# Sertraline treatment



## Ian (Apr 18, 1999)

Interesting article in today's Sunday Telegraph by Dr James Le Fanu.Basically, Dr Ian James from the Royal Free Hospital in North London (scene of the 'Royal Free Disease' outbreak many years ago) was researching with volunteers with CFS the use of the SSRI drug Sertraline.The article reports on the history of two patients who experienced dramatic improvement over a period of time. Unfortunately the Dr's research is not widely known because he died before he had chance to write up his findings; further, they tend to go against the view that 'anti-depressant drugs don't work for Chronic Fatigue'Dr Fanu's article ends by suggesting that readers with CFS request the drug from their GP & report back to Dr Fanu who could then write to the British Medical Journal if results are favourable.Ian


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## Clair (Sep 16, 2000)

Hmmm - well sorry to burst the proverbial bubble but I have ME/CFS and I was prescribed sertralin amongst other SSRI's and didnt get any improvement... my endocrinologist suggests that SSRI treatment for CFS is very much hit and miss and is probably more the case that those individuals who improve are actually dealing with depression.... but I suppose its worth a shot.


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## Ian (Apr 18, 1999)

Yes, it does sound somewhat too good to be true, although Dr. James' view was that what was important was fine tuning of dosage of the Sertralin.Ian


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## Susan Purry (Nov 6, 2001)

Here's the original Telegraph article: http://www.telegraph.co.uk/health/main.jht...xhfeatures.html


> quote:*In sickness and in health: chronic fatigue*(Filed: 16/11/2003) *Could antidepressants help those with ME after all, asks Dr James Le Fanu* It is always a pleasure to pass on readers' personal tips and remedies, but what follows is in a rather different league - with the potential to transform the lives of thousands. Chronic Fatigue Syndrome (also known as ME - Myalgic Encephalomyelitis) must be one of the most argued over medical conditions of all time.Doctors in the past have been less than sympathetic, pointing out how the wide range and severity of symptoms complained of seems quite incompatible with the lack of objective evidence of impairment. Chronic Fatigue, it has been alleged, is either a psychological disorder such as hypochondriasis, or even a "malingerer's charter", an unprovable pseudo-scientific diagnosis much favoured by the indolent and work-shy.Then, without apologising for the offence previously given, the medical profession changed its tune. Doctors conceded that there was clear evidence of some abnormality of brain functions: patients sleeping patterns were often chaotic and their "hypochondriac symptoms" were due to a disturbance of the autonomic nervous system, which controls such crucial things as blood pressure, body temperature and so on. But what to do about it?It seemed logical to prescribe something that might improve the brain function, such as the anti-depressant drug Prozac which boosts the levels of the neurotransmitter seratonin in the brain. This did not mean that those with Chronic Fatigue were depressed (surprisingly, in view of their misfortune, they tend not to be), but rather "just in case" boosting the seratonin levels might work for them as it does for those with depression.Well, it did not, and quite unequivocally so. "Prozac has no beneficial effect on any characteristic of Chronic Fatigue", concluded one of several groups of researchers, writing in The Lancet. And that was pretty much the end of that.Thus doctors treating the condition had little alternative other than to fall back on one or other "coping strategy", such as cognitive therapy or graded exercises, which it was presumed must at least be better than doing nothing. And both do appear to help a little, although not to any great effect, and some patients quite rightly find such approaches onerous, as they do not address the underlying problem.This preamble is the necessary background to appreciate the significance of a recent letter from Mrs Cynthia Floud from Hampstead, north London - erstwhile director of an adoption agency, Justice of the Peace and wife of a polytechnic director. Her busy life was rudely interrupted when, following a walking holiday in Skye, she contracted 'flu from which she never fully recovered. As a result, she spent the best part of a decade "lying in bed listening to Radio 4, unable even to read novels as it tired me too much".She knew all about this as, unfortunately, a couple of years earlier her daughter had also been struck down by Chronic Fatigue, forced to pack in her university course and return home. "We both had so little energy that if we got upset or, conversely, quite elated, we would have to pay for it with several days of feeling very ill."They then read a piece in their local paper, The Ham and High, concerning Dr Ian James from the Royal Free Hospital, who was seeking patients for a research project into their condition. Dr James had become fascinated with the effects of drugs on the brain ever since he had earned the gratitude of legions of musicians by demonstrating the value of betablocker drugs in overcoming the effects of stage fright.Dr James's take on Chronic Fatigue was straightforward: here was a disorder of brain function for which the best treatment must be some drug that could correct whatever was disordered. To be sure Prozac hadn't worked, but that did not mean that some similar drug, such as sertraline, might not do the trick if one got the dosage right. It was all a matter of fine-tuning.Cynthia Floud and her daughter willingly volunteered to be his guinea-pigs, starting intially with a low dose and increasing gradually to 100mg daily. "Nothing happened for eight weeks. Then I woke one morning feeling I had slept heavily, just like I used to do before I was ill," Mrs Floud writes. "My daughter was a week behind me, and I had a worrying time fearing it might not also work for her."Over the following weeks, as their energy levels surged, so their other symptoms resolved as well. They then seemed to reach a plateau, but continued to improve, albeit more slowly. It took five years in all before "that blissful day when once again I could ride my bike through Regent's Park hell for leather".So why is this not common knowledge? Sadly, Dr James died before he had the opportunity to write up his findings, which remain hidden from view, smothered by the blanket of the prevailing medical orthodoxy which holds that "antidepressant-type drugs do not work for Chronic Fatigue".Cynthia Floud, now firing on all cylinders, has been vigorously promoting his cause - but to no avail. Perhaps those intrigued by this story could persaude their family doctor to let them give sertraline a trial. If just half a dozen people echoed Mrs Floud's experience, I could then summarise the results in a letter to the British Medical Journal - and who knows how many people around the world might be grateful?


