Larkin: The interface between chronic fatigue syndrome and depression

[mango]

The interface between chronic fatigue syndrome and depression: A psychobiological and neurophysiological conundrum

Larkin D1, Martin CR2.

Author information

1. School of Psychology, Edge Hill University, L39 4QP Ormskirk, Lancashire, UK.
2. Faculty of Society and Health, Buckinghamshire New University, UB8 1NA Uxbridge, UK.

Neurophysiol Clin. 2017 Mar 14. pii: S0987-7053(17)30007-2. doi: 10.1016/j.neucli.2017.01.012. [Epub ahead of print]

Abstract
The chronic fatigue syndrome (CFS) remains a contentious and controversial presentation despite decades of systematic research from a variety of medical specialties and associated disciplines. Variously championed as a condition of immunological, neurological, neurophysiological, psychiatric or psychological origin, consensus on a cogent and evidenced-based pathway has yet to be achieved.

Irrespective of the ambiguity regarding aetiology, what is incontrovertible is the experience of significant depression, which often accompanies this most distressing clinical presentation. The current paper examines the potential underlying mechanisms, which may determine and explain this relationship between CFS and depression.

In doing so, it offers some insights, which may be of value in the development of evidence-based and scientifically-anchored interventions in individuals experiencing this diagnosis, to improve outcomes in relation to depression specifically and quality of life more generally.

KEYWORDS:
CFS; Depression; Dépression; Fatigue; Myalgia; Myalgie; Neurophysiological substrates; SFC; Substrats neurophysiologiques; Syndrome

https://www.ncbi.nlm.nih.gov/pubmed/28314518

http://www.sciencedirect.com/science/article/pii/S098770531730007

 

[BruceInOz]

From the conclusion:

CFS has long been associated with neuropsychiatric complaints and neuropsychological symptoms. Depression is the key neuropsychiatric complaint reported with CFS. This close association has tended to make it difficult to differentiate between to the two conditions, and some have argued that CFS is a form of atypical depressive illness. However, even though CFS and depressive illness share commonalities, evidence appears to show that both conditions have unique etiologies. Nevertheless, future studies need to explore better ways to disentangle the neuropsychiatric and neuropsychological components from the diagnostic process in CFS.

Have not/will not read any more!

 

[duncan]

"Depression is the key neuropsychiatric complaint reported with CFS."

No, it is not. Cognitive deficits are.

I do not need to waste any more of my time on this...stuff.

 

[TigerLilea]

What a load of crap! I've had this for 26 years now and have yet to come down with depression.

 

[Jan]

I am going to have to stop reading this stuff, it's like self-harming. It just makes me want to scream 'fuck off, it's total bullshit!'

I suffered from ME for 16 years before I experienced depression (despite losing health, relationship, career and home. I slowly rebuilt my life, and although it was far from easy, I eventually set up home on my own). The depression I did have was triggered by grief and the actions of a family member, it was nothing to do with the illness. I recovered from the depression within a year and have not suffered from it again during the past 11 years. How do they explain people like me and many, many others who also do not suffer with depression? 26 out of my 27 years with ME have been free from depression.

So, you may fuck right off with your psychobabble, keep fucking off.........right off...... and don't come back!

(I'm sure I'll be told off for bad language now, sorry if it offends anyone)

This is not aimed at you Mango, or anyone else who alerts us to this stuff, but to the psychobabblers themselves

 

[alex3619]

Irrespective of the ambiguity regarding aetiology, what is incontrovertible is the experience of significant depression, which often accompanies this most distressing clinical presentation.

Incontrovertible? Really? The two are easily separated, its hard to see how they can be confused. There are also scans that separate the two, such as the study done by Komaroff, which was spectral coherence EEG.

 

[Diwi9]

Oh the poor psychobabblers are just trying to squeeze out any last opportunity to get published...their era in dominating this biological disease is coming to a hard and fast end.

 

[alex3619]

Oh the poor psychobabblers are just trying to squeeze out any last opportunity to get published...their era in dominating this biological disease is coming to a hard and fast end.

Whenever a conclusion has been drawn about psychobabble its been to its demise. Yet its not sudden as they keep trying to justify it long after the evidence has spoken. This usually includes moving the focus to some other disease, or by inventing a new label.

[Start Satire]

Assign 1 to X
Repeat until (everyone dies of boredom and old age)

Proponent: Babble theory number X explains it.
Critics: That has just had the null hypothesis confirmed.
Increment X.
Proponent: Aha, we have just come up with a new theory X. You haven't disproved that yet!

Loop to start of Repeat.

[End Satire]

 

[Diwi9]

This usually includes moving the focus to some other disease, or by inventing a new label.

Absolutely! When we have a definitive etiology for ME/CFS, then will come a new name. That way all the old research can remain, as they were studying CFS (an ill-defined syndrome) not the new found illness with known etiology.

 

[alex3619]

Absolutely! When we have a definitive etiology for ME/CFS, then will come a new name. That way all the old research can remain, as they were studying CFS (an ill-defined syndrome) not the new found illness with known etiology.

Yes, as seen with peptic ulcers, MS, RA, Lupus, and many other diseases. Advancing technology kills the mystical explanations. Even a well validated blood test might do that for us.

 

[Woolie]

A lot of the apparent association between CFS and depression may be due to measurement artefact. Our current scales for measuring depression (and even DSM criteria for structured interviews) include items about insomnia, energy levels, etc. Many other items on scales have a loading on physical health (e.g. I don't enjoy going out with my friends any more).

If you're not measuring two independent things, then you can't make much of any observed "associations".

The article says this:

depressive illness is found in most patients with CFS; therefore, CFS has been described as atypical depression.

