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While medications used to treat multiple sclerosis (MS) may not help ease fatigue, they may help keep you awake and manage your tiredness
While medications used to treat multiple sclerosis (MS) may not help ease fatigue, they may help keep you awake and manage your tiredness.
Presently, there are no FDA-approved drugs for treating MS-related fatigue. Doctors may prescribe off-label medications, such as:
- Amantadine: One of the most commonly prescribed medications to treat MS-related fatigue. It is primarily a drug used for Parkinson’s disease but is used off-label for MS-related fatigue. Amantadine is given orally in a dose of 100 mg 2 times a day and has been shown to relieve MS-related fatigue in about 40% of patients.
- Methylphenidate: Another off-label medication for MS-related fatigue, although its primary uses are for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Methylphenidate is used in doses of 10-60 mg a day in 2-3 divided doses. It is used under strict supervision because it is a central nervous system stimulant with potential for abuse. Other stimulant medications that may be prescribed to treat MS-related fatigue include dextroamphetamine-amphetamine and lisdexamfetamine.
- Fluoxetine: Comes under the category of antidepressants called selective serotonin reuptake inhibitors. It has a dual advantage because it helps manage both fatigue and depression in patients with MS. It is given in doses of 10-20 mg orally 1-2 times a day. Additionally, doctors may prescribe other antidepressants such as duloxetine, citalopram, and bupropion.
- Other drugs: Some other off-label medications for MS-related fatigue include modafinil and armodafinil, which are primarily used to treat narcolepsy, shift work disorder, and obstructive sleep apnea. Another drug called pemoline was previously used for MS-related fatigue; however, due to its potential to cause liver toxicity, it has been taken off the U.S. market since 2005.
Besides medications, doctors may prescribe other measures to manage fatigue, which include:
- Sufficient physical activity
- Cognitive behavioral therapy (CBT)
- Active cooling (by using cooling vests, cooling pads, etc.)
- Energy conservation techniques (such as scheduling, pacing, and planning activities to avoid exertion)
- Occupational therapy
- Stress management techniques (such as meditation, yoga, and tai chi)
What causes fatigue in MS?
Fatigue is one of the most common symptoms of MS and affects about 76%-92% of patients suffering from the condition. Although the exact cause of MS-related fatigue is not well-understood, theories suggest that it may be a result of:
- Overactivation of the immune system, which leads to the release of inflammatory mediators (cytokines). This makes a person feel ill or have low energy.
- Studies report that people with MS may need to use more parts of the brain when performing a task compared to those without MS, making them feel more drained.
- MS-related fatigue may be caused by the reduced transmission of electrical signals in the brain which can contribute to sluggishness and fatigue.
Fatigue may also be caused by:
- Side effects of MS medications (interferon beta medications)
- Disturbed sleep
- Underlying health conditions such as anemia, depression, restless leg syndrome, sleep apnea, infections
What does MS fatigue feel like?
MS fatigue is often quite disabling and interferes with quality of life. It generally worsens before and during MS flare-ups and with increased temperatures and humidity.
Unlike ordinary fatigue, fatigue in MS generally appears suddenly and with little to no activity. Some may, however, notice that the fatigue worsens as the day progresses or after doing a certain activity. Generally, people with MS fatigue may:
- Feel unable to perform tasks that they once had no trouble doing
- Feel as though they haven’t slept even though they have just woken up
- Find it difficult to engage in simple activities such as a slow walk, reading, or writing
- Find it overwhelming to do anything mentally demanding