378 Chronic Fatigue Syndrome
strategies and thus may have, in some ways, bene“ted from
the experience of being ill. The “ndings are consistent with
what would be expected for persons dealing with a chronic
illness.
Despite growing knowledge about long-term predictors of
CFS outcome, uncertainty remains regarding the course of
CFS and how the syndrome impacts quality of life over time.
A review of prospective outcome studies in CFS patients
(Joyce, Hotopf, & Wessely, 1997) reveals that a majority of
patients report some improvement one and a half years to four
years after initial medical evaluation, although substantial re-
covery occurs in less than 10% of cases. Also, one-fourth to
one-third of CFS patients report worsening illness over time.
The summary article by Joyce et al. (1997) concluded that
psychiatric disorder and patient belief in a physical cause for
their symptoms were predictors of poor outcome in every
study. However, as Hedrick (1997) noted, •Some studies
found no prospective relationships; others found relation-
ships on only one or a few of numerous factors; and different
factors were found to be signi“cant in different studies. More
importantly, the strength of such relationships is often so low
to be of little signi“cance in either understanding the etiology
of CFS or guiding its treatmentŽ(p. 724).
TREATMENT
Pharmacological and Alternative Treatments
Pharmacological (e.g., Prozac, Serzone, Klonopin, Ampli-
gen) and alternative treatments (SAM-e, NADH, massage,
acupuncture, malic acid, and magnesium) represent two
avenues that may lead to alleviation of the severity of some,
but not all, of the symptoms of CFS (Taylor, Friedberg, &
Jason, 2001).
The most well-known treatment involves Ampligen, an
immune system modulator. Ampligen signi“cantly improved
functional status and reduced symptoms in severely disabled
CFS patients in a double blind placebo controlled study
(Strayer et al., 1994). A subsequent clinical study of Ampli-
gen (Strayer, Carter, Strauss, Brodsky, & Suhadolnik, 1995)
in 15 severely disabled CFS patients found sustained
improvements over a 48-week period in functional status,
cognitive function, and exercise tolerance. Also, reductions
were found in human herpesvirus-6, a herpesvirus that may
play a role in CFS pathogenesis (Strayer et al., 1995). The
treatment is recommended for those patients with sudden
onset of symptoms who have cognitive de“cits. However, it
is a highly controversial drug that has also been anecdotally
reported to be associated with highly negative long-term
physical health consequences (Kansky, 2000). Potential ben-
e“ts reported by patients with sudden illness onset, signi“-
cant limitations in performing activities of daily living, and
cognitive impairment include signi“cant increases in ener gy
and the ability to perform activities of daily living, reduction
in pain, return of immune system functioning to normal
range, and signi“cant improvement in cognitive functioning.
It is important to note that this drug is still in an experimental
phase, and the exact percentage of patients who will bene“t
substantially, if at all in the long term, is yet to be determined.
In short-term studies, use of Ampligen has been found to pro-
duce the following side effects, which tend to occur during
the “rst three months of treatment: initial worsening of nau-
sea, dizziness, headaches, and pain. Ampligen is available in
the United States and Brussels on an experimental basis only
and is extremely expensive. One year of treatment currently
costs over $14,500. Thus, not all individuals with CFS will
have access to this medication (Taylor, Friedberg, & Jason,
2001).
There have also been several rather controversial trials of
providing hydrocortisone, based on the hypothesis that hy-
percortisolism is a contributing factor to CFS. A study by
McKenzie et al. (1998) found that a dosage of 25 to 35 mg re-
sulted in only minimal therapeutic improvements while caus-
ing substantial adrenal suppression. In contrast, a study by
Cleare et al. (1999), which used a lower dose (5 mg or 10 mg
daily of hydrocortisone) led to signi“cant reductions in self-
rated fatigue and disability in patients with CFS, and there
was no compensatory suppression of endogenous cortisol
production. More research needs to be conducted in this area.
Use of most pharmacological and alternative treatments
with individuals with CFS has not yet been adequately and
systematically studied (Reid, Chalder, Cleare, Hotopf, &
Wessely, 2000), and preliminary studies have demonstrated
varying degrees of ef“cacy depending on the speci“c symp-
tom of the condition being treated. It should be cautioned that
pharmocological and alternative treatments were not de-
signed speci“cally to treat CFS and should be best considered
as palliative in treating isolated symptoms only (e.g., pain,
sleep, headache, and possibly fatigue and cognitive problems
in some circumstances). Ongoing consultation with and care-
ful monitoring by a physician or alternative medicine spe-
cialist highly experienced in the treatment of these conditions
are strongly recommended before beginning therapy with
any of these agents.
Regardless of the medication described, very few pharmo-
cological agents have been well-established as effective
(Reid et al., 2000), and what works well for one person may
not be tolerated by, or may be ineffective for, another person.
Reports by patients of hypersensitivity or negative reactions