Wessely, S · L'Encephale · 1994
This review examines ME/CFS by comparing it to an older condition called neurasthenia and explores what causes the illness. The authors suggest that ME/CFS likely involves multiple factors including brain chemistry changes, difficulty perceiving effort, mood problems, and reduced physical activity—rather than being purely psychological or a muscle problem. They recommend cognitive-behavioral therapy (gradual activity increase) and antidepressants as the main treatments, while warning that too much rest can actually make the condition worse long-term.
This review addresses the long-standing debate about ME/CFS etiology and management during a period of significant controversy in the field. By proposing a multifactorial model and questioning the role of excessive rest, it contributes to evolving clinical perspectives on how the condition should be approached therapeutically.
This review does not provide empirical evidence for its proposed multifactorial model, as it is a narrative synthesis rather than a controlled study. It does not establish causal relationships between the proposed factors and ME/CFS, nor does it present comparative efficacy data for the recommended treatments. The reliance on historical comparison with neurasthenia does not prove mechanistic similarity between the conditions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Wessely, S (1994). [Chronic fatigue syndrome. Clinical, social psychological problems and management].. L'Encephale. https://pubmed.ncbi.nlm.nih.gov/7843055/
BibTeX
@article{mecfsatlas-wessely-1994-chronic-fatigue,
author = {Wessely, S},
title = {[Chronic fatigue syndrome. Clinical, social psychological problems and management].},
journal = {L'Encephale},
year = {1994},
note = {PubMed: 7843055},
url = {https://www.mecfsatlas.com/evidence/wessely-1994-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/wessely-1994-chronic-fatigue
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