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Topic Overview

Antidepressants do not cure CFS. They may relieve symptoms such as fatigue, sleep problems, difficulty concentrating, and pain. But they will not affect the course of the illness or the speed of recovery.

Antidepressants that are commonly used to treat chronic fatigue syndrome (CFS) include:

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (for example, Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).
• Tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin), imipramine (Tofranil), and nortriptyline (Pamelor).
• Other antidepressants, such as bupropion (Wellbutrin), trazodone, venlafaxine (Effexor), and mirtazapine (Remeron).

When these medicines are used to treat CFS, they may be given in lower doses than the amounts used to treat depression.

The choice of medicine may depend on the symptoms that are most bothersome, because each medicine has somewhat different side effects. For example:

• If you have trouble sleeping, you may need a medicine to take at bedtime that causes drowsiness.
• If you have trouble concentrating on daily tasks, you may need a medicine to take during the day that can help with concentration and clear thinking.

If depression has been diagnosed along with CFS, antidepressants may be used to treat depression as well.

FDA advisories. The U.S. Food and Drug Administration (FDA) has issued:

• A warning on the antidepressants Paxil and Paxil CR (paroxetine) and birth defects. Some studies have shown that women who took Paxil during their first 12 weeks of pregnancy have a slightly higher chance of having a baby with birth defects.¹
• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

Do not suddenly stop taking antidepressants. These medicines must be gradually tapered off under your doctor's supervision.