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Chronic Fatigue Syndrome

by Dr.Eva Bell
(Bangalore)

Tired all the time? This is a frequent complaint one hears every day. About 15-20% of the urban population suffers from unexplained fatigue for long periods of time, which is not caused by exertion nor relieved by rest. It is accompanied by psychological and social dysfunction. There are associated symptoms like lethargy, memory impairment, severe muscular pain, poor concentration, insomnia, depression or even irritable bowels. The American Centre for Disease control has defined it as “the presence of unexplained persistent fatigue not relieved by rest, and results in substantial reduction of occupation, social and personal activities.”

Though it can affect male and female of all ages and ethnic groups, it occurs mostly in the age groups of 40-50, and almost 80% are women. Some people call it the ‘Shirker’s Syndrome.’ A psychologist from Yale University calls sufferers from Chronic Fatigue Syndrome “psychopaths weak in impulse.” No one has definitely pin-pointed the cause of this fatigue, though many suppositions have been offered.

Fatigue that lasts for more than two weeks and has no obvious physical cause is seen as a case of Chronic Fatigue Syndrome. Usually the fatigue is never an isolated complaint but comes with a cluster of symptoms, some physical, some psychological. It is possible that a convergence of several factors make an individual prone to CFS. Of these, stress is usually the trigger. Depression or personality disorders seem to be closely associated with CFS.

The hypothalamic-pituitary-adrenal axis controls important functions of the body and how we react to stress, work, sleep and other external factors. Some suggest that alteration in genes which control our response to trauma or stressful events, may be a cause.

Others believe that the cause may be hormonal. In CFS, the stress hormone cortisol is found to be low. As a result, the response to external stimuli is impaired.

Changes in neurotransmitters may be caused by high levels of serotonin, deficiency in dopamine and an imbalance between dopamine and nor-epinephrine.

CFS may follow viral or other infections which make a person weak. Many date their weakness to such illnesses.

Upset in the circadian rhythm may also cause long periods of sleeplessness.

Depression or anxiety neurosis or personality disorders are often associated with CFS.

Dr.Parekh of Jaslok Hospital talks of ‘masked’ or ‘hidden’ depression especially in women.

Multiple chemical sensitivity where chemicals found in food or perfumes or drugs may lead to unexplained fatigue. Once these chemicals are removed, CFS may disappear.

Management:

This is a problem not to be taken lightly. Help must be sought as soon as possible.

• Choose a doctor who is knowledgeable and sympathetic. He should recognize that the physical symptoms have a psychiatric component and both need to be treated. Reassurance is important.

• Cognitive Behavioural Therapy will help change distorted images of one’s self. The person will learn to think differently about her stressful symptoms and learn how to cope. The therapist should be a trained person. Several sessions lasting for an hour each time may be needed. At the end of the treatment, the person will find the will power to deal with her health problems in a normal way.

• Exercise is important. Bearing in mind that the person suffers from muscular pain and fatigue, different forms of exercise should be tried out. To begin with, short periods of activity should be alternated with rest. Over a period the duration of exercise can be increased. Sudden stressful exercises should be avoided. House work, walking, cycling are good ways to exercise. Physical activity generates energy and oxygenates every part of the brain and body.

• A well balance diet with plenty of protein and carbohydrate will release steady levels of blood sugar needed for activity. Fibre rich diets, fruits and vegetables are good. Alcohol and smoking should be avoided.

• Deep breathing exercises, relaxation techniques, yoga and meditation will divert attention away from the illness.

• The family should be supportive and non-judgemental. The person must feel free to express her doubts and fears. Energy-draining friends who are always negative and dull should be avoided.

• Hobbies can keep the mind occupied.

Seasonal Affective Disorder (SAD) is seen as a form of CFS. It occurs usually during winter when there is not much sunlight outside. People become moody, irritable and lethargic. In 50% of cases this tendency is inherited. SAD victims are usually in their twenties and 75% of them are women. Light therapy improves the condition.

As Emile Coue suggested in his article “Formula of Autosuggestion.” People with CFS should be taught to say, “Everyday and every way, I am getting better and better.”

The End