I don't think that is true, is it? Only a proportion have depression, and the proportion is relatively small. And WTF? No-one calls it atypical depression, not even the uber-babblers (you know who they are!)

What a cracker:

Externalizing the attribution of specific symptoms may exert a protective influence against certain cognitive changes of depression, as opposed to an internal style of attribution causing the patient to experience greater psychological stress and low self-esteem

Sooo, we're just as messed up as the depressed folks, but because we "choose" to attribute our problems to a physical cause, this has a "protective effect" on our self esteem!

But then in next line, they say this, which directly contradicts the above:

Powell et al. [50] found that patients with CFS attributed their underlying condition to external states, which were reported to be potent, uncontrollable, aversive and frightening. According to Powell et al. [50], this predicts a high rate of depression.

So which is it to be, folks?

Conclusion (tldr translation): we don't really know, we haven't really made up our minds yet, it is all so confusing, but hey, we still got the paper published!

 

[Woolie]

PS I think we should call out anyone who uses the word "neuropsychiatric" when "psychiatric" would do.

Ditto for people calling themselves "neuropsychiatrists" when they are just regular, garden variety psychiatrists.

Neuropsychiatry has a specific meaning. It refers to symptoms seen in neurological populations that affect emotion, motivation, or social behaviour in some way, and therefore look a bit like psychiatric illnesses. Examples include frontotemporal dementia, which is associated with a "flattened affect" (person doesn't appear concerned about the terrible situation they're in), Parkinson's, which is associated with loss of will or drive, that can resemble depression, and injuries affecting the anterior medial areas of the brain, where people can appear to lack initiative and motivation (looks a bit like depression, but without the sadness).

 

[SilverbladeTE]

Psychobabbling arseholes, the actual interface between M.E. and depression!

 

[Art Vandelay]

Rather than wasting my energy coming up with criticisms of these frauds and charlatans, I think I'm just going to post memes in response to this garbage from now on:

 

[Sean]

No-one calls it atypical depression, not even the uber-babblers (you know who they are!)

IIRC, Wessely originally thought CFS was a form of depression, but then changed his mind. About the only thing he has unambiguously conceded.

 

[A.B.]

At the CDC Grand Rounds event in February 2016 Doctor Elizabeth Unger showed the following slide summarizing the function of the study's patient group. The red markers show normal values for healthy people. The blue boxes represent the range for study participants, with the diamonds showing the study participants' average score. The chart demonstrates near-normal mental health and emotional role functioning, but very poor physical function

http://me-pedia.org/wiki/CDC_Multi-site_Clinical_Assessment_of_CFS

I think what Larkin et. al. might be seeing is patients grieving over having their life destroyed by a highly impairing illness. Over time these patients will find their balance again despite ongoing illness. So early on in the illness, patients might be an emotional wreck, but later on they will have nearly normal mental health despite still being as disabled as before. The possibility of a poor case definition or an inexperienced practitioner resulting in patients with primary depression being misdiagnosed also exists.

 

[Forbin]

What's old is new again. I was given the MAO inhibitor Nardil (phenelzine) way back in the early 80's. When that failed to make a dent in my ME/CFS symptoms, I was later given the tricyclic antidepressant Imipramine. Both of these drugs are used individually (but not together*) in treating "atypical depression."

Neither had any effect on my ME/CFS symptoms.

However, I did do one thing that made a difference. I went and had my disabling ME/CFS-related balance problems evaluated at a world renowned otological center.

When I handed the psychiatrist the test results which showed that I did indeed have a significant balance impairment in both ears, he looked at me and said, "You don't need to see me anymore."



[*MAO inhibitors can have serious interactions with tricyclic antidepressants and other drugs. https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#Drug_interactions. ]

 

[IreneF]

Distinguishing between depression and CFS/ME is not too difficult if you look at anhedonia vs. PEM.

I suffered from depression long before I got mysteriously ill. I was diagnosed with CFS; then a couple of years later found an effective antidepressant. It did wonders for my mood but nothing for my physical state.

 

[Molly98]

I am going to have to stop reading this stuff, it's like self-harming. It just makes me want to scream 'fuck off, it's total bullshit!'

I suffered from ME for 16 years before I experienced depression (despite losing health, relationship, career and home. I slowly rebuilt my life, and although it was far from easy, I eventually set up home on my own). The depression I did have was triggered by grief and the actions of a family member, it was nothing to do with the illness. I recovered from the depression within a year and have not suffered from it again during the past 11 years. How do they explain people like me and many, many others who also do not suffer with depression? 26 out of my 27 years with ME have been free from depression.

So, you may fuck right off with your psychobabble, keep fucking off.........right off...... and don't come back!

(I'm sure I'll be told off for bad language now, sorry if it offends anyone)

This is not aimed at you Mango, or anyone else who alerts us to this stuff, but to the psychobabblers themselves

Go Jan!
@Jan it seems what is far more common with the disease and more worthy of further study is the phenomenon of situational Tourettes which afflicts so many of us whenever we come across such bullshit psychobabble or as me and @Countrygirl were discussing yesterday the names of Wessely, White, Crawley, Chalder and co seem to bring on such episodes too.

 

[Keith Geraghty]

this will make you laugh - from Dr Larkin's home page https://www.edgehill.ac.uk/psychology/dr-derek-larkin/

My current research can be summed up in one word ‘Food’. I’m interested in what constitutes ‘healthy food’ and what impact ‘un/healthy food’ has on our biology and psychology. I’m particularly interested in the hormone insulin and its role in obesity. Secondly, I’m interested in the sustainability of ‘healthy foods’.

this is the author who tells us ME/CFS is a form of depression - the rablings of a diet psychologist