Psychology Today: What We Need to Know About Chronic Fatigue - Joel L. Young M.D.

Kalliope

Kalliope

Senior Member (Voting Rights)
Annoying sales pitch of this psychiatrist's book "Understanding and Treating Chronic Fatigue: A Practical Guide for Patients, Families, and Practitioners (Praeger, 2020).
He's also conducted a small trial ten years ago on CFS and the ADHD drug lisdexamfetamine (LDX).

Perhaps the central tension between doctors and their patients was whether ME/CFS was a mental health condition. Patients with the condition strongly reject the inference that their very real physical symptoms were “only in their head.” Many doctors felt that referral to a psychiatrist was the only way to help patients learn to cope with their incurable but non-fatal condition.

Given this tension, it may seem odd that I, a psychiatrist, became so interested in ME/CFS. Regarding the ongoing conflict as to whether the condition is psychiatric, I am sympathetic to both sides of the argument. Beyond question, ME/CFS is a true medical condition. The suffering is real. As with other legitimate diseases, the symptoms are phenomenological and look similar across cultures. Furthermore, ME/CFS is not a pure psychological condition in that it does not result from childhood trauma or the subconscious need for the patient to remain ill to gain attention or sympathy from others. It does, however, fall within the domain of psychiatry because evidence supports that some medications that modulate brain chemistry are effective in the treatment of CFS/ME.

What We Need to Know About Chronic Fatigue

ETA: I gave a wrong link to the trial, the correct one should be this from 2012
https://www.rcbm.net/images/uploads/Psychiatry_Research_.pdf
 
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There's a preview of the book and the content seemed to be okay. The author seems to describe patients more on the milder side. I'm sure it's not perfect but if the average healthcare worker had similar views we would be in a much better position.

I'm not sure about the claim that some medications acting on the brain can treat the illness.
 
Here's link to the preview of the book:
Joel Young, MD, in this heavily researched book, explains why it is a true physical illness, and how it may be treated. He details how he successfully treats the symptoms, which can include severe fatigue, "brain fog," chronic pain, and sleep problems. Unlike doctors who recommend exercise, supplements, or opioid medications, Young integrates options such as long-acting stimulants, meditation, and dietary changes to reduce fatigue and non-opioid drugs, medical marijuana, and self-help options including yoga for the associated chronic pain.

https://products.abc-clio.com/abc-cliocorporate/product.aspx?pc=A6126C
 
Stimulants for the brain are like exercise for the muscles. Some ME doctors have warned against things like modafinil (I think that is the one) which can make people more alert while underlying damage has been done.
 
https://www.drugs.com/mtm/lisdexamfetamine.html

I have no doubt that taking an amphetamine will give anyone an energy surge and possible increased focus. But it does not address any underlying pathology and while it might seem useful in the short run I might expect some really bad results from the long term.

I also suspect that he knows little of the full extent of ME and it's symptoms choosing to focus (as usual) on raising energy capacity.

Long term side -effects could be an issue including heart and circulation problems which are already symptoms in ME.

As usual, I don't know a lot about this but continued use of this drug sounds dangerous to me.
 
So on the basis of a study that tested 26 patients, 11 with placebo and 15 with lisdexamfetamine (LDX), over a period of 8 weeks, he continues to prescribe it thinks that's enough to write a book about it. Outcome measures were mostly questionnaires and some sort of cognitive testing/questionnaire.

The study has never been published in a peer reviewed journal, and there is no follow up data beyond the 8 weeks of the trial.

https://clinicaltrials.gov/ct2/show/NCT01071044
Their basis for choosing this treatment goes something like this:
People with ADHD often have fatigue and muscle pain both of which improve with their LXD treatment, so people with FM (muscle pain) and CFS (fatigue) might also have ADHD and respond to the same treatment. Er, what?

This should be challenged. He's pushing amphetamines on the basis of a tiny unpublished trial and possibly doing a lot of harm.
 
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Here are two other abstracts from same author concerning CFS

Postgraduate medicine - Chronic Fatigue Syndrome: 3 Cases and a Discussion of the Natural History of Attention-Deficit/Hyperactivity Disorder by Joel L. Young - 2015

Fatigue is commonly reported in the primary care setting; however, its cause is often unclear. This article presents 3 cases involving patients with chronic fatigue syndrome who responded poorly to treatment. After clinical evaluation, all patients were found to meet criteria for attention-deficit/hyperactivity disorder (ADHD) and underwent a standard regimen of a psychostimulant medication. After treatment with psychostimulants, the 3 patients reported improved symptoms of fatigue and pain, and cognitive and core ADHD symptoms. These cases suggest that ADHD and chronic fatigue syndrome (and possibly fibromyalgia) share a common underlying mechanism. This article presents a model suggesting that over time, ADHD (predominantly inattentive type) develops into a syndrome of chronic fatigue and pain. These cases indicate that fatigue may be an important presenting symptom of adult ADHD. These cases also suggest the need for additional research to determine the prevalence of ADHD in patients who present with fatigue, and, in those meeting criteria for ADHD, the responsiveness of fatigue to psychostimulant treatment.

Psychofarmachology Bulletin - Fibromyalgia, Chronic Fatigue, and Adult Attention Deficit Hyperactivity Disorder in the Adult: A Case Study by Joel L. Young - 2007 (full paper available as PDF)

Adult attention deficit hyperactivity disorder (ADHD) may share common features with fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS). In an outpatient psychiatric clinic, a number of adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of CFS or FMS. As expected, ADHD pharmacotherapy usually attenuated the core ADHD symptoms of inattention, distractibility, hyperactivity, and impulsivity. Less expected was the observation that some patients also reported amelioration of pain and fatigue symptoms. The utility of ADHD medications in FMS and CFS states may be their innate arousal and enhanced filtering properties. This model supposes that FMS and CFS are central processing problems rather than peripheral disorders of muscles and joints.

Here's list of these and other publication by him at ResearchGate:
https://www.researchgate.net/profile/Joel_Young2
 
I have had ME and FM (presumably) for 50 years and my son, aged 42, has had ADD (i.e. without the hyperactivity which is the type suggested to be related to ME and FM ) all his life.

I have a lot of unexplained pain, 'fatigue' and cognitive problems. He has none.

I have sleep problems. He has none.

He is unable to work effectively without dexamphetamine. It gives me a bigger and longer-lasting boost than caffeine but causes awful PEM from being uncontrollably active.

He is calm and creative when he takes his medication as needed. He is no longer hyper-focussed (paradoxically typical of ADD). After a small dose my anxiety is on the verge of being out of control and probably would be if I weren't distracted by being obsessively focussed on getting things done in a frantic fashion.

Etc.

The effect of his amphetamine is entirely different for both of us. In my admittedly narrow experience I can find no similarities at all.
 
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