What treatments work for anxiety in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? Systematic review.
Stoll, Sarah Victoria Ellen, Crawley, Esther, Richards, Victoria et al. · BMJ open · 2017 · DOI
Quick Summary
Many children with ME/CFS experience anxiety alongside their fatigue symptoms. This review looked at nine studies to find out which treatments help reduce anxiety in children with ME/CFS. While a few treatments showed some promise—particularly therapy approaches like cognitive behavioural therapy and one immune treatment—the evidence is limited and no treatment was specifically designed to target anxiety in this group.
Why It Matters
Anxiety comorbidity is common in pediatric ME/CFS and may complicate management, yet no evidence-based anxiety treatment guidelines exist for this population. This systematic review highlights a critical evidence gap and demonstrates the need for targeted research on anxiety interventions in children with ME/CFS, potentially informing clinical practice standards.
Observed Findings
Nine papers from eight studies met inclusion criteria, with participants <18 years diagnosed with ME/CFS using established criteria.
Four studies used CBT-type approaches; three reported anxiety improvements as a secondary outcome.
One trial of gammaglobulin versus placebo reported anxiety improvement.
One behavioral intervention study and one drug comparison study did not report anxiety outcomes in detail.
No studies stratified outcomes by anxiety diagnostic status or baseline severity.
Inferred Conclusions
CBT-based treatments may offer some benefit for anxiety in children with ME/CFS, though evidence is indirect and limited.
Immunomodulatory treatments may have secondary anxiolytic effects, though this requires further investigation.
No current evidence supports a specific best-practice treatment for children with comorbid ME/CFS and anxiety.
Remaining Questions
Which anxiety treatments are most effective when specifically targeted at children with ME/CFS and concurrent anxiety?
Does baseline anxiety severity or anxiety disorder status modify ME/CFS treatment outcomes or prognosis?
What This Study Does Not Prove
This review does not establish which anxiety treatments are actually most effective for children with ME/CFS, as no study was specifically designed to test anxiety interventions in this population. It does not determine whether anxiety severity influences overall ME/CFS outcomes or whether standard anxiety treatments are equally effective in children with ME/CFS compared to other pediatric populations. The improvements observed were secondary outcomes and may not reflect causal treatment effects.
Tags
Symptom:Fatigue
Phenotype:Pediatric
Method Flag:Weak Case DefinitionExploratory OnlyMixed Cohort