Fatigue is one of the most common symptoms of multiple sclerosis (MS), affecting about 80 percent of people with this condition. Stimulants are among the many approaches sometimes used to help manage MS fatigue. Also known as neurostimulants or psychostimulants, these prescription drugs increase wakefulness and energy levels. But like all drugs, they can cause side effects, too.

Here’s what you need to know about stimulants for MS fatigue to help you have a productive conversation with your doctor.

How Does Fatigue Affect People With MS?

People with MS fatigue experience extreme exhaustion, or a lack of physical and mental energy. Fatigue is tiredness unrelated to lack of sleep or overexertion. It’s often disabling, getting in the way of day-to-day life. “My brain and body just stop working,” a MyMSTeam member said about their fatigue.

Fatigue can also make other symptoms of 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 said fatigue was their worst MS symptom. The exact cause of fatigue in MS is still unknown, so treating it can be challenging.

MS fatigue is complex and can be difficult to measure. It may be related to:

• Changes in your brain due to MS
• A result of other MS symptoms, such as depression and trouble sleeping
• A side effect of drugs used to manage MS or its symptoms
• A symptom of another condition

When Are Stimulants Used for MS Fatigue?

Doctors usually try other approaches before prescribing stimulants for MS-related fatigue. These strategies might include learning ways to conserve energy, staying cool, and exercising regularly. Doctors usually suggest ways to manage fatigue that don’t involve medicine first.

If a doctor does prescribe stimulants, the drugs are usually just one part of treating MS fatigue. Many means of managing fatigue don’t involve using medicine, and they often work better.

Are Stimulants for MS Fatigue Effective?

Psychostimulants work by speeding up the central nervous system (CNS). These medications also help increase the amount of two important neurochemicals: norepinephrine and dopamine.

For most people with MS fatigue, stimulants on their own aren’t very effective. In some cases, stimulants combined with other interventions can help MS fatigue. Scientists need to do more studies to know for sure how effective stimulants are for treating MS fatigue.

Studies show contradictory or conflicting results about how well psychostimulants work against MS fatigue. One 2021 study looked at the effects of the stimulants modafinil (Provigil), methylphenidate (sold as brand names such as Ritalin LA and Concerta), and amantadine on MS fatigue. They compared those results against how well a placebo worked. A placebo is an inactive substance, sometimes called a sugar pill. It’s used in clinical trials to compare the test treatment to something that’s known not to be effective for the disease or condition being treated.

Researchers compared all the results to find out whether any of the drugs worked better than no treatment at all. They found that amantadine, modafinil, and methylphenidate weren’t more effective at reducing MS fatigue than placebo.

What Is the Risk of Abuse and Dependency When Using Stimulants?

Stimulants can be habit-forming, which means people might start to depend on them. This is one of the biggest risks of these medicines, so doctors are careful about giving stimulants for MS fatigue.

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

Which Stimulants Are Used for MS Fatigue?

Stimulants are mainly prescribed to treat attention-deficit/hyperactivity disorder (ADHD), narcolepsy, and excessive daytime sleepiness. CNS stimulants are sometimes prescribed off-label for MS fatigue — a use not approved by the U.S. Food and Drug Administration (FDA).

Everyone with MS is different. What works to improve fatigue in one person might not work for another or may cause bothersome side effects.

Adderall for MS Fatigue

Most commonly known by the brand name Adderall, amphetamine/dextroamphetamine is available as pills or capsules. It also comes in an extended-release, or longer-lasting, formulation.

Does amphetamine/dextroamphetamine help with fatigue? Many MyMSTeam members have reported that for them, it does. Here are a few member comments about this stimulant:

• “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.”

Amphetamine/dextroamphetamine may cause side effects like changes in appetite, fast or pounding heartbeat, and insomnia. “If I don’t time it just right, I do think it affects my sleep pattern,” shared a MyMSTeam member.

Modafinil and Armodafinil

Modafinil and the related drug armodafinil are mainly used to treat narcolepsy and excessive daytime sleepiness. These drugs belong to a newer class of stimulants called eugeroics. Modafinil is available in a chewable tablet form.

Members of MyMSTeam have reported 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.”

Anxiety, insomnia, increased blood pressure and heart rate, tremors, and headache are common side effects of modafinil. One MyMSTeam member said, “I used to be on modafinil but found I was grinding my teeth and clenching my jaw a lot.”

Methylphenidate

Methylphenidate works on the CNS similarly to amphetamines. This stimulant can be taken orally (by mouth) or through a dermal patch (Daytrana) that’s placed on the skin and releases the medication over time.

Here’s what some MyTeamMembers have said 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.”

Methylphenidate may cause side effects such as increased blood pressure and heart rate, nausea, stomach pains, and loss of appetite.

Talk to Your Health Care Team About Stimulants

All medicines can have side effects. Work closely with your neurologist to weigh the risks and benefits of adding a stimulant for the treatment of fatigue. You may have to try several approaches to manage fatigue before you find one that improves your energy and quality of life.

To avoid dangerous drug interactions, make sure your neurology team, other health care providers, and your pharmacist are up to date on all of the medications you take. This includes over-the-counter remedies and nutritional supplements.

Connect With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 215,000 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.