ADHD Drugs for Chronic Fatigue Syndrome

How Well Do They Work?

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Could drugs meant for hyperactive children be an effective treatment for chronically fatigued adults? Is illogical as it sounds, they might be.

Some doctors prescribe ADD/ADHD drugs for their patients with chronic fatigue syndrome (ME/CFS) and say they've seen positive results. We have a growing body of evidence to back this up, but more research is needed.

These drugs are classified as neurostimulants, which means that they stimulate brain activity.

(Paradoxically, they have a calming affect on ADD/ADHD brains.)

The most popular neurostimulants are:

  • Ritalin and Concerta, which contain methylphenidate
  • Dexedrine, which contains dextroamphetamine
  • Adderall, which contains amphetamine and dextroamphetamine
  • Vyvanse, which contains lisdexamfetamine

Why Use Neurostimulants?

The exact mechanism of these drugs isn't known (which is actually quite common in drugs that affect the brain), but they're believed to change the availability of two neurotransmitters -- norepinephrine and dopamine -- that are thought to be dysregulated in both ADD/ADHD and ME/CFS.

Low norepinephrine is linked to loss of alertness and memory problems, while dopamine deficiency is linked to cognitive impairment and inability to focus attention. These symptoms are shared by ADD/ADHD and ME/CFS.

One small study (Young 2003) demonstrates that, in adults, the two conditions share a lot of other symptoms as well, including unexplained fatigue, widespread muscle pain, and diagnoses of ME/CFS or the similar condition fibromyalgia.

Some doctors even hypothesize that children with ADD/ADHD may be at risk for developing ME/CFS as adults, and a small 2013 study (Young, Postgraduate Medicine) supports that. Researchers looked at three cases of ME/CFS in which the patient didn't respond well to treatment. They discovered that all three of them met the criteria for ADHD and responded to treatment with neurostimulants.

They concluded that ADHD and ME/CFS (and possible fibromyalgia as well) likely have common underlying mechanisms, and also that ADHD may evolve into ME/CFS or something similar.

A 2006 study (Blockmans) of methylphenidate for ME/CFS demonstrated a significant improvement in about 20% of participants. That's hardly an overwhelming endorsement. However, many researchers believe ME/CFS consists of several subgroups that each require different treatment. Do the people who responded to methylphenidate represent a particular subgroup? We don't yet know enough to say either way.

A 2003 preliminary study (Olson) of dextroamphetamine showed that 9 out of 10 participants with ME/CFS had significantly less fatigue while taking the drug compared to a placebo. In 2015, a study came out that found dextroamphetamine was beneficial in a variety of conditions that are more common in women than in men, including ME/CFS, fibromyalgia, pelvic pain, and interstitial cystitis.

A 2013 study (Young, Psychiatry Research) of lisdexamfetamine suggested that the drug was significantly more effective than placebo when it came to executive brain function, which is a set of mental skills that help you get things done.

It also improved their pain, fatigue, and global function.

Are Neurostimulants Right for You?

These medications are already on the market and are relatively inexpensive, which makes them easy for people to obtain. A drawback is that they carry a risk of addiction and therefore may require close oversight, which means frequent doctor's appointments.

If you're interested in trying these drugs, talk to your doctor. Keep in mind that some doctors may not be willing to prescribe these drugs off-label for ME/CFS based only the evidence we have so far.

Sources:

Blockmans D, et. al. The American journal of medicine. 2006 Feb;119(2):167.e23-30. Does methylphenidate reduce the symptoms of chronic fatigue syndrome?

Check JH. Clinical and experiimental obstetrics & gynecology. 2015;42(3):267-78. Symathomimetic amines are a safe, highly effective therapy for several female chronic disorders that do not respond well to conventional therapy.

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

Valdizán Usón JR, Idiazábal Alecha MA. Expert review of neurotherapeutics. 2008 Jun;8(6):917-27. Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate.

Valdizán Usón JR, Idiazábal Alecha MA. Expert review of neurotherapeutics. 2008 Jun;8(6):917-27. Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate.

Young JL. Psychiatry research. 2013 May 15;207(1-2):127-33. Use of lisdexamfetamine dimesylate in treatment of executive functioning deficits and chronic fatigue syndrome: a double blind, placebo-controlled study.

Young JL. Postgraduate medicine. 2013 Jan;125(1):162-8. Chronic fatigue syndrome: 3 cases and a discussion of the natural history of attention-deficit/hperactivity disorder.

Young JL, Redmond JC. Psychopharmacology bulletin. 2007;40(1):118-26. Fibromyalgia, chronic fatigue, and adult attention deficit hyperactivity disorder in the adult: a case study.

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