Treatments & Approaches

There’s no single approved cure for ME/CFS yet, but many people benefit from a mix of pacing, orthostatic intolerance management, sleep and pain support, and carefully selected therapies. Responses vary—go low and slow, and work with a clinician.

⚠️ IMPORTANT MEDICAL DISCLAIMER

This content is for educational purposes only and is NOT medical advice. All treatments should be discussed with a qualified healthcare provider. Individual responses vary - what works for one person may not work for another. Always consult your doctor before making any medical decisions.

Pacing (Energy Management)

Core

Foundational strategy to avoid post-exertional malaise (PEM): balance activity and rest to stay within your energy envelope.

Track triggers and delayed crashes (often 24–48h later).
Use heart-rate pacing or activity caps to prevent overexertion.
Prioritize tasks, pre-emptive rest, and gentle, spread-out routines.

Orthostatic Intolerance (OI) Treatments

For symptoms that worsen upright (lightheadedness, palpitations, ‘brain fog’). Treating OI can meaningfully improve function.

Non-Rx: fluids, salt (if safe), compression garments, reclined work.
Medications (discuss with a clinician): fludrocortisone, midodrine, beta-blockers, ivabradine, pyridostigmine.
Screen with active stand / NASA lean; consider autonomic referral.

Caution: Medication choice depends on blood pressure/heart rate phenotype; requires medical supervision.

Low-Dose Naltrexone (LDN)

Immune-modulating therapy (commonly 0.5–4.5 mg) reported to help pain, sleep, and sometimes cognition for some patients.

Start low, titrate slowly to tolerance.
Often compounded; nighttime dosing is common.
Monitor for vivid dreams, insomnia, or headaches early on.

Caution: Evidence is emerging; responses vary. Avoid with opioids (may block analgesia).

Low-Dose Aripiprazole (LDA)

Experimental

Very low doses (e.g., 0.25–2 mg) have anecdotal/early reports of benefit for fatigue and PEM in some individuals.

Start extremely low and move slowly if tried.
Track benefits vs. side effects carefully.
Consider only with a clinician familiar with risks.

Caution: Potential adverse effects (akathisia, restlessness, metabolic changes). Evidence remains limited.

Antivirals (selected cases)

In a subset with documented herpesvirus reactivation, antivirals (e.g., valganciclovir, famciclovir) may be considered by specialists.

Use only after targeted testing and clinical evaluation.
Regular labs may be required to monitor safety.
Benefits are mixed; best in carefully selected patients.

Caution: Prescription-only with non-trivial risk profiles; specialist oversight recommended.

Mitochondrial Support

Supportive

Nutrient support aimed at cellular energy metabolism; some patients report incremental benefits.

Common options: CoQ10/Ubiquinol, magnesium, riboflavin (B2), B12, acetyl-L-carnitine, creatine, NAD+/niacin.
Address deficiencies first (e.g., vitamin D, iron/ferritin).
Introduce one at a time; keep a response log.

Caution: Evidence quality varies; watch for interactions and over-supplementation.

Complementary & Relaxation Therapies

Supportive

Gentle mind-body and complementary approaches that may aid stress reduction, sleep, or pain relief when used appropriately.

Examples: meditation, acupuncture, gentle massage, restorative yoga, breathing exercises.
Use only low-intensity, non-exertional forms; avoid pushing past energy limits.
May improve well-being, anxiety, or sleep; not disease-modifying.

Caution: Evidence is limited; avoid overexertion or programs claiming cure.

General Supplements & Symptom Aids

Supportive

Targeted supplementation may help sleep, pain, or inflammation for some people.

Examples sometimes used: vitamin D repletion, omega-3, magnesium glycinate, melatonin, antihistamines for MCAS-like symptoms (discuss with a clinician).
Treat comorbidities (e.g., anemia, thyroid, sleep apnea) when present.
Start low/slow; avoid frequent changes to see true effects.