS) are central nervous system (CNS) stimulants that are either amphetamines or are amphetamine-like in structure. Amphetamines have been used in the past to elevate mood, reduce feelings of fatigue and increase alertness, concentration and motivation.
Stimulants increase blood pressure and the heart rate and constrict the blood vessels and increase blood glucose levels. Many are similar in chemical structure to the neurohormone norepinephrine, which some studies suggest may be raised in ME/CFS.
In the past, amphetamines were used to treat many disorders including asthma and other respiratory diseases, obesity and neurological disorders, but their potential for abuse and addiction has restricted their use to just a few conditions such as attention deficit disorder. When taken in the prescribed doses the risk of addiction is reportedly very low.
Central nervous system stimulants may be helpful in ME/CFS because they increase alertness, concentration, motivation and energy and can assist with circulatory problems.
The experience of ME/CFS physicians
Dr. Lapp and Dr.Teitelbaum appear to have had considerable success with these drugs. Dr.Teitelbaum states that stimulants “can be very helpful for many people with CFIDS”. He believes that Dexedrine and Ritalin are underused in ME/CFS. Stimulants such as methylphenidate (Ritalin), dexamphetamine (Dexedrine or Adderall), and modafinil (Provigil) are Dr. Lapp’s first choice in this area.
Dr. Bateman has had more success using central nervous system stimulating drugs with FM-type patients than with patients with purer ME/CFS. She says, “The more pure CFS you have, the less you can fix it with a stimulant” and she raises the problem of sensitivities to drugs.
Dr. Pocinki notes: “For patients who are complaining of fatigue or cognitive dysfunction, stimulants like Provigil, Ritalin or Adderall may be prescribed to boost energy and improve focus and concentration […] However, you can’t prescribe stimulants without keeping a careful eye on how they impact other aspects of the illness. They can make rest and sleep more difficult, or worse, they can precipitate the dreaded push-crash cycle.”
Dr. Cheney does not use stimulants. He believes that while SSRIs and stimulants may be beneficial in the short term, in the long term they can ‘fry your brain’.
The links below provide more information about the use of specific stimulants in ME/CFS.