Medications for MS Fatigue: Do they Work?
Something you'll find no shortage of when browsing the internet for articles about multiple sclerosis (MS) is information about fatigue. More specifically, articles about how different people living with MS experience and treat their fatigue differently.
Fatigue is often the most debilitating MS symptom
You see, despite being such a common aspect of life with MS, we really don't know much about this symptom. Fatigue is often considered by many people living with MS to be one of the most debilitating symptoms they deal with on a regular basis. Even with all the physical and cognitive disabilities that MS has left me with, I would say that fatigue is what holds me back the most in my day to day life. Because of this, I am pretty dependent on the medications used to help manage fatigue, which is what I want to talk about today.
Does my fatigue medication actually help?
As the medication I use to help me manage my fatigue is a controlled substance, I have to actually drive to my neurologist's office so he can physically write me a new prescription when I need a refill. Yesterday was one of those "trip to the doctor's for a refill" days, and while he was writing me a new script, he asked me, "So, would you say that this actually helps?"
It's not a simple answer
Before answering, I had to pause and think for a few seconds because I found this question to be so interesting. As an MS specialist who has been prescribing his patients this stuff for years, he obviously knew the objective facts as to whether or not it's efficacy was clinically significant, so I assumed he was asking for my subjective opinion. I told him that for me, it wasn't as simple as "yes" or "no," and that's what made me want to write today's post.
What does it mean for a fatigue medication to work?
Now do keep in mind, this is all based on my own experience with these medications. I am 100% sure that not everyone will totally agree with everything I have to say because we are all different. I've said it a million times before and I'll say it at least a million more times; what works for one doesn't work for all. If it did, we probably wouldn't have such a large assortment of medications to choose from. As well, if you are thinking about starting one of these medications for the first time (or maybe trying a new one), I think it's important to start one with the right expectations. Ask yourself, what does it mean for a fatigue medication to "work"?
A little more strength to carry the weight
In my experience, it's not like you take a pill and, just like that, no more fatigue until the pill wears off. When I take my medication, the fatigue is still there, but it becomes easier to work through it kind of like how cold medication doesn't eliminate a cold, but it may help reduce the symptoms of one. If you think of fatigue like the weight of a huge boulder on your back that you have to walk around with, I would say that these medications don't really remove the weight of the boulder but instead give you a little more strength to carry it. The heaviness in my body caused by my fatigue is always there, but these medications make it a little less difficult to not be crushed by it. At least that how it feels to me.
Nuvigil and Ritalin
After trying a decent variety of medication to help me manage my fatigue, I've found two that "work." I primarily use Nuvigil (armodafinil), but sometimes, to give myself a small "tolerance break," I'll switch to Ritalin (methylphenidate).
How Nuvigil makes me feel
The way I described to my neurologist how Nuvigil works was that it doesn't make me feel like I got an amazing night of sleep. It doesn't make me feel energetic the way I did before MS came into my life. While sometimes I can definitely feel a rush of "energy," it's most often like you are tired and trying to sleep, but someone is hovering over you and poking your forehead whenever your eyes start to close so that you'll stay awake. I've read lots of articles online saying that Nuvigil/Provigil is the closet thing there is to the fictional smart drug "NZT" from that movie "Limitless," but for me? That's definitely not how I would describe it.
How Ritalin makes me feel
Ritalin is a little different for me. While Nuvigil definitely "promotes wakefulness," Ritalin does precisely what I would have expected a "stimulant" to do. When I take Ritalin, it's like my brain is ticking a little faster. I feel like I drank 10 cups of coffee, and I can think a bit more clearly, but it doesn't last long. Maybe a few hours? And if I only take one pill, those few hours are often followed by a huge crash, which can render me more fatigued than I was in the first place. It doesn't seem like everyone deals with that crash, but I'm not everyone, I'm me. Again, everyone is different. Either way, my point is, it "works," which again, I would define as "giving me the strength to carry the crushing weight of fatigue" and not as "eliminating the weight of fatigue."
Just one part of my fatigue-management strategy
One last detail before I go; I didn't start to see these medications really work as well as I've described them to until I started looking at them as just one part of my fatigue-management strategy. As counterintuitive as it may sound, once I began to regularly exercise, my fatigue greatly improved, and these medications became so much more effective. Exercise, diet, and stress management are probably just as important as medication when it comes to fighting MS-related fatigue. But as always, talk to your doctor first before making any changes to your treatment regimen.
So, what about you? Do you take any medication to help you manage your fatigue? If so, does it help? How would you describe to people how it works?
Do you live with any comorbidities aside from MS?