From the Guidelines

Cognitive-behavioral therapy is the recommended treatment for chronic fatigue.

Cognitive-behavioral therapy: This treatment has the greatest evidence, with multiple studies consistently finding significant improvement in health function, health-related quality of life, or physical function in patients with chronic fatigue syndrome 1.
Mindfulness-based therapies: There is also strong evidence supporting mindfulness-based therapies, such as mindfulness-based stress reduction and meditation awareness training, which have been shown to reduce functional impairment and improve quality of life in patients with chronic fatigue syndrome 1.

Stimulants: The use of stimulants for the treatment of fatigue in patients with chronic fatigue syndrome is not recommended due to insufficient evidence 1.
Duloxetine: There is insufficient evidence to recommend the use of duloxetine for patients with chronic fatigue syndrome 1.

Patient preferences and resource availability: When considering treatment options, it is essential to take into account patient preferences and resource availability, as adherence to treatments can vary 1.
Exercise: While exercise has been shown to be beneficial in some studies, the evidence is not as strong as it is for cognitive-behavioral therapy and mindfulness-based therapies 1.

From the Research

Cognitive behavior therapy (CBT) has been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise in patients with chronic fatigue syndrome (CFS) 2, 3, 4.
Graded exercise therapy (GET) is also a recommended treatment for CFS, but its effectiveness and safety are still being debated 5, 3, 4.
Exercise therapy, in general, may reduce fatigue at the end of treatment, but the long-term effect is uncertain 5.
Adaptive pacing, which involves educating patients to pace their activity to avoid exceeding their limited energy capacity, may be beneficial for some patients 5.
Antidepressants may be used to manage concurrent depression, pain, and sleep disturbances in patients with CFS, but their effectiveness in reducing fatigue is uncertain 4, 6.
Other treatment options, such as transcutaneous electrical acupoint stimulation, have shown promise in reducing fatigue and associated symptoms, but more research is needed to confirm their effectiveness 6.

Treatment should prioritize comorbidities and symptoms based on severity, and patients should be educated about pacing their activity to avoid triggering postexertional malaise 2.
A thorough clinical assessment is necessary before starting any treatment, and rehabilitative treatment should be delivered by appropriately trained therapists working in close collaboration with the patient 3.
The etiology of CFS is unclear, and its management is complex, involving dysfunction of the immune or adrenal systems, genetic markers, or a history of childhood trauma 4, 6.

CFS is a multifaceted illness with many symptoms and a wide array of clinical presentations, and its diagnosis is often a diagnosis of exclusion 2, 6.
The understanding of CFS is evolving, and further research is needed to improve diagnosis and management 6.
The Centers for Disease Control and Prevention (CDC) criteria for CFS include severe fatigue lasting longer than six months, as well as the presence of at least four specific physical symptoms 4, 6.