For most of the population dealing with fatigue, feeling better may simply be a matter of getting more sleep, drinking a midday coffee, an afternoon nap, or even medications. For people with multiple sclerosis, it is not that simple.

Fatigue has increased my one cup of tea a day habit to one cup of tea and two cups of coffee. The extra caffeine does nothing to perk me up. I can still nod off on the couch within five minutes of sitting down and less than an hour after my second cup of coffee. When fatigue first became an issue, I would have to talk myself into naps after work. I hated giving into sleep that late in the day and with so much to do, but I felt like I had to regain energy to finish out the evening. I soon realized napping was a waste of time since it did nothing to reenergize me. Most often I just felt more tired for it.

As for medications, there are no FDA approved drugs to treat MS fatigue. There are several drugs that can be prescribed for off-label use, meaning the drug is FDA approved to treat another condition. While there are several off-label drugs used for MS fatigue, there is conflicting evidence if any of them actually offer any improvement.

Below are some medications that have been used in the treatment of MS fatigue. Except for aspirin, they all require a prescription, so you will need to consult your physician. Even with aspirin, it is a good idea to speak with a medical professional before beginning treatment or a trial run.

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Stimulants

Adderall (amphetamine and dextroamphetamine). Adderall is most often prescribed to treat narcolepsy and attention deficit hyperactive disorder (ADHD). In the case of MS fatigue, Adderall is typically prescribed to improve mental alertness in the presence of brain fog or cognitive fog.

Ritalin (methylphenidate) Ritalin, much like Adderall, is also used in the treatment of narcolepsy and ADHD. Ritalin may also be used to increase cognitive function in the presence of MS fatigue. Both Ritalin and Adderall work by increasing dopamine levels in the brain which is thought to be beneficial in decreasing MS fatigue.

Nuvigil and Provigil (armodafinil and modafinil, respectively). Nuvigil and Provigil are used to increase wakefulness. They are prescribed in cases of obstructive sleep apnea, shift work disorder, and narcolepsy. In the case of MS fatigue, they are used to treat sleepiness.

Side effects of stimulants can include insomnia, nervousness, irritability, dizziness, headache, nausea, weakness, loss of appetite, weight loss, and muscle tightness.

Antiviral Drugs

Gocovri and Symmetrel (amantadine) Gocovri and Symmetrel are used to prevent or treat certain types of influenza infections. They are also given as adjunct in the treatment of Parkinson’s disease. Though these drugs have sometimes shown useful in treating MS fatigue, the reasons why are unknown.

Side effects include insomnia, headaches, nausea, dizziness, hallucinations, headache, dry mouth, loss of appetite, and constipation.

Antidepressants

Depression is the most common mood disorder found in people with MS. There is a lot to be said about it, including why it happens and the effects it has on a person’s life and the people around them. For the purpose of this post, we are not going to delve into the details of it, but stick to the topic of medications used to treat it.

Whether antidepressants do anything to directly combat MS fatigue is unknown. It is most likely that simply alleviating depression will alleviate the fatigue that goes with it. Antidepressants have also been shown to decrease nerve pain in people with MS. This may be beneficial in getting a person more active and thus combating fatigue in that manner.

Prozac (fluoxetine) Prozac works by blocking the absorption of serotonin in the brain. Serotonin is a neurotransmitter. Increasing the amount of serotonin helps brain cells transmit messages to each other. This results in a more stable and better mood. Prozac is used in the treatment of depression, obsessive-compulsive disorder (OCD), panic attacks, and select eating disorders.

Cymbalta (duloxetine) Cymbalta also increases levels of serotonin in the brain, but also works to increase norepinephrine as well. Norepinephrine plays a role in regulating memory, attention, stress reaction, mood and energy levels. Cymbalta is used to treat depression, nerve pain, and anxiety.

Effexor XR (venlafaxine) Effexor XR works very similar to Cymbalta in that it regulates both serotonin and norepinephrine levels in the brain. Effexor XR is used to treat depression, several types of anxiety disorders, and panic disorder.

Wellbutrin (bupropion) Wellbutrin works by increasing norepinephrine and dopamine in the brain. Dopamine is another neurotransmitter that plays a role in mood and behavior. Wellbutrin is used to treat major depressive disorder and seasonal affective disorder (SAD).

Side effects of antidepressants can include headache, nausea, dry mouth, insomnia, dizziness, fatigue, weight gain, decreased libido, and increased sweating.

Aspirin

Aspirin is cheap, easily accessible, and doesn’t require a prescription. A study found that two 325mg tablets a day significantly reduced fatigue in MS patients over those given a placebo. The effects can usually be seen within a month or two. A trial run of aspirin can be a simple and feasible.

Side effects include heartburn, upset stomach, drowsiness, and in rarer cases, stomach ulcers.

I do not have any personal experience with any of these medications. I am fortunate that my fatigue is currently manageable on most days. The information provided is basic. You should consult your doctor to find out which medication is right for you. Some of the medications listed could interfere or adversely react with medications you may already be taking. The side effects listed are the most common and least severe. While uncommon, every medication has the potential for more severe side effects.

Use of any medication should be monitored by a licensed physician, especially the use of antidepressants in adolescents. These drugs carry a black box warning from the FDA warning of an increased risk of suicide with use.

If you currently use any medications to combat your MS fatigue I would love to hear about your experience. Or, if you decide to try any of the medications talked about here, keep me updated on how it goes.