A practical approach to chronic fatigue syndrome

Chronic fatigue may have several physical causes, but a psychiatric condition is often involved. A substantial minority of patients are not diagnosed by conventional tests and do not respond to antidepressant therapy. These patients should be referred for psychiatric opinion or observed for new developments. Extensive virologic testing and unorthodox treatment approaches have no scientific basis at present. Claims of dramatic new diagnostic tests or therapy should be treated with caution because of the long history of unsuccessful attempts to categorize chronic fatigue into one diagnosis and the strong placebo effect shown in controlled trials.