[Therapeutic guidelines in chronic fatigue syndrome]

The treatment of CFS is not definitive up till now and it is limited both by ignorance of its causes and by different applicable operative case definitions. It has been etiopathologically related to infectious agents, neuromuscular illnesses, neuro-endocrinous-immunologic alterations and to different psychiatric disorders, particularly depressive disorders. Consequently, a great variety of therapeutic strategies have been tried, most of them with insufficient results. Among the medicamentous ones: immunity activator agents such as recombinant interleukin-2, nonspecific immunitary modulators such as seric gamma globulin, antivirus drugs such as acyclovir, muscular relaxants such as ciclobenzaprine, H2 receptor blockers and steroid and nonsteroid anti-inflammatory drugs such as ibuprofen, naproxen and fulbiprofen. Better results seem to have been obtained with antidepressants, and amfebutamone and serotonin-reuptake selective inhibitors are specially promising. Among the nonmedicamentous strategies, cognitive behavioural treatment can be effective and the so called "psychiatric management of the patient with CFS" has been proposed as a global, pragmatic, individualized, comprehensive approach which must be completed with other interdisciplinary interventions on the patient and his environment.