And here's some feedback from Dr Charles Shepherd. It was posted to the Co-Cure email list (www.co-cure.org):


> quote:MAY BE REPOSTEDI've only just been scanning through the various postings about the itemin the Sunday Telegraph regarding the use of sertraline/Lustral inchronic fatigue. And by strange co-incidence the role of serotonin (thebrain chemical that this drug affects) was one of the topics discussedat the Melvin Ramsay Society meeting last Friday.We've known for some time that serotonin is one of the brain chemicalsthat is almost certainly involved in ME/CFS but it doesn't appear thatSSRIs/selective serotonin reuptake inhibitors (ie drugs likesertraline/Lustral and fluoxetine/Prozac) are the magic answer to anytype of chronic fatigue. In fact, a very large randomised controlledtrial into the use of fluoxetine in ME/CFS, which was published in TheLancet some time ago, found no obvious benefits.But what is interesting is that people with ME/CFS appear to respond ina variety of ways if you increase their levels of brain serotonin byprescribing one of the SSRI drugs. Some people are extremely sensitiveto very low doses (ie half the normal starting dose/25mg of Lustral) andI know from trying this drug on myself that it made me feel awful withdepersonalisation, diarrhoea, dizziness and sweating. So if a doctor isgoing to prescribe an SSRI to anyone with ME/CFS it should usually becommenced at the lowest possible dose and then increased very gradually.There is, however, quite a lot of anecdotal evidence to suggest that asmall sub-group of pwme/cfs do benefit from the use of SSRIs - not justfor co-existent clinical depression. And this suggests that there maybe pwme/cfs who have low (downregulated), normal, and raised(upregulated) levels of serotinin. The problem is that we don't, atpresent, have any way of accurately identifying which group peoplebelong to - something which would give doctors a much better clue as towhether an SSRI might be worth a try. So this is clearly an area ofcausation/management which is worthy of further research.I think it was Professor Dedra Buchwald who referred to the latestpublished research study into serotonin and ME/CFS during her MelvinRamsay lecture on the genetics of ME/CFS. Details of the paper are asfollows:Association between serotonin transporter gene polymorphism and chronicfatigue syndromeJournal: Biochemical and Biophysical Research Communications, Volume311, Issue 2, 14 November 2003, Pages 264-266Authors: Masaaki Narita, Naoko Nishigami, Naoko Narita, Kouzi Yamaguti,Nobuo Okado, Yasuyoshi Watanabe and Hirohiko KuratsuneDr Charles Shepherd


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## Susan Purry (Nov 6, 2001)

Just an aside, it really REALLY irritates me when doctors of all people call M.E./CFS 'Chronic Fatigue'. Grrrrr...... they should know better! Chronic fatigue is a symptom common to many illnesses, not an illness in its own right. Calling M.E./CFS 'Chronic Fatigue' is not only inaccurate it's misleading. I know, I know, I'm preaching to the choir here!


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## Ian (Apr 18, 1999)

Susan,Thanks for posting the whole article & Dr. Shepherd's overview which i thought very pertinent.On the appellation thing I was slightly surprised too, as Dr Fanu should know better and you would think that the Royal Free, of all places, would be aware of such distinctions.Ian


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## Susan Purry (Nov 6, 2001)

Quite! I expected better from the Royal Free. I used to go there to see Dr William Weir - nice chap. Dr Shepherd says this:


> quote:There is, however, quite a lot of anecdotal evidence to suggest that asmall sub-group of pwme/cfs do benefit from the use of SSRIs - not justfor co-existent clinical depression. And this suggests that there maybe pwme/cfs who have low (downregulated), normal, and raised(upregulated) levels of serotinin.


I wonder if this is true for the general population without clinical depression?


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