NO
ENERGY
Biology of
Chronic Fatigue Gains Focus
by Judy
Foreman September 5, 2005
For years, many doctors and others dismissed
people with Chronic Fatigue Syndrome as depressed, lazy, or just plain
whiny.
Now, a slew of research -- more than 2,000 scientific papers by
some counts -- is suggesting that chronic
fatigue is not a psychiatric illness, but a nasty mix of immunological,
neurological, and hormonal abnormalities.
Several types
of brain scans, for instance, have found different patterns of blood flow to
certain regions of the brain in patients with chronic fatigue, and other studies
have shown that patients have difficulty in thinking and processing information,
and are unable to do several mental tasks at once.
''There are objective
brain abnormalities in many patients with CFS that are consistent with the
symptoms patients describe," said Dr. Anthony Komaroff, a chronic fatigue expert
and editor-in-chief of Harvard's Health Publications, a division of Harvard
Medical School.
Chronic fatigue, which has no known cure, is more
than feeling tired all the time. Definitions vary, but the one the
federal government uses says it is characterized by persistent, unexplained
fatigue lasting at least six months, as well as four of the following:
sore throat, tender lymph nodes, muscle pain, multi-joint pain,
headaches, un-refreshing sleep, malaise after exercise, and impaired memory or
concentration.
The syndrome -- which can come on after an acute
infection, a head injury, a major life stress, or from no obvious triggers at
all -- now affects 800,000 to 2.5 million Americans, most of them women, said
Dr. William Reeves, chief of CFS research at the federal Centers for Disease
Control and Prevention.
But the ailment is tricky to diagnose because its
symptoms overlap with those of other conditions such as depression, Gulf War
Syndrome and fibromyalgia. A federal study now underway is designed to measure
the activity of thousands of genes in 190 people, some with CFS, some without,
to find a distinctive genetic fingerprint for chronic fatigue.
The goal,
said Reeves, is a blood test for chronic fatigue.
''This illness is a
nightmare that is extraordinary," said Dr. David Bell, a specialist in
Lyndonville, N.Y.
''If you're lucky, you get over CFS in a couple
of years. If you're not, it stays with you for the rest of your
life."
Jean Harrison, 52, a former art restorer who lives in
Salem, has been unlucky. She thinks she's had mild chronic fatigue since she was
6, but she wasn't diagnosed until she was 41, when her symptoms got worse. ''For
a long time, my doctor thought I was depressed, so I exercised to help with
that. But when the doctor realized I kept getting much worse after exercise, she
concluded I had CFS. I was thrilled to finally get a diagnosis, after
all those years of people saying, 'What's wrong with you?'
"
Now, Harrison is ''almost housebound," she said. ''If I do too much, I
can end up being asleep for days. If I haven't overextended, I can be awake for
7 to 8 hours. I can't exercise at all -- it's unthinkable to walk a mile. If I
have supper with my family on a Sunday, I have to spend all day Monday in bed.
It's a devastating illness."
Like Harrison, many people with chronic
fatigue are first told they have depression. But the afflictions are quite
different, with depression triggering an increase in the stress hormone cortisol
and chronic fatigue a decline, said Harvard's Komaroff. While depression gets
better with drugs like Prozac, the fatigue of CFS does not.
Jean
Harrison's perplexing response to exercise is also typical of
many chronic fatigue patients, perhaps because in them, exercise triggers the
release of fatigue-inducing immune chemicals called cytokines. People with the
syndrome sometimes can exercise as hard as healthy people -- they just feel
awful for a day or two afterward, Reeves said.
''There is considerable
evidence from published studies that in CFS the immune system is
overactive," said Komaroff.
Given the complexity of Chronic
Fatigue Syndrome, perhaps it's not surprising that treatments are piecemeal and
not very effective and that some doctors get almost as discouraged as their
patients.
''Very few doctors are willing to
care for CFS patients because it is such a downer," said Dr.
Hugh Calkins, director of electrophysiology at Johns Hopkins Medical
Institutions in Baltimore.
Still, experts point to remedies that may help
relieve some of the symptoms. In doses five to 10 times lower than those used
for depression, tricyclic antidepressants like Elavil can improve sleep, said
Komaroff.
And cognitive behavior therapy, which teaches people to
re-evaluate their negative thoughts and behaviors, does help some people with
CFS to use optimally the little energy they have.
But
mostly, it's a game of patience -- and hope, that the strides in research will
translate into better diagnosis and ultimately, better treatments, for chronic
fatigue.
DISCLAIMER: I am not a medical doctor. I
am a fibromyalgia/chronic fatigue syndrome survivor. The purpose of this website
is not to diagnose or cure any disease or malady, but is presented as food for
thought. This information cannot take the place of professional medical
advice. Any attempt to diagnose and treat an illness should come under the
direction of a physician. No guarantees are made regarding any of the
information in this website.
DOMINIE'S FIBROMYALGIA & CHRONIC
FATIGUE SYNDROME HOMEPAGE
DISCLAIMER: I am not a medical doctor. I
am a fibromyalgia / chronic fatigue syndrome survivor. The purpose of this website
is not to diagnose or cure any disease or malady, but is presented as food for
thought. This information cannot take the place of professional medical
advice. Any attempt to diagnose and treat an illness should come under the
direction of a physician. No guarantees are made regarding any of the
information in this website.