Written in 2009. For additional information that includes newer medications as of 2015, see More resources.

Important notice: Please note that the information on Treatment provided here has been compiled by patients for patients, and represents a summary of what patients may have experienced in working with their individual health care providers. The information in this website is not a substitute for professional medical advice. Please consult with your physician or other healthcare provider in matters pertaining to your medical care. See our full Medical Disclaimer.

Health Care Providers: Please see the information in ME/CFS: A Primer for Clinical Practitioners.

It is important to take extra steps to avoid medication interactions or errors, like being sure that the risks and benefits, side-effects and proper use of medications are reviewed and understood by the patient before leaving the visit. All doctors and healthcare providers should be told which medications and supplements are being used, in order to prevent interactions. 

One serious and potentially life-threatening interaction is called, Serotonin Syndrome, which can happen if too many products are combined that increase serotonin levels.

Some foods and beverages can affect how some medications work, so medications should usually be taken with water (unless otherwise instructed). 

And when picking up prescriptions from the pharmacy, it is a good idea to double-check them while at the counter to see if they are the right medication and in the right amount

Sleep Disorder

Inability to fall asleep, stay asleep and/or experiencing other disruptions during sleep are just a few of the types of sleep problems experienced by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Fibromyalgia (FM). One of the most serious disruptions that warrants sleep study and special intervention is sleep apnea. 

Periodic limb movement, unusual sensations, and/or restless legs syndrome (RLS) are other problems that can disrupt sleep and are treated with specific medications that affect dopamine release. Due to the complexity of these distinct disorders, they are not included under general sleep aids and medications.

Some simple things that patients can try on their own (or with the help of a sleep specialist) are to develop good sleep hygiene habits—like avoiding caffeine late in the day, going to bed and getting up around the same time each day, keeping the room comfortably cool, and using the bed primarily for sleep.

Some find having a small snack of bananas, warm milk, oatmeal or whole-wheat toast with a little honey will help to relax them for sleep because of the tryptophan or other soothing brain chemicals that are released by these foods. There are several herbal products that can be used to help with sleep and relaxation—please refer to our Supplements section.

Several over the counter products, like Benadryl (diphenhydramine hydrochloride) or Unisom (doxylamine) are occasionally used because as antihistamines that cross the blood/brain barrier, they tend to make people drowsy/sleepy.

These are found to be more effective for occasional use rather than long-term use because sedating effects will start to decrease. The most common treatments to help with sleep will be medications (often more than one) that help to initiate sleep and promote deeper sleep (stages 3 and 4). There are four primary groups of medications which are used for their specific effects, such as:



Pain is a major symptom in both FM and ME/CFS, although many don't initially think of ME/CFS as illnesses with pain. Since patients experience many types of pain—such as muscle aches and spasms, fatigue pain in muscles from lactic acid build-up, myofascial pain, multiple joint pain, neuropathy, and headaches, including migraines—therefore, pain is often treated with a combination of medications and/or therapies.

Many patients find they have a hard time getting adequate treatment of their pain and are often met with resistance by their doctors—in particular, primary care physicians. This is often due to not understanding how to use certain medications, misconceptions about dependence versus addiction and/or efforts to avoid scrutiny by regulatory agencies. 

It may become necessary for patients to seek out doctors who specialize in treating pain, possibly rheumatologists or physiatrists (specialists in physical medicine and rehabilitation) and/or pain management. There are clinics/centers dedicated to pain management which operate as small private practices or as pain management clinics within hospitals.

Home remedies can include use of ice or heat packs. Ice packs help to reduce swelling and slow down the nerve impulses to a localized area of pain, while heat packs help to increase blood flow to a localized area of pain and ease stiffness. The most commonly prescribed treatments are listed below, while it is understood many other medications/ protocols are being used.

[N.B. The only solution to lactic acidosis pain is bed rest while your body breaks down the lactic acid.—Ed.]

Fatigue and cognitive function

Disrupted sleep or poor quality of sleep and pain in themselves contribute to fatigue and impaired cognitive function. The ability to study sleep patterns, but also other brain activity patterns, has helped researchers see other deficits in these illnesses.

Many clinicians working with ME/CFS and FM patients will prescribe medications which can increase alertness and concentration. On the other hand, some doctors don't support their use at all because they say increased firing of certain neurons, over time, may actually damage brain cells.

Therefore, patients and their physicians need to take into account the effect of their fatigue and difficulty with concentration on their daily functioning, ability to work and overall quality of life versus the risks of these types of medications. They should also consider alternative options as there are a variety of supplements used to help promote mitochondrial energy production—these are covered in the Supplements article and Mitochondrial Dysfunction, Post-exertional Malaise and ME/CFS.

