Patients experiencing the symptoms look for professional advice and treatment. In terms of medicines, the ME Association sets out some general principles for treating ME/CFS symptoms:25

·       evaluate symptoms carefully, especially if it is a new symptom in case it relates to another condition;

·       where appropriate, try non-pharmacological and self-help strategies first or alongside drug treatment;

·       people with ME/CFS are often very sensitive to drug side-effects, especially those that affect brain chemical transmitters, so start with a low dose and titrate upwards;

·       consider reducing the dose if a symptom has been stablised;

·       monotherapy is preferrable, but may not always be possible, for example in controlling pain.

The British Association for CFS/ME (BACME) updated its guidance to symptom management in October 2020. It notes that there are no drug therapies that will:26

·       improve fatigue – neither generally nor the specific fatigue of ME/CFS;

·       mitigate the symptom of over-exertion exacerbating fatigue or other symptoms, sometimes called ‘payback’;

·       significantly improve ‘brain fog’ (ow grade confusion, memory loss or other cognitive difficulties) in patients with ME/CSF;

·       improve lymphadenopathy symptoms related to ME/CSF;

·       have an impact on recurrent upper respiratory infections (recurring sore throats is commonly reported in ME/CSF).