Chronic Fatigue Syndrome And Depression

What Is Chronic Fatigue Syndrome

Chronic fatigue syndrome is also called myalgic encephalomyelitis. CFS causes extreme fatigue that has no clear cause.

CFS makes you extremely tired. Even a full nightâs sleep doesnât help. Your fatigue may be worse for a whole day after any type of exercise or activity. Youâre too wiped out to do almost anything: take a shower, go to work, cook dinner, do the laundry, or go to the supermarket. You might be unable to get out of bed for any reason. You could have trouble falling asleep or staying asleep.

CFS often causes pain. You could have muscle aches, joint pain, or headaches. Itâs also common to have blurry vision or see spots, and to have memory or concentration lapses. You may feel foggy or unable to remember details.

CFS can cause these symptoms, too:

• Irregular heartbeat
• Shortness of breath

CFS has no known cause. Possible causes include a hormone imbalance, infection with the Epstein-Barr virus or other viruses, the common yeast infection, Candida albicans, or an overactive immune system. Your genes might play a role in CFS too, because it often affects people in the same family.

Fatigue: Dont Assume Its Depression

Fatigue is a part of a wide spectrum of diagnoses ranging from being a symptom in depression, anxiety, seasonal affective disorder,53 and multiple other diagnoses to being a full syndromal disorder in CFS, yet CFS goes undiagnosed in 80% of cases and is often misdiagnosed as depression. The Diagnostic and Statistical Manual of Mental Disorders doesnt list CFS as a diagnosis although the International Classification of Diseases, 10th Revision, does.12 In clinical practice, CFS presentations range from complicated cases associated with a psychotic state resulting in multiple murders in one case report54 to noncomplicated presentations with multiple psychiatric disorders, primarily depression.55 It is very important to understand the distinctive features between chronic fatigue and depressive disorder when evaluating a patient with a main complaint of fatigue. A full detailed history accompanied by questionnaire forms can be very helpful to differentiate CFS from major depressive disorder. There is still no specific test that can confidently differentiate between them. Multiple studies have tried to find distinctive factors and they are listed in Table 2.

Prevalence Of Depression Among Those With Cfs

Our finding of a 36% prevalence rate of depression in this representative Canadian sample is comparable to the 32% rate found in a US community-based sample of individuals with chronic fatigue. These rates are many times higher than that of the general Canadian population where an estimated 5.6% have a 12-month prevalence of major depression. This is consistent with previous research regarding the elevated rates of depression among individuals with chronic health conditions, such as CFS. More specifically, individuals suffering from medically unexplained physical symptoms, including CFS, are twice as likely to experience a psychological episode. Furthermore, the rates of depression among those with CFS appear to be much higher than those found in other chronic illnesses, such as inflammatory bowel disease , rheumatoid arthritis , chronic back pain and type 2 diabetes .

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Hhs/iom New Criteria Study 2015

On 15 August the US Department of Health and Human Services issued a notice of intent to award a contract to the Institutes of Medicine for a Study on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome with the purpose of : ârecommending clinical diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome â. The award of contract was halted due concern over âpotential sole source requisitionâ although subsequently joint funding was agreed between The Office on Womenâs Health and the HHS. The IOM commenced work on the project in the Autumn of 2013 with its first public hearing listed for 27 January 2014.

The completed report recommends a name change to Systemic Exertion Intolerance Disease , a new diagnostic criteria, and some testing. It was published with a lengthy literature review, and various materials, all of which are available at the National Academies of Science website.

How Are Cfs And Depression Different

CFS may have symptoms that donât happen with depression, like a frequent sore throat, weakness, and swollen or tender lymph nodes. Pain is more common with CFS than depression.

CFS symptoms like severe fatigue often start or get worse after physical activity, so it could help to cut back on exercise. Depression symptoms sometimes improve after physical activity, so more exercise might make you feel better.

People with CFS often view it as a physical illness. People with depression usually think of their illness as psychological.

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Search Strategy Development Selection And Data Collection Process

Keyword search terms were decided by both authors . Each author made a list of key concepts related to the research question, including synonyms and related words. In addition, the Ovid Search Builder was used to identify possible synonyms. Consensus on which search terms to include was reached by discussion.

The initial title and abstract screening were performed by one of the authors . Careful reading of other potentially relevant papers besides original research papers was performed by the same author . Both authors independently assessed full-text papers for inclusion. As for reports that were not available in full text, the abstracts combined with the data available in the secondary references, were assessed for inclusion. In case of disagreement, consensus was reached on inclusion or exclusion by discussion. The reference lists of eligible papers were screened by one of the authors .

Getting The Right Diagnosis

Because CFS and narcolepsy are so alike, doctors may not be able to make a diagnosis simply by hearing about your symptoms. Some sleep tests can confirm if you have narcolepsy, but no single test can tell if you have CFS. Your doctor will have to do blood and urine tests to rule out other conditions first.

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Create A Relaxing Bedtime Routine

Fibro fatigue isnt necessarily something that can be fixed with a good nights sleep, but quality sleep can help over time.

