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Cognitive behaviour therapy and exercise are the only effective treatments for chronic fatigue, says study

BMJ 2002; 324 doi: (Published 01 June 2002) Cite this as: BMJ 2002;324:1298
  1. Zosia Kmietowicz
  1. London

    Cognitive behaviour therapy and graded exercise are the only treatments that have proved to be effective for chronic fatigue syndrome and myalgic encephalomyelitis, say researchers.

    There is insufficient evidence that all the other treatments often used in patients with chronic fatigue—including immunological and antiviral therapy, drugs (antidepressants, corticosteroids, anticholinergic agents), and homoeopathy—work, says the review of evidence carried out by the NHS Centre for Reviews and Dissemination at the University of York.

    But the review says that it is unclear whether combining treatments may gives better outcomes and how different groups of patients respond.

    Young people aged under 18 years and people confined to bed or a wheelchair are two groups that have been excluded from trials, and it is uncertain whether even graded exercise and cognitive behavioural therapy work in these patients.

    The review, published as part of the Effective Health Care series, is the third analysis of treatment for chronic fatigue in the last eight months. In September a report published in JAMA (2001;286:1360-8), which summarised two of the three analyses, found similar results. The current review was produced jointly by the York team and US investigators from the San Antonio Evidence-based Practice Center at the University of Texas Health Science Center.

    However, the latest assessment, which will be available free to all NHS staff, should help UK doctors in particular understand how they can help patients with chronic fatigue, said Professor Simon Wessely, professor of epidemiological psychiatry at King's College, London.

    Dr Anne-Marie Bagnall, one of the authors of the research, commented: “We are pleased to be able to make the results of our research available to the NHS and hope that they will be of use in helping health professionals make decisions about the treatment of patients with this condition. However, there is a large amount of work still to be done in evaluating the interventions that are currently available.”

    Tony Britton, a spokesperson for the ME Association, welcomed the review, but said that for some long-term, severely ill patients the advice to exercise might be inappropriate. “This material is a welcome addition to the information being made available to GPs,” he said. “But we are still waiting for a definitive statement on management guidelines from NICE, which we expect to be produced in the next two years.”

    Interventions for the Management of CFS/ME is available free to NHS staff from the NHS Centre for Reviews and Dissemination (revdis{at}, tel 01904 433634) or at

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