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Adrienne Dellwo

Chronic Fatigue Syndrome & ADHD: What's the Link?

By February 13, 2013

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Research Brief

Researchers exploring a possible link between chronic fatigue syndrome (ME/CFS) and attention deficit/hyperactivity disorder (ADHD) say fatigue may be an important symptom of adult ADHD, and that people with ME/CFS or other types of persistent fatigue should be looked at for ADHD.

Their new study looked at three cases of ME/CFS in people who'd responded poorly to treatment. Researchers found that all three met the criteria for ADHD, and all three responded well to psychostimulant medications, which are a common part of ADHD treatment. They say the patients saw improvements in fatigue, pain, cognitive dysfunction and other symptoms.

Researchers concluded that ADHD and ME/CFS may share a common underlying mechanism, and that over time, ADHD may develop into a syndrome chronic fatigue and pain. (It's unclear whether this would most appropriately be considered a new form of ADHD or a subset of ME/CFS.)

From previous research, we know that ME/CFS and ADHD both involve neurotransmitter dysregulation that may involve serotonin, norepinephrine and dopamine. However, that alone isn't enough to say they're related - neurotransmitters perform different jobs in different regions, and different jobs within a region based on specific receptors, so it's a complicated matter.

Some doctors do prescribe ADHD medications off-label for ME/CFS, and they work for some (but not all) people.

Some doctors have talked about a theoretical post-ADHD chronic fatigue syndrome for several years, and this research is one piece of evidence firming up that theory.

Do you think ADHD and ME/CFS are related? Did you have ADHD before ME/CFS? Have ADHD drugs helped your ME/CFS? Leave your comments below!


February 13, 2013 at 10:07 am
(1) Rachael says:

“Do you think ADHD and ME/CFS are related?”
Yes, I do, along with migraines, fibroymalgia, anxiety/depression and autism. All of these disorders have the same underlying cause systemic inflammation and oxidative stress which disrupts the function or the nervous system. People who develop these disorders often have an exaggerated response to viruses/ bacteria, chemical toxins, specific foods and are more allergic than the general population.
“llnesses such as autism, ADD/ADHD, and chronic fatigue syndrome all have different “labels” but are actually variations on the same thing: neuro-immune dysfunction syndromes (NIDS)” Dr. Michael Goldberg

February 13, 2013 at 11:03 am
(2) Xenera says:

I’m not sure. I did not have ADHD, but my sib who does NOT have CFS, ‘may’ have had some ADHD when young.

Treatment with any stimulant based drugs kind of concerns me though. I was treated for a period of time with a narcolepsy drug when I HAD to perform above my capabilities. I have to say it wasn’t all bad. However, when I finally went off them I had one of the most severe crashes ever. It was as if those months of performance above my threshold just kept on adding up in my body.

February 13, 2013 at 12:22 pm
(3) kattsqueen says:

Yes I do,,I believe for many it may boil down to a genetic ion channelopathy,, as it is in my case,, Many are autosomal dominant in inheritence and very closely mimic fibromyalgia and are also accompanied by chronic fatigue,, A diet low in carbs sodium and high in potassium would probably help a lot of people,, these conditions are considered rare but in my opinion are rarely diagnosed ..kcb

February 13, 2013 at 3:10 pm
(4) Clb says:

Yes, I definitely think there is a link though I have tended to think that it’s all possibly part of the same thing, maybe not two separate things at least in some cases. Having been on a long journey with two teens (now adults) with CFS/autonomic dysfunction/ADD, I often think it is all part of one condition. This is an interesting topic and one I’ve thought about often. Many mysteries yet to be unraveled and much appreciation to those devoting time to studies and research!

February 14, 2013 at 1:36 pm
(5) Valentijn says:

This conclusion drawn by the “researchers” (theories created by one guy running a mental health office), are rather baseless. First of all, it was based on observing three CFS patients improving on ADHD drugs. It was not research.

2nd of all, an improvement while on the ADHD drug oes not mean that there is any similarity, other than that one drug being beneficial to both, yet he is interpreting it to mean that ADHD and CFS are different stages of the same illness.

I take an ADHD drug (I have ME/CFS) and it helps me a lot … by improving my blood pressure. I have never had ADHD symptoms yet an ADHD drug helps me with some ME symptoms. This does not mean I have ADHD.

Drugs have many uses beyond their on-label use, and it is baffling that anyone would think that everyone responding to a drug must have the disease.

