In spite of a great deal of attention over the last several years, Chronic Fatigue Syndrome remains a diagnostic and treatment dilemma. Over that past 2 years, a combined effort involving the departments of Neuropsychology, Immunology and Medicine has been underway at UCLA to help answer some of these questions. The focus of the research has been to attempt to find possible links between certain alterations in brain chemistry and the effects that these abnormalities may have on immune function. Combined with the basic research, has been a study of several drugs thought to be useful in this order.

So far, early results point to the possibility that an initial alteration in certain neurotransmitters in the brain may lead to an overstimulation in the immune system. The increased production of certain immuno-chemicals such as interferon and one or more of the interleukins may account for many if not all of the symptoms of CFS.

While the event or events which trigger the onset of the disease are still unknown, the study has revealed certain factors which appear to be important.

1) A genetic pre-disposition to acquiring CFS seems to be necessary. This may be the reason that there is a large female to male predominance in this disorder. The possible linkage of susceptibility to CFS and certain personality traits also seems to follow the same pattern of other diseases with strong genetic components such as gout and arthrosclerosis (hardening of the arteries).

2) The link between CFS and certain viral infections has been an intriguing one. Most of the patients studied at UCLA have had CFS appear following an infectious disease. Of interest, however, has been that while 60-70% of patients seem to develop CFS following a viral illness, we have also found CFS developing after bacterial infections and, in several patients, parasitic diseases. It is therefore likely that any infectious challenge to the body may be sufficient to initiate the illness.

3) Psychologic stressors have proved to also be an important trigger of the disease. It appears that both physical and psychological stressors must come together in a susceptible person to initiate chemical changes.

These in turn may lead to an over stimulation of the immune system and the production of increased levels of certain immune chemicals in the early stages of CFS. A scheme of these proposed interactions appears at right.

Of greatest practical interest to persons suffering with CFS has been the ongoing drug trials at UCLA. The drugs chosen for the study have been those that were thought to combat one or more of the previously mentioned aspects of this disorder.

Although antihistamines and non-specific moderators of the immune system such as gamma-globulin have shown some partial effects, the most promising results have come from the use of some of the tricyclic compounds. One drug in particular, Sinequan (doxepin), in a pilot study involving 50 patients has shown positive results in 87% of these cases. A larger study involving 150 patients using this drug as well as placebo controls is currently underway.

It appears that drugs like Sinequan can balance the levels of certain neurotransmitters within the brain possibly stopping the adverse interactions between the brain and the immune system. Of interest, receptors to those chemicals known to be affected by Sinequan have been found on the surface of the lymphocytes, the cells most involved in the body's immune reactions. The results of the pilot study will soon be published allowing for critical review of this information.

Because of the increasing numbers of patients who have responded dramatically to this treatment, a group has been established comprised of patients who appear recovered from CFS. They have been speaking to various CFS support groups in an attempt to share their experiences and provide some measure of hope that recovery from this illness can be achieved. We have found this to be a most gratifying area of our project and hope to see it expanded rapidly over the next few months.

While many questions remain unanswered regarding CFS, we feel that significant progress is being made by our project as well as a number of others and that increasing numbers of sufferers of CFS may now begin to see advances in the understanding, diagnosis and, most importantly, treatment of this disorder. (Reprinted from "Reporter" Vol XIV, 1990. Newsletter of the CFIDS Society International, Portland, Oregon, USA.)

Ed: Sinequan is also used to treat depression, but the doses usually used in trials with CFS patients were much lower than those used to treat depression. Information on exact dosages and treatment durations should be made available in the near future, as the article stated.

Reprinted from Emerge, September 1990.