Though antidepressants are usually prescribed to help with sleep and pain, some can also provide an energizing/activating effect and improve mental clarity. This is accomplished according to how certain neurotransmitters are inhibited or increased, especially by a group of medications called, selective serotonin reuptake inhibitors (SSRI's) which primarily increase serotonin to the nerves.

Some examples of commonly prescribed SSRIs include Prozac (fluoxetine), Paxil (paroxetine), Lexapro (escitalopram) and Zoloft (sertraline). Weight gain, sexual dysfunction, anxiety and/or sleep disturbance are some of the more frequently reported side effects of these medications. Patients should be closely monitored for worsening symptoms of depression or mood and/ or suicidal thoughts during first weeks of treatment.

One of the older medications used for its activating properties is Wellbutrin (bupropion)—it is defined as a norepinephrine and dopamine reuptake inhibitor and is chemically different from tricylic antidepressants and SSRIs. A higher incidence of seizures has been reported in some patients using Wellbutrin than with other antidepressants.

Another medication in its own class is Provigil (modifinil) originally intended to treat daytime sleepiness found in narcolepsy. It is used to help relieve MS-related fatigue and more recently, to improve mental clarity in ME/CFS and FM. Its mechanism differs from most other stimulants as it primarily targets the part of the brain which keeps people awake. It may disturb sleep in some patients, even though this medication is taken during the early part of the day. The FDA issued a warning in 2007 that Provigil has been linked to serious skin rashes and psychiatric symptoms (i.e. anxiety, mania, or hallucinations) and urged caution if used for patients with a history of psychosis, depression, or mania.

Other stimulating medications are borrowed from Attention Deficit Disorder (ADD), such as Ritalin (methylphenidate) or Cylert (pemoline). Straterra (atomoxetine) is also in this category but is found not to be as stimulating as the older formulas. While they might help some people with concentration, they can also negatively affect mood and raise blood pressure.  Sometimes amphetamines (like Adderall and Dexedrine) are prescribed to patients with ME/CFS and FM to improve concentration, even though initially these type of medications were used to suppress appetite, treat ADD and drowsiness in narcolepsy.

Other medical causes of fatigue

Two potential, underlying sources of fatigue may be an underactive thyroid and/or underactive adrenal glands. The thyroid gland in a number of individuals with ME/CFS and FM may either fail to produce sufficient amounts of thyroid hormones or their bodies make poor use of the hormones that are being produced. This, in turn, can cause fatigue, sluggishness, slowed metabolism and increased risk of iron and B12 deficiency. 

Some doctors will try to improve thyroid function by prescribing  Synthroid, but it is important to realize there are various treatment approaches and interpretations of thyroid tests.

About two-thirds of ME/CFS and FM patients are thought to have low adrenal function which can also cause fatigue, poor response to stress and predispose individuals to recurring infections. Some doctors will prescribe low-dose Cortef (hydrocortisone) to help support adrenal function, but others will regard this treatment as being controversial.

Doctors practicing holistic or integrative medicine may be more familiar and receptive to the newer treatment approaches as well as offer additional ways to help improve fatigue and energy production.  Some commonly used alternative products are reviewed in the Supplements article.

Mood disturbances/depression

SSRIs (as described under Fatigue and Cognitive Function above) are also prescribed to help stabilize mood and/or reduce depression. The newer formulas will target other neurotransmitters along with serotonin, like norepinephrine. These are categorized as selective serotonin and norepinephrine reuptake inhibitors (SNRIs), Norepinephrine Serotonin Reuptake Inhibitors (NSRIs) and those primarily adjusting norepinephrine release are referred to as norepinephrine reuptake inhibitors (NRIs). These neurotransmitters have been found to affect pain, sleep, fatigue, cognitive as well as mood disturbance; therefore, adjusting these may provide improvement of these symptoms.

One of the newest SNRIs on the market is Cymbalta (duloxetine). Cymbalta's initial use was to treat major depression and anxiety. It has other properties which help to relieve nerve pain as well as improve one's mood, sleep, energy level, and decrease nervousness and as a result, the FDA approved its use for FM. 

Effexor (venlafaxine) was one of the first SNRIs which came out in 1993. This type of medication (as well as some benzodiazepines and sleeping pills) can be very sensitive to sudden interruption of use and may produce "brain sparks /shivers" in some patients (described as electric shock-like sensations in their brain but also extending to parts of the body, sometimes along with feeling of disorientation, vertigo and/or lightheadedness). Therefore, when any of these types of medications need to be discontinued, they should be tapered off gradually.

