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ADHD Drugs for Chronic Fatigue Syndrome
Some healthcare providers prescribe attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) drugs for their patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and say they’ve seen positive results. We have a growing body of evidence to back this up, although more research is needed.
These drugs are classified as neurostimulators, 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 neurostimulators 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.1
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.
Researchers have demonstrated that, in adults, the two conditions share a lot of common symptoms including unexplained fatigue, functional impairment, and anxiety.2
Some healthcare providers 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.3 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.
In a 2016 study, the long-term impact of taking methylphenidate for ME/CFS demonstrated a significant improvement in about one-third of the participants.4 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 study published in 2015 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.5 Although dextroamphetamine has been proven an effective treatment for ME/CFS in the past, the research is limited.6
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.7 Executive brain 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 it 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 healthcare provider more frequently.
If you’re interested in trying these drugs, talk to your healthcare provider. Keep in mind that some healthcare providers 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 currently taking.
Can Caffeine Relieve Your Chronic Fatigue?
On some mornings, there’s nothing like a good cup of coffee to get you started with your day. But for people with chronic fatigue syndrome, there may be healthier ways to boost energy.
Considering the fact that millions of people rely on caffeine to perk them up throughout the day, it may seem like a good idea to turn to the stimulant to combat the persistent dreariness and fatigue that are symptoms of chronic fatigue syndrome, or CFS. But doctors overwhelmingly advise against it.
Caffeine: An Energy Loan Shark
One important reason caffeine is not recommended as an energy booster for people with CFS is that its effects are very short-lived. “Caffeine, just like sugar, is a loan shark for energy,” says Jacob Teitelbaum, MD, medical director of the national Fibromyalgia and Fatigue Centers. “It gives an initial burst of energy, but takes away more than it gives, leaving people craving even more sugar and caffeine.”
What’s more, adds Dr. Teitelbaum, caffeine can worsen other mechanisms in the body that are leading to fatigue. “Caffeine actually aggravates adrenal exhaustion and low blood sugars, amplifying the anxiety and stress symptoms and fatigue,” he says.
However, Teitelbaum says that not all caffeine is off-limits. As with most things, he emphasizes moderation, especially for patients with chronic fatigue syndrome. “One cup of coffee, or preferably tea, in the morning to get started is okay, but after that I recommend decaffeinated.”
Stimulants That May Help Chronic Fatigue
Not all stimulants are bad when it comes to treating CFS. Teitelbaum has studied one natural stimulant, called D-ribose, that may help. “We have now completed two studies showing that one scoop of D-ribose (5 grams) taken three times a day for three weeks and then twice daily after that increases energy an average of 45 to 60 percent in patients with chronic fatigue syndrome,” says Teitelbaum. “It does not feed the yeast and has a negative glycemic index, and therefore is very helpful to increase energy. B vitamins and magnesium are also very important.”
John Salerno, MD, a chronic fatigue syndrome specialist with Patients Medical in New York City, adds that a few other natural supplements may also help with chronic fatigue syndrome symptoms. “Supplements such as L-carnitine, coenzyme Q10, vitamin B12, and L-taurine work very nicely and have no side effects,” says Dr. Salerno. Be sure to talk to your doctor before beginning any supplement regimen.
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Chronic Fatigue Syndrome and ADHD Drugs
One interesting development in the search for answers about chronic fatigue syndrome is that the drugs prescribed for attention deficit hyperactivity disorder (ADHD) may also help treat chronic fatigue syndrome. “Interestingly, the medications ritalin and dexedrine can be very helpful at lower doses in those with chronic fatigue syndrome, as they help stabilize the low blood pressure and the low dopamine levels found in chronic fatigue syndrome,” says Teitelbaum.
“I have always felt that there was an element of ADHD or ADD in CFS patients, and that is why these stimulants work so well in this population,” says Morris Papernik, MD, a specialist in chronic fatigue syndrome at the ProHealth Physicians Group in Glastonbury, Conn. “Which stimulant to use depends on your physician’s comfort level with the drug, and your response to it. For example, if you get manic on Provigil (modafinil), you probably don’t want to try anything stronger, such as Adderall (amphetamine/dextroamphetamine) or Ritalin (methylphenidate).” Some of these types of drugs have shown promise in small studies, but results are inconclusive, and they are not FDA-approved for the treatment of CFS. More study is needed before ADHD drugs are routinely used for chronic fatigue.
As with any medication, the best approach is to ask your doctor if these drugs might help you, and then work closely with him or her as you begin treatment.