A relaxing bedtime routine is an important first step toward getting a good nights rest.

Here are a few tips for a healthy sleep routine:

• go to bed and get up at the same time every day
• avoid alcohol, nicotine, and caffeine
• invest in a good quality mattress
• keep your bedroom cool and dark
• turn off screens at least an hour before bedtime
• keep electronics out of the bedroom
• avoid having a large meal before bedtime
• take a warm bath before bed

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Fatigue: Don’t Assume It’s Depression

Fatigue is a part of a wide spectrum of diagnoses ranging from being a symptom in depression, anxiety, seasonal affective disorder,53 and multiple other diagnoses to being a full syndromal disorder in CFS, yet CFS goes undiagnosed in 80% of cases and is often misdiagnosed as depression. The Diagnostic and Statistical Manual of Mental Disorders doesn’t list CFS as a diagnosis although the International Classification of Diseases, 10th Revision, does.12 In clinical practice, CFS presentations range from complicated cases associated with a psychotic state resulting in multiple murders in one case report54 to noncomplicated presentations with multiple psychiatric disorders, primarily depression.55 It is very important to understand the distinctive features between chronic fatigue and depressive disorder when evaluating a patient with a main complaint of fatigue. A full detailed history accompanied by questionnaire forms can be very helpful to differentiate CFS from major depressive disorder. There is still no specific test that can confidently differentiate between them. Multiple studies have tried to find distinctive factors and they are listed in Table 2.

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Diagnosing Depression And Fatigue

To make a depression diagnosis, your doctor will ask you about your medical history and give you a questionnaire that assesses depression. They may use other methods, such as blood tests or X-rays, to make sure another disorder isnt causing your symptoms.

Before diagnosing you with chronic fatigue syndrome, your doctor will run several tests to rule out other conditions that can cause similar symptoms. These may include restless leg syndrome, diabetes, or depression.

Differences Between Depression And Me/cfs

Hawk, Jason, and Torres-Harding defined a number of key symptoms that were worse or different in ME/CFS compared to clinical depression without ME/CFS:

• Significant post-exertional malaise was found in ME/CFS patients

PEM is now a required diagnostic criteria for ME/CFS in most countries

• fatigue lasts for a greater the percentage of the time in ME/CFS
• shortness of breath severity is higher
• ME/CFS patients have less self-reproach

Using the symptoms above list, Hawk, Jason, and Torres-Harding were able to report 100% correct classification between patients with major depressive disorder versus ME/CFS.

LaFerney, a psychiatric clinical nurse specialist, adds:

Dr. Sarah Myhill adds an additional difference between depression and CFS:

• Response to exercise: Exercise makes CFS patients much worse, but can be positively therapeutic in pure depression

Clinical trials and patient evidence have both shown that:

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The Prevalence Of Suicidal Ideation Among Depressed Individuals With Cfs

Our findings indicate that 22% of the depressed respondents with CFS had seriously considered suicide in the past 12 months and an additional 25% had seriously considered it during an earlier time period. Since our findings indicate that medical professionals see almost all CFS patients on at least an annual basis, there is great potential for effectively identifying these individuals through regular screenings for depression and suicidal ideation and subsequently referring and/or treating those suffering from these mental health conditions.

The Role Of Depression In Cognitive Impairment In Patients With Chronic Fatigue Syndrome

Abstract:

BACKGROUND AND OBJECTIVE: To analyze the role of depression in cognitive deficits of patients with chronic fatigue syndrome .

PATIENTS AND METHODS: 57 women with CFS were assessed by neuropsychological tests that included measures of attention: CalCap, Mental control of the WMS-III, PASAT, forward and backward digits , symbol digit modalities test executive functions: Stroop Test, Trail Making Test , FAS, Tower of London memory: Auditory-Verbal Learning Test , Rey Complex Figure , and psychomotor skills: Grooved Pegboard. The raw scores on the tests were adjusted according to normative data and transformed to T scores. The sample was divided into two groups based on the presence or absence of depression, assessed by clinical interview and administration of the Hospital Anxiety and Depression Scale . This study compared neuropsychological test scores between the two groups.

RESULTS: CFS patients showed cognitive deficit in attention and executive functions, regardless of the presence of depression. There were no significant differences between the two CFS groups.

: The cognitive impairments in patients with CFS are not secondary to the presence of depression. These results should be taken into account in the implementation of therapeutic programs in these patients.

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Strengths And Limitations Of This Study

• This review used a systematic approach to identify updated evidence for treatment approaches for comorbid anxiety and/or depression in paediatric chronic fatigue syndrome/myalgic encephalomyelitis, and combined it with previous review results to provide a comprehensive synthesis of all evidence available since 1991.

• Non-English language articles were included.

• Grey literature and unpublished material was not included.

• There was insufficient data to carry out a meta-analysis.