Milnacipran is the first NSRI to come on the market and it is different from Cymbalta, an SNRI, and older SSRIs, since it affects norepinephrine and serotonin in a more equal/ balanced way. During clinical trials, it was found to cause fewer undesirable side effects (such as sexual dysfunction).

In January 2009, the FDA approved milnacipran for the management of FM,  which will be sold under the brand name of Savella. It is expected to be available by prescription around March 2009. Reboxetine is another drug being studied in patients with FM. It is an NRI and currently used outside the US as treatment of depression.

Cardiovascular and blood pressure irregularities

Autonomic nervous system (ANS) dysfunction can present as neurally-mediated hypotension (NMH) or orthostatic intolerance (OI), but there are several other related conditions that fall into this category. ANS-driven disorders are moderately common in people with ME/CFS and FM, including children and youth with ME/CFS, but are not limited to these illnesses.

Basically, one's blood pressure will have an abnormal response to change of position (while standing) and the cardiovascular system will have to work much harder to maintain blood pressure and blood flow to the brain. Florinef (fludrocortisone) was one of the first treatments used to treat NMH by helping the body retain salt. 

Over time, it was found to lose its effectiveness because of potassium depletion and because it was not felt to be a very beneficial treatment. Other treatments might include medications to increase blood volume, work on vasoconstriction, or stimulate release of certain neurotransmitters.

Cardiac involvement

Mitral valve prolapse (MVP), low cardiac output, and a distinct cardiac disorder called "diastolic cardiomyopathy" has been found in ME/CFS by one of the leading doctors, Dr. Paul Cheney, who has followed patients with this illness over the past two decades. "Diastolic cardiomyopathy" refers to the heart muscle's failure to relax and to not allow proper filling. It was noticed in most patients (though not all) with ME/CFS. This problem is undergoing more research and there no specific treatment recommendations at this time.

Studies by Dr. Lerner at the University of Michigan documented intermittent tachycardia in a very high percentage of 51 ME/CFS patients (1988 CDC definition for CFS). The tachycardia was accompanied by T-wave abnormalities as measured by 24-hour Holter monitoring.

The studies found that 12 lead standard ECGs and 2-D echocardiograms do not generally show these cardiac abnormalities in ME/CFS. It is common for such abnormalities to be misdiagnosed as anxiety attacks, and thus of psychiatric origin. Instead, in Dr. Lerner's patients  they seemed to be the result of viral infection.

Digestive disturbances

Many people with ME/CFS and FM find they have food sensitivities and various digestive problems. Some patients develop acid reflux disorder or might experience bowel irritability, abdominal cramping, and/or changes in bowel movements.

Digestive enzymes can help to break down food which makes it easier to digest and absorb nutrients. These enzymes can also help to reduce bloating, gassiness, and heartburn. 

GERD and stomach acid problems

Sometimes heartburn or acid indigestion (especially if frequent) may be symptoms of a larger problem called Gastroesophageal Reflux Disorder (GERD), a digestive disorder in which partially digested food and stomach acid and enzymes will back up into the esophagus. Sometimes, these secretions can travel all the way into the throat, which is then referred to as laryngopharyngeal reflux. The problem is usually caused by the lower esophageal sphincter muscle failing to close properly after food has passed into the stomach.

Certain medications, like NSAIDS, some asthma, blood pressure, tranquilizer and other pain medications cause this muscle to over-relax while some medications can irritate the GI lining. Food allergies, especially dairy, certain deficiencies, but also chronic immune disorders can also contribute to development of GERD. The standard treatment is to use medications which will either reduce stomach acid or suppress it from being made (from Rolaids to Tagamet or Pepcid (histamine H2-blockers) to proton pump inhibitors, like Prilosec or Nexium).

Though reducing or suppressing stomach acid may provide relief, it is important to realize the stomach needs a certain amount of stomach acid with which to sterilize food before it goes into the intestinal tract and to keep other bacteria in check, including yeast overgrowth. Plant enzymes and multi-strain probiotics are just a few of the digestive aids one might want to consider and review with his/her doctor. 

There are non-invasive things one can also do, like following a general anti-reflux diet, not laying down for 3 or 4 hours after eating, not bending at the waist after eating, elevating head of the bed by 4 to 8 inches, and taking extra measures to maintain regular bowel elimination.

