People with chronic fatigue syndrome should be offered talking therapy and exercise therapy, research suggests.
Talking therapy may help some
The work in the Journal of the Royal Society of Medicine was commissioned by the NHS's drug advisor NICE, which is drawing up guidance for doctors.
In the study, CFS - also known as ME (myalgic encephalomyelitis) - responded best to the therapies. Drug treatments had little benefit.
There is controversy over the causes of CFS and how to treat it.
Some say the causes are predominantly biological, while others claim there is a strong psychological element.
CFS was officially recognised as a genuine illness in the UK by the Royal Colleges of Physicians and General Practitioners in October 1996.
Up to 240,000 people in the UK have CFS. People with the condition experience prolonged fatigue and a number of other symptoms, including headaches, poor sleep and joint and muscle pain.
CFS is not contagious, but viral infection, stress and toxins have all been suggested as possible triggers.
To assess which treatments work best, Mr Duncan Chambers and colleagues at the University of York looked at 70 individual CFS studies.
Cognitive behavioural and exercise therapies appeared to reduce symptoms and improve physical function in adult patients with CFS.
Most pharmacological treatments, such as antidepressants, showed no benefit.
Immunological and antiviral treatments did show some beneficial effects but they were also associated with harmful side-effects.
Homeopathy and supplements such as essential fatty acids and magnesium showed some small beneficial effects in single trials. But Mr Chambers said more trials were needed to be sure of this.
He said the last five years had seen a significant increase in the size and quality of the evidence base on interventions for CFS, however, more research was required into all treatments.
The draft guideline from the National Institute for Health and Clinical Excellence (NICE) recommends that when an adult or child's main goal is to return to normal activities, the therapies of first choice should be cognitive behavioural therapy or graded exercise therapy.
It warns against unstructured, vigorous exercise as this may worsen symptoms.
Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (NICE) , said: "CFS can cause prolonged illness and disability, which has a substantial impact on patients and their families.
"Uncertainties about diagnosis and management, and a lack of clinical guidance for healthcare professionals has exacerbated this impact.
"A national best practice guideline from NICE will help those working in the NHS to provide effective support, and we look forward to hearing the views of patients, carers, families and healthcare professionals during consultation."
NICE expects to issue final guidance in April 2007.