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The cause and disease mechanism of chronic fatigue syndrome (now known as systemic exertion intolerance disease) remain elusive, with unproven and ineffective viral, neuroimmunologic, endocrinologic, and psychiatric theories and associated treatments. Current treatment recommendations, based on multiple studies with modest effects, concern cognitive-behavioral therapy (CBT) and graded exercise. Psychotropic medications are unproven. Now, these authors have used public data to reanalyze the largest and supposedly most definitive study (NEJM JW Psychiatry Apr 2011 and Lancet 2011; 377:823), which found CBT and graded exercise to be superior to adaptive pacing (to limit excessive activity) and specialist care (control).
The authors note that th…