Supportive And Symptomatic Treatment

Educating patients about CFS and validating their illness experience in addition to establishing a working alliance are the initial steps in the treatment.1,65 Direct the treatment toward the most problematic symptoms, as prioritized by the patient,1 and other illness-perpetuating factors.65 Encourage a well-balanced diet, and discuss with patients their nutritional habits. Advice about preventing over- and under-activity is essential. Start low and go slow is the correct advice for activities and exercise, the same as for using medications. Gear activities toward improving function in areas that are of greatest importance in achieving activities of daily living and remain open-minded about alternative therapies and discuss them with your patients when appropriate.1 Consider referring or asking for consults and discuss that with patients early in the treatment.

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Forms Of Oi In Me/cfs

Orthostatic Hypotension

Orthostatic hypotension is defined by a sustained BP reduction of at least 20 mm Hg systolic or 10 mm Hg diastolic during the first 3 min after assuming an upright posture . This problem is rarely seen in children except at times of febrile illness, acute dehydration, hemorrhage, adrenal insufficiency, excessive histamine release, or as a response to certain medications.

A more common pediatric variant, termed initial orthostatic hypotension , is characterized by a transient drop in BP immediately after standing, but resolving within 60 s. Its recognition requires a continuous beat-to-beat BP measurement device. The diagnosis is missed by standard, automated sphygmomanometer measurements . Although this is not usually a condition that requires clinical treatment, chronic orthostatic symptoms in those with IOH have been reported , suggesting that they can develop other orthostatic abnormalities on more prolonged monitoring.

Postural Tachycardia Syndrome

Postural tachycardia syndrome is increasingly being recognized as the most common form of OI in pediatric ME/CFS. As is the case for pediatric ME/CFS, postural tachycardia syndrome is more common in females than males, is more common after the onset of puberty, and often follows an apparent infectious illness .

Neurally Mediated Hypotension

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If I Was Cured Tomorrow

The Forgotten Plague Facebook page had a “If I was cured tomorrow…” campaign encouraging ME/CFS patients to upload their dreams to highlight this difference from depression.

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Hypotheses And Recommendations For Future Research

Few studies have examined the associations between psychological and immunological variables in CFS/ME and the results of the present systematic review must, therefore, be treated with caution. However, we are hopeful that the present review will prove to be a useful, up-to-date tool for researchers seeking to further explore the psychoneuroimmunology of CFS/ME. The hypotheses in the following sections are based on the assumptions that immune dysfunction is a maintaining factor in CFS/ME and that psychological interventions may improve immune system function. According to a recent systematic review and meta-analysis including 56 studies on patients with various psychiatric disorders and physical diseases, psychosocial interventions can be reliably associated with enhanced immune system function . Psychological interventions may thus represent a viable strategy for reducing disease burden and improving health.

The Relationship Between Chronic Fatigue Syndrome And Depression

Chronic fatigue syndrome is also known as myalgic encephalomyelitis and is sometimes abbreviated as ME/CFS. The most recent term proposed is systemic exertional intolerance disease . It is characterized by unexplained extreme fatigue lasting for at least six months in duration that is not explained by any other underlying medical illness.

Other symptoms include:

• Unexplained muscle/joint pain

Persistent fatigue, painful physical symptoms, sleep disturbances, poor concentration, psychomotor retardation, and decreased libido are characteristic features of both depression and chronic fatigue syndrome. As a result, individuals may be misdiagnosed with one or the other or both.

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What These Disorders Are

Narcolepsy is a chronic sleep disorder that upsets your bodyâs sleep-wake cycles. If you have it, youâll find it hard to stay awake for long periods of time, no matter what youâre doing. You could fall asleep while talking to someone else or while eating.

Itâs unclear what causes narcolepsy, but there are a few theories:

• Your genes could play a part.
• You could be low on a brain chemical that helps your body know when to sleep and when to stay awake.
• Your immune system could be attacking nerve cells in your brain by mistake.

CFS, which is now sometimes called myalgic encephalomyelitis, also makes you tired, but in a very different way. If you have CFS, you have extreme fatigue that lasts for 6 months or more and isnât a symptom of another health issue.

Like narcolepsy, experts donât know exactly what causes CFS. You may have it because of:

• A problem with your immune system
• Imbalanced hormones
• Physical or mental trauma

Anyone can have one or both of these conditions. Youâre more likely to have CFS if youâre a woman and slightly more likely to have narcolepsy if youâre a man.

Isnt Saying That Cfs Is A Mental Health Issue Just A Way To Minimise My Condition

Its hard enough to have a physical health condition that is not yet fully understood and was not too long ago classified as a medically unexplained symptom .

To be told its connected to your mental health can admittedly leave one feeling as if their condition is not been taken seriously, or as if they are being told its all in their head.

Thankfully, in the UK chronic fatigue is now dealt with respect and taken seriously. Although the National Institute for Clinical Excellence has of yet not supported the World Health Organization classification of CFS as a neurological illness, they do not minimise it into a mental health issue only, either.

Instead NICE states that chronic fatigue syndrome can be as disabling as multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, congestive heart failure and other chronic conditions.CFS/ME places a substantial burden on people with the condition, their families and carers, and hence on society.

Classifications aside, to ignore the increasing evidence that there is a mental health connection to CFS is to overlook tools and support that, if they cant make you better, can at least alleviate your suffering.

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