February 14, 2013 at 8:52 pm
(6) Marilyn says:

I don’t see any correlation. My son, who is now 29, was diagnosed at 4 with ADHD. His symptoms were impulsivity, easily frustrated, hyperactive, behavior problems. He was put on stimulant medications and was very successful in school, even though once they wore off it wasn’t a lot of fun in the evenings for me, a single parent. He did have mono at the age of 5 and grew up with chronic sore throats and swollen glands as I did, but I was never diagnosed with mono. I now know I carry the EBV virus, so I did have mono. For a person with ADHD, stimulants work the opposite. They slow them down giving the ability to think better before reacting. I take Adderall for my CFS for the stimulation or I wouldn’t be able to get out of bed. Yes, both affect areas of the brain, but CFS is a problem with the immune system, ADHD isn’t. Is there any correlation? Well it would take a lot more research than has been presented here.

February 14, 2013 at 10:06 pm
(7) Cindy says:

Some day we will again have the liberty to heal. Kids will be allowed to stay home from daycare and school when they are sick. Workers won’t spread their germs on the job. I think CFS/ME is a disease of energy production at the cellular level. The root cause has yet to be identified conclusively but probably infectious. It has been consistently reported that overexertion causes crashes and at times is life threatening. It is scary to see how pushed our society is to continue over achieveing at all costs. QEEG and neurofeedback are diagnostic and therapeutic tools that can accurately identify abnormal brain function and assist with identifying appropriate pharmaceutical interventions. The worst thing a CFS/ME patient can do is to start taking amphetamines in an effort to “keep going”. It would be worthwhile to start testing ADD / ADHD for the root cause of that disorder and I would not be surprized to hear it is from a subclinical infection…chlamydia pneumoniae? mycoplasma? Epstein Barr? HHV6? Cytomegalovirus? RSV?

February 15, 2013 at 3:28 pm
(8) Heather says:

Hrm. My father thinks he has ADHD.

He has sleep apnea.

I also have sleep apnea. A co-worker was noticing that after I got put on sleep medicine, I seemed to follow a coherent train of thought. She said that before I was on sleep medicine, my mind seemed to bounce all over the place.

I really think fatigue can manifest itself in so many ways.

February 15, 2013 at 6:39 pm
(9) shelley says:

funny enough I have fibromyalgia and sometimes im hyper…this could also relate the ADHD! Maybe I should get tested for it also!

February 15, 2013 at 7:30 pm
(10) C says:

Ironic that I myself, like so many others diagnosed with these illnesses, have bee so very active previous to getting sick. Makes me wonder about this topic. ….just a thought.

February 15, 2013 at 9:16 pm
(11) Shakota says:

I thave fibro and think I qualify for CFS/ME and what I’ve noticed lately, especially after exercise, is the inability to focus and sustain a thought or intention more than a few seconds. Hence I’m wandering around wondering what was I supposed to be taking care of?

The only time I feel focused is when I’m excited about something. All these symptoms are new, since fibro and concommitant CFS. I think it may be on the edge of ADHD.

February 16, 2013 at 6:48 am
(12) Andrew Kinsella says:

On a very superficial level, ADHD is a very challenging problem for the adult- everything takes twice as much effort- so an association with ADHD and fatigue is hardly surprising.

(Neurologically there is far more to the issue than just that).

However, ALL of the DSM labels are somewhat artificial- they are tools for us to hang our understandings off, they do not have solid, real existence.
In this setting, the issue of “off label prescribing” is something of concern only to bureaucrats.

As a health professional, my only comment re stimulants would be”start low, go slow”- a person with CFS/fibromyalgia can easily be driven too hard by stimulants- and that will turn short term gain into long term loss.

February 16, 2013 at 7:04 pm
(13) DAVID says:

Not sure. My wife always thought I was ADHD, but I was always high energy with lots on interests, and did ok in school. I did try Ritalin for several weeks and felt it was very helpful for fms. Helps to cut through the fatigue fog.
I know my fibromyalgia developed from 6 years of very low growth hormone levels due to empty sella syndrome. I was also testosterone deficient from the same issue. And let me tell you, having low testosterone for that long will kill a relationship. The salt in the fms wound.
I feel 300mg of Wellbutrin is fairly close to what Ritalin was doing for me, and a bit safer.

February 18, 2013 at 8:53 am
(14) Liz says:

Agree with the article but I don’t think it’s a ‘one-size-fits-all’ answer. My husband and I have recently relocated to Costa Rica and my CFS has completely turned around. Living in a consistent climate and eating a beans and rice based diet in a country that is almost gluten free has been my answer. I still have the odd day where I’m out of sorts but I’m so grateful to be getting my life back.

February 18, 2013 at 5:03 pm
(15) Lorraine says:

Having ADHD as a child I find this very interesting.

February 20, 2013 at 3:34 am
(16) Jodie says:

This is really interesting!! I am 33,was diagnosed with narcolepsy and am being treated with the same stims,although recently finding out that I have hypersomnia and cfs/me. I have cousins who have ADHD and can very much relate to them (although it is often my mind that has energy and problems concentrating..my body is permanantly sleepy)
I can see how there could be a link here…would be brilliant to find out!

