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Doctors' Answers to "Frequently Asked Questions" - Chronic Fatigue Syndrome

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Chronic Fatigue Syndrome - Wellbutrin vs. Prozac
Question: I've been diagnosed as clinically depressed and also having chronic fatigue syndrome. One doctor prescribed Prozac and another suggested Wellbutrin. Which do you think may be better? I was on serzone for several months and was very angry all the time, was still depressed, and got a rash on my face, arms, and back.

Answer: Technically, you can't be diagnosed as having depression and chronic fatigue. That is because the definition of chronic fatigue excludes other diseases being present. Having said that, there are clearly individuals who probably have both. Concerning the antidepressants, you will have to try them and see the effects on you individually. I would probably start with Wellbutrin, since there is some correlation between Serzone and Prozac in their effect. Wellbutrin is a completely different class of drug.

Swollen Glands
Question: I have Chronic Fatigue Syndrome/FM. I'm wondering if there is any treatment to provide symptomatic relief of swollen glands in the neck? Also, what can one do for muscle spasms? I have tried and cannot tolerate Flexoril and Robaxicet.

Answer: Chronic Fatigue Syndrome is a chronic disorder characterized try several diagnostic criteria. One of these is recurrent swollen lymph nodes in the neck and sore throats. Treatment of these nodes is symptomatic. That is, using acetaminophen, heat, and non-steroidal anti-inflammatories for the discomfort, as much as you would for any non-specific sore throat. The muscle spasms are difficult to treat. Occasionally increasing deep sleep with anti-depressants like Elavil will be useful.

Chronic Fatigue/Epstein Barr
Question: I am thinking about dating someone who has been diagnosed with Epstein Barr/chronic fatigue syndrome. Can I become infected by french-kissing her? I read that after a certain age you are not as susceptible or you have already been exposed and have developed antibodies. I am 42 years old, and in excellent health.

Answer: Chronic Fatigue does not appear to have any relationship to Epstein-Barr. This was an initial idea, but not backed up by any subsequent research. We do not know the cause of chronic fatigue and it may well be infectious. However, EB virus is not the agent.

Chronic Fatigue Syndrome
Question: I've been diagnosed as having CFS for 12 months. During this time I have suffered from general flu-like symptoms, as well as fatigue and muscle pain on exertion. Lately I have been suffering from a sore, swollen throat and slight temperatures all of the time, even when I don't exert myself. My tongue appears swollen on one side. I have had a throat swab but it was negative, showing no growth. Is it possible that this could be triggered by some form of food allergy or even influenced by hormones? My doctor is at a loss and has referred me to a consultant endocrinologist. In the past two months I have been suffering constantly with a sore throat and a course of Erythroped A did nothing to alleviate my symptoms. I am a medical student at St. Bartholomew's Hospital in London and am having trouble continuing with the course just with the CFS, but the throat problems are hindering my studies even more. Do you have any suggestions about what the problem may be or further tests I should have?

Answer: One of the diagnostic criteria for chronic fatigue syndrome is exactly this type of recurring sore throat. So far we have no idea what causes it. You might try some other methods. Ensure that there is no reflux, for example. Focus on non-infectious causes for the sore throat. In the past, treatment of the pharyngitis of CFS has been of little benefit.
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