Could antidepressants help those with ME after all asks Dr James Le Fanu

http://www.indymedia.org.uk/en/2003/11/281795.html

bron: The Telegraph (UK)

datum: 16/11/2003

It is always a pleasure to pass on readers' personal tips and remedies, but

what follows is in a rather different league - with the potential to

transform the lives of thousands. Chronic Fatigue Syndrome (also known as

ME - Myalgic Encephalomyelitis) must be one of the most argued over medical

conditions of all time.

Doctors in the past have been less than sympathetic, pointing out how the

wide range and severity of symptoms complained of seems quite incompatible

with the lack of objective evidence of impairment. Chronic Fatigue, it has

been alleged, is either a psychological disorder such as hypochondriasis, or

even a "malingerer's charter", an unprovable pseudo-scientific diagnosis

much favoured by the indolent and work-shy.

Then, without apologising for the offence previously given, the medical

profession changed its tune. Doctors conceded that there was clear evidence

of some abnormality of brain functions: patients sleeping patterns were

often chaotic and their "hypochondriac symptoms" were due to a disturbance

of the autonomic nervous system, which controls such crucial things as blood

pressure, body temperature and so on. But what to do about it?

It seemed logical to prescribe something that might improve the brain

function, such as the anti-depressant drug Prozac which boosts the levels of

the neurotransmitter seratonin in the brain. This did not mean that those

with Chronic Fatigue were depressed (surprisingly, in view of their

misfortune, they tend not to be), but rather "just in case" boosting the

seratonin levels might work for them as it does for those with depression.

Well, it did not, and quite unequivocally so. "Prozac has no beneficial

effect on any characteristic of Chronic Fatigue", concluded one of several

groups of researchers, writing in The Lancet. And that was pretty much the

end of that.

Thus doctors treating the condition had little alternative other than to

fall back on one or other "coping strategy", such as cognitive therapy or

graded exercises, which it was presumed must at least be better than doing

nothing. And both do appear to help a little, although not to any great

effect, and some patients quite rightly find such approaches onerous, as

they do not address the underlying problem.

This preamble is the necessary background to appreciate the significance of

a recent letter from Mrs Cynthia Floud from Hampstead, north London -

erstwhile director of an adoption agency, Justice of the Peace and wife of a

polytechnic director. Her busy life was rudely interrupted when, following a

walking holiday in Skye, she contracted 'flu from which she never fully

recovered. As a result, she spent the best part of a decade "lying in bed

listening to Radio 4, unable even to read novels as it tired me too much".

She knew all about this as, unfortunately, a couple of years earlier her

daughter had also been struck down by Chronic Fatigue, forced to pack in her

university course and return home. "We both had so little energy that if we

got upset or, conversely, quite elated, we would have to pay for it with

several days of feeling very ill."

They then read a piece in their local paper, The Ham and High, concerning Dr

Ian James from the Royal Free Hospital, who was seeking patients for a

research project into their condition. Dr James had become fascinated with

the effects of drugs on the brain ever since he had earned the gratitude of

legions of musicians by demonstrating the value of betablocker drugs in

overcoming the effects of stage fright.

Dr James's take on Chronic Fatigue was straightforward: here was a disorder

of brain function for which the best treatment must be some drug that could

correct whatever was disordered. To be sure Prozac hadn't worked, but that

did not mean that some similar drug, such as sertraline, might not do the

trick if one got the dosage right. It was all a matter of fine-tuning.

Cynthia Floud and her daughter willingly volunteered to be his guinea-pigs,

starting intially with a low dose and increasing gradually to 100mg daily.

"Nothing happened for eight weeks. Then I woke one morning feeling I had

slept heavily, just like I used to do before I was ill," Mrs Floud writes.

"My daughter was a week behind me, and I had a worrying time fearing it

might not also work for her."

Over the following weeks, as their energy levels surged, so their other

symptoms resolved as well. They then seemed to reach a plateau, but

continued to improve, albeit more slowly. It took five years in all before

"that blissful day when once again I could ride my bike through Regent's

Park hell for leather".

So why is this not common knowledge? Sadly, Dr James died before he had the

opportunity to write up his findings, which remain hidden from view,

smothered by the blanket of the prevailing medical orthodoxy which holds

that "antidepressant-type drugs do not work for Chronic Fatigue".

Cynthia Floud, now firing on all cylinders, has been vigorously promoting

his cause - but to no avail. Perhaps those intrigued by this story could

persaude their family doctor to let them give sertraline a trial. If just

half a dozen people echoed Mrs Floud's experience, I could then summarise

the results in a letter to the British Medical Journal - and who knows how

many people around the world might be grateful?