Irritable Bowel Syndrome

One of the most commonly used treatments of Irritable Bowel symptoms is probiotics (which are actually dietary supplements containing beneficial bacteria or yeasts which can help to offset the overproduction of other (bad) bacteria). There are numerous formulas on the market but one particular formula containing B infantis was studied in FM patients and found to be especially effective. It is called Align and can be ordered from two of the leading drugstores.

Xifaxan (rifaximin) is an antibiotic which is sometimes prescribed to kill off small intestinal bacterial overgrowth (which can be checked for via a lactulose breath test) and to treat diarrhea. This particular medication has been used to treat travelers' diarrhea and is used in many countries. There were two other medications marketed for treatment of diarrhea and abdominal pain in women, but these have been withdrawn by the FDA (though one, Alosetron (Lotronex), is occasionally used in very severe and resistant cases and can only be prescribed by doctors registered with the company).

Infections—Bacterial, Viral and Fungal

Many people who are diagnosed with ME/CFS can link their onset to some type of infection and a significant number of these individuals will continue to have recurring infections, such as sinus, respiratory system, cardiac, musculoskeletal and/or bladder. 

Urinary infections

Many of the bladder infections are bacterial in nature and may require repeated courses of antibiotics. Very often, urine will be cultured to determine the specific strain and which medication is the most effective in treating it. Mycoplasma and chlamydia are two types of microorganisms found fairly often in ME/CFS which can cause persistent infections. Many of these infections require more aggressive and extended treatment than one standard course of antibiotics, and some infections respond better to specific types of antibiotics.

General recommendations are not to take magnesium products within 6 hours of an antibiotic (as they can interfere with absorption of the medicine) and not to use antibiotics beyond their expiration date. It may be helpful to be on Nystatin, an antifungal medication, while on antibiotic treatment.

Yeast infections

Yeast infections or yeast overgrowth tend to develop more frequently in patients with ME/CFS and FM which may be partially due to frequent infections requiring treatment with antibiotics (which will kill off both good and bad bacteria). Other factors promoting yeast overgrowth can be a diet high in sugar (sugar feeds yeast) and poor sleep which negatively impacts immune function. 

Yeast infections are often treated with Nystatin and/or Diflucan and Sporanox. The latter two medications are quite expensive and may increase risk of inflammation of the liver. Yeast overgrowth can be brought under control by using acidophilus/probiotic therapy, by avoiding intake of sugar and yeast products, and/or by adhering to a strict anti-Candida diet. There are many books as well as cook books written specifically on this topic.

Viral infections

A number of viruses have been implicated in ME/CFS, particularly from the herpes  and enterovirus families. Antiviral agents, like Acyclovir and Famvir, have been prescribed in the past to treat some strains of herpesvirus infections, but have been found to be ineffective against HHV-6 and HHV-7. 

Valtrex (valacyclovir) was studied in ME/CFS patients with reactivated Epstein-Barr virus (EBV) and improvement of physical function and cardiac function was shown.

Amantadine is another type of antiviral, usually used to treat Type-A influenza virus (at the onset of the flu) and is sometimes used in ME/CFS for its stimulating properties.

A very potent antiviral agent called Valcyte (ganciclovir) is currently being studied in ME/CFS patients to determine if or how it blocks HHV-6, EBV, and other herpesviruses. The majority of the study patients experienced significant improvement. However, it is important to note that Valcyte is considered to be potentially toxic and patients must be very closely monitored while taking this medication. 

Ampligen is an immunomodulatory type of drug, which has remained in an experimental state for ME/CFS in the U.S. since 1988. It acts on double-stranded RNA.  The New Drug Application submitted by the drug manufacturer to the FDA in late 2007 was regarded as incomplete. If /when the FDA approves Ampligen, it may be the first specific treatment for ME/CFS in the U.S. It is already approved by the European Union.

More resources

A conceptual breakthrough? Very exciting results on possible causes, tests, treatments for CFIDS symptoms by Dr. David Bell

Chronic Pain Control by Dr. David Bell

Complementary and Mainstream Treatment Approaches by Dr. Jeanne Hubbuch

Comprehensive Treatment of Fibromyalgia by Dr. Robert Bennett

Conventional Medicine Treatment for ME/CFS

Dr. Cheney Warns Against Long-term Use of SSRIs

Dr. Klimas speaks to MassCFIDS on cutting-edge developments

Exciting and hopeful news for CFIDS research and treatment from Dr. Gow on altered gene expression

Important Treatment Articles

Mitochondrial Dysfunction, Post-exertional Malaise and ME/CFS

Orthostatic Intolerance and CFS

Pharmacological Therapies Approved for FM

Report on the 6th AACFS Conference, 2003

Report on the 8th IACFS Conference, 2007

Treatment Overview