MS Fatigue | When Stimulants Are Used | Effectiveness | Risk | Stimulants Used | Weighing Decisions | Support

One of the most common symptoms of multiple sclerosis (MS) is fatigue, which affects as many as 95 percent of people with this condition. People with fatigue experience extreme exhaustion or a lack of physical and mental energy. Fatigue is tiredness unrelated to lack of sleep or overexertion and is disabling enough to get in the way of day-to-day life. “My brain and body just stop working,” a MyMSTeam member said about their fatigue.

In some cases, central nervous system (CNS) stimulants may help some people with their MS fatigue. CNS stimulants, also known as neurostimulants or psychostimulants, are a class of prescription drugs that increase wakefulness and energy levels. It is not clear whether psychostimulants are effective in treating fatigue.

MS Fatigue

MS fatigue can be debilitating, drastically affect your quality of life, and can make other symptoms of relapsing-remitting MS worse. People with all types of MS experience fatigue. “I have no energy,” said a MyMSTeam member. “And I think the fatigue makes my sleep issues worse.” In one survey, almost 55 percent of people stated that fatigue was their worst MS symptom. Because the exact cause of fatigue in MS is still unknown, treating it can be challenging.

MS fatigue is complex and not fully understood:

• Fatigue may be related to the inflammatory or immune-mediated effects of MS.
• Fatigue can be a side effect of a drug or therapy used to manage symptoms, and it can make MS symptoms worse.
• Fatigue may be a symptom of another condition altogether.

When Are Stimulants Used for MS Fatigue?

Most guidelines state that stimulants should only be considered for the treatment of MS fatigue after other measures (energy conservation strategies, staying cool, regular exercise) have failed. Health care providers are recommended to try an effective combination of nondrug interventions to treat MS fatigue before prescribing medication.

When prescribed, stimulant drugs are usually one of several fatigue management strategies used to treat MS-related fatigue. Many fatigue management strategies, therapies, and tools don’t involve medication. There is also more and better data to support these nondrug MS fatigue therapies.

Are Stimulants Effective for MS Fatigue?

Psychostimulants work by speeding up the CNS and increasing the amount of two important neurochemicals: norepinephrine and dopamine. For most people struggling with MS fatigue, stimulants on their own are not very effective. In some cases, stimulants can help MS fatigue in combination with other fatigue management interventions. Clinical trials on how well various stimulants treat MS fatigue thus far have been limited.

Current evidence shows contradictory or conflicting results about how well psychostimulants work against MS fatigue. For example, one small study published in the journal Multiple Sclerosis found that methylphenidate was likely less effective at alleviating MS fatigue than placebo.

The TRIUMPHANT-MS study by Johns Hopkins University compared how well modafinil, methylphenidate, amantadine, and placebo helped with MS fatigue. (A placebo is an inactive substance, sometimes called a sugar pill, used as a baseline in a clinical trial to compare the test treatment against.) This clinical trial compared each drug (and the placebo) to find out whether they worked better than no treatment at all. TRIUMPHANT-MS determined that modafinil and methylphenidate were not more effective at reducing MS fatigue than placebo.

Risk for Abuse and Dependency

Because of their influence on dopamine (the chemical that makes us feel good), CNS stimulants can be habit forming. In fact, one of the greatest risks of stimulant drugs is their potential for misuse and their risk of dependency. Physicians may hesitate to prescribe stimulants for MS fatigue for these reasons.

Because of their abuse and dependency risk, these drugs are controlled or scheduled substances according to the Drug Enforcement Agency. Amphetamine/dextroamphetamine (Adderall) and methylphenidate (Ritalin) are Schedule 2 drugs, for their high risk for abuse and addiction. Modafinil (Provigil) and armodafinil (Nuvigil) are Schedule 4, as these risks are thought to be lower.

Which Stimulants Are Used for MS Fatigue?

Stimulants are primarily prescribed to treat attention-deficit hyperactivity disorder, narcolepsy, and excessive daytime sleepiness. Although not approved by the U.S. Food and Drug Administration for this use, CNS stimulants are sometimes prescribed off-label for the treatment of MS fatigue.

Every individual with MS is different, and what works to improve fatigue in one person might not work for another, or may cause bothersome side effects.

Adderall

Most commonly known by the brand name Adderall, amphetamine/dextroamphetamine is available in pill or capsule form and comes in an extended-release formulation.

Here are some reports from MyMSTeam members about their experiences with Adderall for MS fatigue:

• “Adderall has worked great for me as well. It gets my mind to focus.”
• “It keeps me focused, and I feel I stay a lot more productive during the day.”
• “I take it when I need it, but only if it’s before 8 a.m. Otherwise, I don’t sleep.”

Possible side effects of amphetamine/dextroamphetamine include changes in appetite and insomnia. “If I don’t time it just right, I do think it affects my sleep pattern,” shared a MyMSTeam member.

Provigil and Nuvigil

Modafinil and its close relative armodafinil are primarily used to treat narcolepsy and excessive daytime sleepiness. These drugs belong to a newer class of stimulants called eugeroics. Modafinil is available in chewable and tablet form.

Members of MyMSTeam report a range of experiences with modafinil:

• “I feel like I’m not in zombie mode now.”
• “It simply allows me to be a little more alert — not a lot, but enough to get through the day.”
• “It didn't do anything for me.”
• “I didn’t really feel like modafinil helped that much.”
• “Provigil gives me bad headaches.”

Common side effects of modafinil include anxiety, insomnia, and headache. One MyMSTeam member said, “I used to be on modafinil, but found I was grinding my teeth and clenching my jaw a lot.”

Ritalin

Methylphenidate, a stimulant that works on the CNS similarly to amphetamines, goes by several brand names including Ritalin (immediate release), Concerta (extended release), and Daytrana (dermal patch).

Here’s what some MyMSTeam members had to say about methylphenidate:

• “Ritalin gave me more energy and focus to complete tasks at work and make it through the day.”
• “It has allowed me to return to the living instead of being completely and utterly fatigued all day.
• “I tried Ritalin, but it drives me nuts.”
• “Ritalin helped me a lot, but I’ve had to give it up because it aggravates my anxiety.”

Common side effects of methylphenidate include increased blood pressure and heart rate, stomach pains, and loss of appetite.

Weighing Decisions About Stimulants

All medications carry the risk of side effects. Determining whether the possible risks are worth the potential benefits is a complex decision-making process that factors in many variables. Make your neurologist your partner, and work closely with them to weigh the risks and benefits of adding a stimulant to your MS treatment regimen.

To avoid dangerous drug interactions, make sure all your health care providers and your pharmacist are up to date on the medications you take — including over-the-counter remedies and nutritional supplements — for each health condition.

Find Your Team

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 184,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Have you tried a stimulant for your MS fatigue? Did it help? Did you experience side effects? Join the conversation in the comments below or post on your Activities page.