louisek asked me about this in another post, but I thought it would be good to label it for more general interest. Note that I originally mentioned this concept in comparing it to mild hypomanias (particularly those called "mixed states") that those with manic-depression sometimes experience. This may be especially relevant because: * At least according to the info in Osler's Web, manic-depressives and CFS patients are pretty much the only people who have the unidentified bright objects on MRI's of their brains. * Many manic-depressives seem to suffer from seizures of those parts of the brain that control emotions. Anti-convulsants such as Lamictal and Depakote control the disease successfully in many cases. One of my doctors (Morris Papernik) told me recently that Lamictal has had some success in treating the agitated exhaustion of CFS as well. * Many people believe that Klonopin and Xanax seem useful for controlling agitated exhaustion of CFS because of their anti-seizure activity. Other benzodiazapines apparently a) do not have as much anti-seizure activity and b) are not as helpful to CFS sufferers. * Both manic-depression and CFS often are preceded by head injuries. I don't know quite what to make of this information. It does seem that there is a weird relationship between CFS and manic-depression, though. For what it's worth, I've had very mild mood swings since adolescence (and have a strong family history of depression and mild manic-depression). My mood swings were exacerbated by a head injury (and now are controlled with Lamictal). The CFS followed the head injury by about a year. I'm interested in theories about this topic. I haven't seen nearly enough on it. Meanwhile, here is some information on the topic of "agitated exhaustion." It comes from the book "Chronic Fatigue Syndrome: A Treatment Guide" by Erica Verrillo and Lauren Gellman. This book is a decade old, but I highly recommend it anyway. It lists pretty much every weird symptom associated with CFS and attempts to give explanations for them (based on interviews with CFS experts). I've not found any other book or information source about CFS that does this nearly as well. Best, Lisa ** Agitated Exhaustion The term "agitated exhaustion" is used by Dr. David Bell in his book, "The Doctor's Guide to Chronic Fatigue Syndrome," to characterize the type of fatigue typical of the acute stage of CFIDS and it describes very well the inability to "turn off" that the severely ill suffer. It is often described as a "tired and wired" feeling. A person with this type of fatigue does not feel sleepy, although the desire for rest is overwhelming. This type of exhaustion is usually accompanied by insomnia and catecholamine-related symptoms such as rapid pulse, hyperventilation, panic, and loss of appetite. The cause of this type of fatigue is thought to be neurologic. Dr. Paul Cheney puts forth a possible explanation for many of the neurologic upsets experienced in CFIDS (CFIDS Chronicle, Spring 1995). He proposes that toxins that accumulate in the brain as a result of cell dysfunction, liver toxicity, or excess cytokine production can lead to alterations in the normal firing pattern of the brain, resulting in a state of sustained neuronal arousal. In the state that Dr. Cheney describes, even small stimuli spark strong responses from the nervous system. The continued state of arousal characteristic of acute and severe CFIDS results in agitated exhaustion. Dr. Cheney points out that nearly every treatment that slows nervous system responsiveness aids in controlling neurologic symptoms, including benzodiazepines (Klonopin), magnesium, taurine, nimodipine (Nimotop), melatonin, calcium channel blockers, butyric acid (Butyrex), and gamma-aminobutyric acid (GABA). Meditation, hypnosis, acpuncture and biofeedback can also provide help.