February 25, 2013 at 12:36 pm
(17) Georgia says:

I didn’t think I had ADHD until a few years ago my doctor put me on a med.for ADHD and it’s really helped me focus and even made me feel more alert.of course that’s not all the time. Nothing ever is with fibromyalgia. I often still have problems following people’s conversations. If I in a fibro. Fog interacting is next to impossible. So, yea I thing ADHD is very likely to be part of fibromyalgia.

March 8, 2013 at 1:16 am
(18) Gloria says:

Empty sella syndrome can leave a person with VERY LOW levels of ALL of the pituitary hormones — thyroid hormones, cortisol levels and oxytocin (a feel good hormone) and others.
Dr. John Lowe wrote about the effects of low thyroid hormone in his book called The Metabolic Treatment of Fibromyalgia.

@ Liz
It could be that your Vitamin D level is a lot higher in Costa Rica than it was in your previous place of residence — I certainly found that high optimal Vitamin D levels have helped me feel better (more energy and less pain) and also recently read some research that it is helpful for those who have Celiac Disease and other digestive issues.

May 9, 2013 at 10:44 am
(19) Trudi says:

I have met a lot of people with ME, and have always been astonished by how many have family members with ADHD. I have a son and a nephew who have been diagnosed with ADHD, a sister with ME and have ME myself – and though I have never been diagnosed, probably ADHD as well.
Many years ago, I met a woman who worked with girls with ADHD. She claimed girls were underdiagnosed, as they usually coped – however, at one point they “met the wall” and became “burnt out” (to mix metaphors). There seems to be some kind of connection.

May 31, 2013 at 4:46 am
(20) Corinna says:

This is something I’ve always wondered. As a child I was told I was hyperactive, when I got ill I never took time to heal. I was diagnosed with M.E in my twenties and have since been given a diagnosis of ADD about 5 years ago. (The hyper side I’m assuming burnt out) My level of M.E has knocked me to at present just below a normal low making me look like a lazy person. Although the pain is getting difficult again I cope but along with this has come recurrent shingles and I also have autistic traits. My middle child has severe ADHD with autistic traits also and I worry about him. I think more research needs to be done but this is heading in the right direction.

June 25, 2013 at 2:17 pm
(21) Les says:

Im always tired, been my major complaint for years, coffee does not wake me up, I need to sleep shortly after I wake up. no matter how many hours I sleep, I still feel tired. I have adhd

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December 9, 2013 at 9:46 am
(28) Sara says:

CFS/ME easily causes ADD-like symptoms, because of energy swings and neurotransmitter disruption. Doesn’t make them the same.

CFS/ME (whatever originally cause) has as central problem the cell’s inability to properly create energy (use oxygen and clean up free radicals). Cells can’t operate efficiently. There are other factors too, of course. Point is, much that makes a CFS/ME person feel better temporarily is just pushing the system.

Yes, ADD drugs, and other stimulants can make one feel better — but cells are being damaged by this “push.” Paul Cheney, a long time innovative researcher has changed much of what he recommends for that reason. He’s seen hundred of patients feel better because system stimulated …. but have declining function over time.

Sometimes one has to go with the “push” drugs or supplements, just to do what is necessary. But important to remember (even if can’t always test), that feeling better temporarily is not the same as some level of system recovery that allows longterm improvement — and watch at least as much as possible, whether a supplement is just an addictive stimulant, or actually seems to be strengthening the system.

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March 14, 2014 at 6:29 am
(30) Lesley says:

I am more of the mind that it is exhausting to live with ADHD (especially if you combine working full time with bringing up an adhd child on your own as i did). All through my life I have had mini beakdowns where I have suffered either stomach probs (ulcer and IBS), exhaustion, and more recently long term chonic migraine. I believe these are more the result of trying to keep up with everyone else, regardless of the additional stress cuased by way of thinking and effects of adhd. If we had the luxury of not having any pressures such as work etc, I believe we could limit our physical ailmaents you discuss, but unfortunately this society is designed for the majority – from birth to grave, and does not allow for our needs and way of funtioning in the way it could, if adhd were more recognised, understood, accepted and catered for. Its impossible for those without adhd (the majority) to understand the impact of adhd and the additional stress it brings. Therefore I believe, and it is only my theory, that many of these pysical conditions are bourne out of complete burn out and exhaustion.

April 4, 2014 at 9:38 am
(31) Annie says:

I understand the inflammation issue but there is something you can do to counteract that part along with the fatigue and headaches. Go gluten free. Gluten causes massive inflammation in the body and migraines. This will certainly help!!!

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