Evidence browser

E0 ConsensusReviewPEM unclearObservational

Behavior problems in children and adolescents with chronic physical illness: a meta-analysis.

Pinquart, Martin, Shen, Yuhui·Journal of pediatric psychology·2011

This large review of 569 studies found that children and teenagers with chronic physical illnesses—including ME/CFS—experience higher rates of emotional and behavioral problems compared to healthy peers. Children with ME/CFS showed particularly high levels of emotional problems like anxiety and depression. The review emphasizes that doctors should routinely screen young patients with chronic illnesses for psychological distress and refer them to mental health services when needed.

Cognitive Impairment

Treating chronic fatigue syndrome - a study into the scientific evidence for pharmacological treatments.

Kreijkamp-Kaspers, Sanne, Brenu, Ekua Weba, Marshall, Sonya et al.·Australian family physician·2011

This study looked at what medicines and supplements 94 people with ME/CFS were taking and checked what scientific evidence supported their use. The patients were using hundreds of different treatments, with antidepressants, pain relievers, sleep aids, and B vitamins being the most common. However, when researchers searched for rigorous studies proving these treatments work for ME/CFS, they found very limited evidence—only 20 good-quality trials existed for the medicines patients were using.

E0 ConsensusReviewPEM not requiredSystematic-Review

Daily physical activity of patients with the chronic fatigue syndrome: a systematic review.

Evering, Richard M H, van Weering, Marit G H, Groothuis-Oudshoorn, Karin C G M et al.·Clinical rehabilitation·2011

This review looked at 17 studies comparing how physically active people with ME/CFS are compared to healthy people. The research found that people with ME/CFS are significantly less active than healthy controls—doing only about 68% of the physical activity of healthy people. The studies also found that day-to-day variation in activity levels was similar between the two groups.

Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis.

Pinquart, Martin, Shen, Yuhui·Journal of pediatric psychology·2011

This large review looked at 340 studies to see whether children and teens with chronic illnesses experience more depression than healthy children. The researchers found that on average, children with chronic illnesses do report higher levels of depression, with ME/CFS showing the strongest link. The study recommends that doctors working with chronically ill children routinely check for depression and refer them to mental health support when needed.

E0 ConsensusReviewPEM not requiredSystematic-Review

Anxiety in children and adolescents with chronic physical illnesses: a meta-analysis.

Pinquart, Martin, Shen, Yuhui·Acta paediatrica (Oslo, Norway : 1992)·2011

This large review combined results from 332 studies to compare anxiety levels in children with chronic illnesses versus healthy children. Children with chronic illnesses, including ME/CFS, showed higher levels of anxiety than their healthy peers. ME/CFS was among the conditions most strongly linked to anxiety in children.

Hypothalamic-pituitary-adrenal axis dysfunction in chronic fatigue syndrome.

Papadopoulos, Andrew S, Cleare, Anthony J·Nature reviews. Endocrinology·2011

ME/CFS patients often have abnormal levels of cortisol, a stress hormone produced by the body. This review found that people with ME/CFS tend to have lower cortisol levels than healthy people, with less variation throughout the day and a weaker response to stress. These hormone changes are linked to worse symptoms and disability, and treatments like cognitive behavioral therapy may help restore more normal cortisol levels.

Endocrine Disruption

E0 ConsensusReviewPEM not requiredSystematic-Review

Mindfulness-based stress reduction for people with chronic diseases.

Merkes, Monika·Australian journal of primary health·2010

This review looked at 15 studies testing whether mindfulness meditation programs (called MBSR) help people with chronic illnesses feel better. The studies included people with ME/CFS, fibromyalgia, chronic pain, and other long-term conditions. All 15 studies found that people who participated in these programs experienced improvements in their symptoms, mood, and quality of life, with no negative effects reported.

E0 ConsensusReviewPEM unclearReview-Narrative

Psychiatric aspects of chronic fatigue syndrome and fibromyalgia.

Van Houdenhove, Boudewijn, Kempke, Stefan, Luyten, Patrick·Current psychiatry reports·2010

This review examines how ME/CFS and fibromyalgia are connected to psychiatric symptoms like depression and stress. The authors explain that these conditions involve overlapping physical symptoms—extreme tiredness, difficulty with activity, brain fog, and widespread pain—that often start after infections or injuries. They suggest that the best approach for patients is personalized lifestyle management and self-care tailored to individual needs, rather than a one-size-fits-all treatment.

Sleep

Cognitive functioning in chronic fatigue syndrome: a meta-analysis.

Cockshell, S J, Mathias, J L·Psychological medicine·2010

This study combined results from 50 research papers to understand how ME/CFS affects thinking and memory. Researchers found that people with ME/CFS have real, measurable problems with attention, memory, and processing speed—essentially, the brain takes longer to handle and organize information. However, other thinking skills like vocabulary, reasoning, and basic motor skills were not affected.

Cognitive Impairment

Chronic fatigue syndrome: is there a role for non-antidepressant pharmacotherapy?

Van Houdenhove, Boudewijn, Pae, Chi-Un, Luyten, Patrick·Expert opinion on pharmacotherapy·2010

This review examined whether medications can help ME/CFS patients. Researchers looked at studies from 1988 to 2009 and found that while some drugs (like antivirals and antibiotics) might temporarily help symptoms, they can also cause more harm than good. A few stimulant medications helped some patients, but the long-term safety is unclear. The authors concluded that medications alone are not the best first-line treatment and work best alongside self-management and rehabilitation.

