Case report: Recovery from refractory chronic fatigue syndrome with CBT and modafinil, 2021, Garg et al

[Andy]

Abstract
Many patients with chronic fatigue syndrome (CFS) fail to derive benefit from evidence-based treatments such as cognitive–behavioural therapy (CBT) and graded exercise therapy leading to permanent disability. To discover whether a repeat prescription of modafinil might potentiate the benefits of CBT leading to social recovery as defined by 2 or more point improvement in energy and muscular pain/concentration and return to work or full-time training. Three patients with treatment-resistant CFS (mean duration 17.66 years) treated with modafinil and CBT in a Liaison Psychiatry clinic were retrospectively reviewed. Progress was reviewed at baseline, 4–6 months and 10–24 months. Patients rated their fatigue, pain and concentration using 10-point Likert scales. 2/3 achieved clinically meaningful improvements in energy and pain/concentration and 3/3 achieved social recovery. Modafinil, when prescribed over the medium term, would appear to be a potentially useful potentiating agent when added to CBT.

Paywall, https://casereports.bmj.com/content/14/3/e240283

Modafinil "is a medication to treat sleepiness due to narcolepsy, shift work sleep disorder, or obstructive sleep apnea.", https://en.wikipedia.org/wiki/Modafinil

 

[Sly Saint]

So, if you don't respond to CBT, drug you up and try again?

 

[Trish]

It seems a bizarre idea that a drug would make CBT work better. Maybe just try the drug on its own? Preferably in a double blind trial.

 

[Sphyrna]

Time for a CBT+Modafinil vs. CBT only clinical trial, so we can guarantee to generate results here?

I have a prescription for modafinil, but all it does for me, after absorption, is to increase heart rate for a couple of minutes, followed by triggering PEM without a latency period. I guess I might just be missing out on the CBT, though.

Anyone got access to the whole thing? Btw, I found "treatment-resistant CFS" really funny for some reason, because it just feels like a tautology.

 

[Jonathan Edwards]

This seems just silly to me: look back and see if you can find any patients that were better after CBT and modanafil. Bound to find about three.

This isn't really even a case report. It is an exercise in automatic bias.

The website for Douglas Turkington Limited is intriguing.
These people looks if they sell CBT for things it is no use for as a living.
Gordon Douglas Turkington is a student - presumably DT's son learning the tricks of the trade. Maybe Maggie is his mum!

 

[Invisible Woman]

Many patients with chronic fatigue syndrome (CFS) fail to derive benefit from evidence-based treatments such as cognitive–behavioural therapy (CBT) and graded exercise therapy leading to permanent disability.

That's because the "evidence base" is deeply flawed. It's so bad that despite decades of the best efforts by the finest minds in Team BPS it proves that GET & CBT do not work for ME and probably not for much else.

treatment-resistant CFS

If you're using the wrong treatment, a treatment that fails to help.the majority and makes a significant number worse, then it is not treatment resistance. It is simply the wrong treatment.

Fail.

 

[Grigor]

The paper.

 

[Arnie Pye]

The website for Douglas Turkington Limited is intriguing.
These people looks if they sell CBT for things it is no use for as a living.
Gordon Douglas Turkington is a student - presumably DT's son learning the tricks of the trade. Maybe Maggie is his mum!

I found two possible listings for Turkingtons as directors in the Companies House website - it may be a true family business with siblings, cousins and children involved :

https://find-and-update.company-information.service.gov.uk/company/07192064/officers
https://find-and-update.company-information.service.gov.uk/company/11652543/officers

 

[JemPD]

That's because the "evidence base" is deeply flawed. It's so bad that despite decades of the best efforts by the finest minds in Team BPS it proves that GET & CBT do not work for ME and probably not for much else.



If you're using the wrong treatment, a treatment that fails to help.the majority and makes a significant number worse, then it is not treatment resistance. It is simply the wrong treatment.

Fail.

mic drop