Psychotropic treatment of chronic fatigue syndrome and related disorders.
BACKGROUND
Chronic fatigue syndrome (CFS) and fibromyalgia frequently are associated with symptoms of major depression. For this reason, antidepressants have been used in treatment of these disorders; however, little direction has been provided into this application in psychopharmacology.


METHODS
First, nine studies were reviewed regarding the relationship of the symptoms of fatigue and depression. Next, 23 reports (12 double-blind studies, 7 open studies, and 4 case reports) were reviewed for the effectiveness of therapy as assessed by global response and improvement of both depression and pain. Studies were differentiated by type of controls, as well as by alleged mechanism of action of the pharmacologic agent.


RESULTS
Disturbances in brain neurochemistry shared by CFS and major depression may serve as a basis for the effectiveness of some antidepressants in CFS. Response to some antidepressants in patients with CFS or fibromyalgia may occur at doses lower than those used in major depression, e.g., amitriptyline 25-75 mg/day. We further found that the more serotonergic treatments (e.g., clomipramine) were more successful in alleviating pain than depression, whereas catecholaminergic agents (e.g., maprotiline, bupropion) seemed particularly effective for symptoms of associated depression.


CONCLUSIONS
To maximize response of the physiologic and psychological consequences of the disorder, more investigation is needed to replicate the apparent findings that relate the neurochemical impairment underlying CFS and fibromyalgia to the type of antidepressant mechanism.
Goodnick
P J
PJ
Department of Psychiatry, University of Miami, FL 33136.
Sandoval
R
R
D006916:5-Hydroxytryptophan / Q000627:therapeutic use; D000639:Amitriptyline / Q000031:analogs & derivatives / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D005356:Fibromyalgia / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012436:S-Adenosylmethionine / Q000627:therapeutic use
D000929:Antidepressive Agents, Tricyclic; D011619:Psychotropic Drugs; D000639:Amitriptyline; D016651:Lithium Carbonate; C004704:cyclobenzaprine; D012436:S-Adenosylmethionine; D006916:5-Hydroxytryptophan