There
is no other condition that has so many symptoms, and sufferers,
and such a paucity of physical signs and positive investigation
results (or, indeed, so many names) as chronic fatigue syndrome.
For this reason, and the fact that a proportion of those with
the condition (often self-diagnosed) undoubtedly have either
psychological problems or depressive illness, it is a diagnosis
many doctors make with reluctance, particularly, as once made,
it tends to be part of the baggage carried through life. True
chronic fatigue, or post-viral fatigue, as many doctors prefer
to call it, undoubtedly does exist. In its simplest form it
could just be the exhaustion that follows influenza. In some
cases the condition can be profound and prolonged, notably after
infectious mononucleosis (glandular fever). In most cases of
chronic fatigue syndrome the original virus infection is not
easy to determine, even with blood tests. The symptoms of this
condition are general malaise, poor co-ordination, poor concentration,
dizziness, weakness and depression. A particular feature, unlike
depression, is that, very often, the person feels well on getting
up but quickly "runs out of steam". An active day is, very often, followed by an exhausted day. These symptoms can last for a few months or many years. Numerous attempts have been made to devise a blood test that will confirm this condition, rather than just suggest it, but that does not mean one will never be found. One psychiatrist, not entirely convinced of the physical basis of the disease, described it as “ the body going on strike”, a view that may be supported by the fact that so many sufferers are high achievers, or intending achievers, in academic and sporting fields.
The absolute first essential in the management of chronic fatigue syndrome is for the physician to be sure that there are no other, possibly treatable, medical conditions causing the symptoms. These include all manner of physical disorders including blood conditions such as anaemia and hormone problems such as hypothyroidism and the menopause. The sufferer from chronic fatigue syndrome, ideally, should be under the care of both physician and psychiatrist because the patient’s mental state in this otherwise relatively untreatable condition is paramount.
Significantly, or not, depending upon one’s view of chronic fatigue syndrome, anti-depressants are one of the few medications that frequently help. All kinds of medications have been tried, and by the very nature of the condition tend to have a high placebo effect, unfortunately fairly short-lived. But as has often been said, a placebo (a medication that appears to work but has no known, actual effect) is better than nothing at all. Cognitive therapy and a very highly organised lifestyle can help e.g. encouraging the sufferer to get up at the same time each morning however he, or she, feels. A very active day might be followed by 3 or 4 days of exhaustion. People can suddenly get better from the condition, almost over night on occasion, and others can deteriorate into a state of complete chair ridden immobility. |
