ADHD Drugs for Chronic Fatigue Syndrome

Children bouncing on bed
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Could drugs meant for hyperactive children be an effective treatment for chronically fatigued adults? As 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.

They're used for ADD/ADHD because, paradoxically, they have a calming effect on ADD/ADHD brains. Given that, it makes more sense that they'd be helpful in a condition defined by fatigue.

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 are symptoms that these two conditions have in common.

One small study demonstrated that, in adults, the two conditions share a lot of other symptoms as well, including unexplained fatigue, widespread muscle pain, and diagnoses of fibromyalgia, which is a condition similar to ME/CFS that also involves dysregulation of norepinephrine and dopamine.

Some doctors even hypothesize that children with ADD/ADHD may be at risk of developing ME/CFS as adults, and a small 2013 study published in the journal Postgraduate Medicine supports that hypothesis.

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 possibly fibromyalgia as well) likely have common underlying mechanisms, and also that ADHD may be able to evolve into ME/CFS or something similar.

A study in The American Journal of Medicine on methylphenidate for ME/CFS demonstrated a significant improvement in about twenty percent 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.

An earlier preliminary study of dextroamphetamine published in Psychosomatics 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 in Clinical and Experimental Obstetrics & Gynecology 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 in Psychiatry Research suggested that lisdexamfetamine was significantly more effective than placebo when it came to improving executive brain function in ME/CFS. Executive function is a set of mental skills that help you get things done, and it's often compromised in this condition. The drug also improved participants' pain, fatigue, and global function.

A Word From Verywell

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, so if you take them, you may have to see your doctor more frequently.

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. Be sure to talk about your full range of symptoms, other conditions you may have, and what drugs and supplements you're taking.

Remember that no single medication works for everyone with ME/CFS and that it's unlikely to take away all of your symptoms.

Sources:

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

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

Young JL. Psychiatry research. 2013 May 15;207(1-2):127-33. Use of lisdexamfetamine dimesylate in the 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/hyperactivity disorder.

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