Possible detrimental effects of cognitive behaviour therapy for chronic fatigue syndrome.

Heins, Marianne J, Knoop, Hans, Prins, Judith B et al.·Psychotherapy and psychosomatics·2010

This study looked at whether cognitive behaviour therapy (CBT) makes ME/CFS worse for some patients. Researchers combined data from three separate trials and found that patients getting CBT were no more likely to experience symptom worsening than patients not receiving treatment. The researchers concluded that CBT appears to be a safe treatment for ME/CFS.

E0 ConsensusReviewPEM not requiredSystematic-Review

Clinical uses of melatonin: evaluation of human trials.

Sánchez-Barceló, E J, Mediavilla, M D, Tan, D X et al.·Current medicinal chemistry·2010

This review looked at 20 years of clinical trials testing whether melatonin (a natural hormone that regulates sleep) could help treat various diseases. The researchers found that melatonin appears to be safe and helpful for sleep problems and certain conditions, but more research is needed to confirm whether it helps with chronic fatigue syndrome and other illnesses.

Sleep

The genetics and epigenetics of fatigue.

Landmark-Høyvik, Hege, Reinertsen, Kristin V, Loge, Jon H et al.·PM & R : the journal of injury, function, and rehabilitation·2010

This study reviewed scientific literature to understand whether genetics (inherited traits) and epigenetics (chemical changes that affect how genes work) influence fatigue in people with ME/CFS and other conditions. The researchers found that while some biological systems appear to malfunction in people with persistent fatigue, no clear genetic or epigenetic markers have been reliably identified yet. The authors argue that future research needs to be larger, better-designed, and consider how genes, environment, and body systems work together.

Endocrine DisruptionBiomarkers

E0 ConsensusReviewPEM unclearSystematic-Review

Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia.

Porter, Nicole S, Jason, Leonard A, Boulton, Aaron et al.·Journal of alternative and complementary medicine (New York, N.Y.)·2010

This review looked at 70 research studies testing complementary and alternative treatments for ME/CFS and fibromyalgia. The researchers found that most studies (86%) reported at least some positive effect from the treatments tested, with acupuncture, meditation practices, and supplements like magnesium and L-carnitine showing the most promise. However, the quality of these studies varied widely, making it difficult to draw firm conclusions about which treatments actually work.

E0 ConsensusReviewPEM requiredReview-Narrative

A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS): CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS.

Twisk, Frank N M, Maes, Michael·Neuro endocrinology letters·2009

This review challenges the common medical recommendation to treat ME/CFS with cognitive behavioral therapy (CBT) and graded exercise therapy (GET). The authors argue that these treatments are not effective for ME/CFS and may actually harm many patients by worsening their symptoms, particularly through exercise-induced post-exertional malaise—a characteristic crash that occurs after physical activity. Instead, the review suggests that ME/CFS has biological causes that make intense exercise potentially dangerous rather than therapeutic.

Post-Exertional Malaise

E0 ConsensusReviewPEM unclearSystematic-Review

Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity.

Panossian, Alexander, Wikman, Georg·Current clinical pharmacology·2009

This review examined whether herbal supplements called adaptogens can help with fatigue and ME/CFS. Researchers found that some adaptogens—particularly Rhodiola rosea—showed promise in clinical studies for improving attention, thinking, and mental energy in people with fatigue and chronic fatigue syndrome. The review suggests these herbs may work by helping the body manage stress through changes in specific stress-response proteins and hormones.

Cognitive Impairment

The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review.

Drachler, Maria de Lourdes, Leite, Jose Carlos de Carvalho, Hooper, Lee et al.·BMC public health·2009

This review looked at 32 studies involving over 2,500 people with ME/CFS to understand what kind of support they need most. The research found that people with ME/CFS want help understanding their illness and getting a diagnosis, respect from doctors and healthcare workers, support from family and friends, reliable information about the condition, and practical strategies to manage their symptoms and stay connected with others. The most important finding was that healthcare providers and those around patients need to truly understand ME/CFS and respond with compassion to help people rebuild their lives.

[A meta analysis on randomized controlled trials of acupuncture treatment of chronic fatigue syndrome].

Wang, Jing-jing, Song, Yu-jing, Wu, Zhong-chao et al.·Zhen ci yan jiu = Acupuncture research·2009

This review analyzed 28 studies testing whether acupuncture helps people with ME/CFS. Researchers combined results from randomized controlled trials (the gold standard for testing treatments) and found that patients receiving acupuncture reported better outcomes than those in control groups. However, the authors note that more high-quality studies are needed to confirm these findings.

[Etiology of functional somatic syndromes].

Nakao, Mutsuhiro·Nihon rinsho. Japanese journal of clinical medicine·2009

This review explores why people develop functional somatic syndromes—a group of conditions including ME/CFS, fibromyalgia, and irritable bowel syndrome that cause real suffering but don't show clear structural damage on standard tests. The authors suggest that mood, stress sensitivity, genetics, and environment all play important roles in these conditions, and that how patients interact with their doctors matters too.

Autonomic Nervous System