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Chronic fatigue syndrome (CFS) is a condition causing persistent fatigue that lasts for at least 6 months (or longer) and isn't due to another medical condition (e.g., hypothyroidism). It was once thought to affect only highly educated young adults who are "high achievers" or career-oriented professionals. It is now known that CFS affects people of all ages and from all walks of life.

CFS is about 2 to 4 times more common in women than in men. It is associated with extreme and prolonged fatigue that isn't relieved by rest. People with CFS experience persistent tiredness so severe that it may prevent them from working, exercising, and enjoying life. CFS is a poorly understood condition and there is no clear consensus about its diagnosis and treatment.

CFS is also known as myalgic encephalomyelitis (ME) or chronic fatigue immune dysfunction syndrome (CFIDS).

CFS is only just gaining acceptance as a "real" medical condition. Until recently, many people suffering from CFS symptoms were brushed off as psychiatric cases or were told "it's all in your head."

We don't know exactly what causes CFS, but it appears to be triggered by many different factors. Viral infections, genetic predisposition, environmental toxins, and immune reactions are all considered possible causes of the disorder. The persistent tiredness was once attributed to a virus called the Epstein-Barr virus (this virus is responsible for mononucleosis) but the link remains scientifically unproven and is no longer considered a potential cause

Recent research has focused on abnormalities in the levels of certain hormones, specifically cortisol (the stress hormone) and the female sex hormones. No one knows exactly what causes the regulation of these hormones to be affected in CFS.

For some people, surgery, a head injury, or other traumas may trigger CFS. Some medications including benzodiazapines, beta-blockers, sedatives, antidepressants, and excessive use of antibiotics can cause fatigue.

It's likely that not one single factor is responsible, but rather a combination of factors. Physical activity and physical or emotional stress seems to make CFS worse. However, further research is needed to figure out its causes and to better understand this puzzling condition.

Extreme fatigue that lasts at least six months is the hallmark symptom of CFS. People are constantly exhausted and feel that their stamina is continuously low. Other symptoms include:

• mild fever
• sore throat
• tender neck with swollen lymph nodes
• decreased ability to concentrate
• muscle weakness and joint pain
• headaches
• memory and concentration problems
• difficulty sleeping

Problems with concentration and memory often occur. A person might have mental fogginess, impaired short-term memory, or the inability to concentrate to the point where regular activities are disrupted. Other symptoms such as gastrointestinal problems, sleep disorders, or abnormal body temperatures are also commonly reported.

Symptoms may be severe enough to interfere with work performance, leading to sick leave and extended periods of bed rest. The symptoms of CFS can last for several years. However, they're usually at their worst in the early stages of the illness. Some people never return to their original energy levels. Symptoms tend to reappear during times of emotional or physical stress.

Doctors use two commonly accepted sets of criteria to diagnose chronic fatigue syndrome. Both require that the individual has experienced, for at least six months, unexplained and disabling fatigue that is not relieved by rest. Fatigue is considered unexplained if a thorough physical examination and medical testing have excluded other conditions that could cause fatigue.

Other criteria necessary to diagnose chronic fatigue syndrome include mental changes such as poor memory, muscle or joint pains, headaches, tender lymph nodes, unrefreshing sleep, and worsening of symptoms after exercise.

Although there are no recommended or proven treatments to date, management of CFS includes reassurance and support about the condition and how things will improve with time. It is difficult to predict when and how much someone with CFS will improve, since this varies a great deal between individuals.

Cognitive behavioural therapy and exercise (starting slow and increasing over time) appear to produce the most benefit. A doctor will likely combine a number of different treatments aimed at addressing your specific symptoms, including:

• medical intervention and medications
• alternative therapies
• psychotherapy (cognitive behavioural therapy)
• physical and lifestyle adjustments

Since no medication has been specifically proven to cure CFS, medications are used to treat some of the symptoms that are seen with CFS. For depression, antidepressants such as selective serotonin reuptake inhibitors (SSRIs; e.g., paroxetine*, sertraline) or tricyclic antidepressants (TCAs; e.g., amitriptyline, imipramine) may be used. Antianxiety medications such as lorazepam may be used to treat anxiety. Sleeping pills, such as zopiclone, may be used to treat certain sleep disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for headaches, fever, and general aches and pains.

CFS can sometimes go away on its own. Medications should therefore be tried for short periods and then stopped, and the person's status should be reassessed before continuing with medication treatment.

Some people seek alternative therapies, including massage, acupuncture, herbal products, and dietary supplements. Herbal preparations that have been used by some people with CFS include astragalus, borage seed oil, bromelain, comfrey, echinacea, garlic, ginkgo biloba, ginseng, primrose oil, quercetin, St. John's wort, and shiitake mushroom extract.

The value of alternative remedies is questionable. With few exceptions, most of these remedies haven't been shown to be effective for treating CFS patients. Many people believe that just because herbal products are "natural" they're also safe. This isn't always true: besides containing an active compound that may have medicinal properties, unrefined plant preparations also have other substances that can harm you. Comfrey and high doses of ginseng, for example, are known to have harmful effects. As well, herbal preparations and dietary supplements can interfere with other medications you may be taking or cause side effects.

Before taking alternative remedies, talk to a doctor or pharmacist about what's safe and appropriate for your specific situation.

Psychotherapy is another strategy that can help people with CFS and their families to cope with the symptoms of CFS. Cognitive behavioural therapy may help alleviate some of the distress and concerns about CFS and its affects on your work and personal life.

Physical and lifestyle changes may also be recommended. Prolonged lack of exercise can exacerbate physical weakness. A graded exercise regimen can be a means of restoring some of the loss of energy and stamina. "Graded" exercise means starting exercise slowly and gradually increasing the amount and intensity over time.

Learning ways to manage energy levels is important; for instance, overexertion during periods of good health can lead to a return of symptoms. Finding ways to cope and deal with physical and emotional stresses can help prevent a return of CFS symptoms.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.