Are endogenous depression and cfs close relatives?

[gregh286]

And perhaps it's the result of alien abduction

Creating a vague explanation to support a pet hypothesis seems rather pointless. Especially when the pet hypothesis has been pretty well disproven, and alternative illness models are strongly supported by a large body of medical research.

Seriously, what's the fascination with trying to equate ME/SEID with depression? They have no similarities. None. Unless you believe mild "fatigue" is the core symptom of

Wish it was alien abduction..least we could see the bastard.

 

[cmt12]

I don't think having CFS/ME associated with depression is necessarily useful since doctors don't understand what causes depression either. I just see it as a good thing that these subjective distinctions and assumptions are being questioned. Doctors don't operate the way they do because it's correct but because they don't know any better.

 

[Richie]

Several studies have shown that ME/CFS can be objectively measured using exercise testing. V02 and Anaerobic threshold are low compared to sedentary controls and go lower if tested a second time after exercise. This corresponds with an exacerbation of symptoms including brain fog, GI symptoms, headaches, flu like feeling, etc.. In depression and anxiety disorders, people feel tired but they don't score low on exercise testing. They also don't score worse the second test and their symptoms are typically improved by vigorous exercise, not increased by it.

Acer
How can an inflamed brain or spinal cord be measured by an exercise test? What is being measured is an objective physiological problem amongst people with an ME/CFS label but not the presence or level of ME itself.
This is an objective finding which is not shown by people with depression or anxiety, as you say, unless they have this co-occurently with VO2 PEM. But there are many people who might pass Vo2 but still be organically ill.
We need these dichotomies (normal vo2/abnormal, low cortisol/high cortisol etc to help differentials but the interpretation and subsequent categorisation of patients is a different matter.
There are doctors out there in both the psychologising and anti psychologising camp . who, if they encountered a fatigued patient who had normal VO2 max would diagnose "depression" or "neurosis" as if these are the only alternatives to VO2 max PEM type CFS/ME, and despite the fact that depression IS NOT ALWAYS accompanied by tiredness and there are numerous organic fatigue sate illnesses which have never been thoroughly measured on Vo2 max (e.g. comparison was made between CFS/ME cases and sarcoidosis, the latter having normal VO2 max, but did they measure active sarcoidosis or post sarcoidosis fatigue patients. PSF overlaps massively with ME/CFS symptomatically. Even in the absence of an abnormal VO2 max the overlap between post sarcoid and ME/CFS would be striking, and given VO2 max does not measure neurological inflammation, post sarcoid could claim to have ME too!
As Irene says, semantics becomes the problem and this will remain so until normal, investigative medicine, reflected in proper subgrouping and nomenclature is begun. Sadly for us....

 

[Richie]

Part of the problem here is semantic. Both depression and CFS/SEID are typically diagnosed by asking the patient questions about symptoms. (Blood tests are usually done to rule out other disorders that might cause those symptoms.) Both depression and CFS can be described using the same terminology: "I'm tired; I can't sleep, and I don't feel any better if I do sleep; I can't get anything done; my life is falling apart, I can't keep up. . . ." Most docs are tuned into recognizing depression, not CFS, so that's what they will diagnose.

How many people have actually been diagnosed using 2-day exercise testing?

irese
i agree about Doc's ""tuning" but we do not want to inadvertently encourage them in this., by making VO2 max PEM the differential between depression and organic fatigue.
V.O2 Max will tell us whether we have VO2 max PEM. It will not tell us about neuroinflammation, ongoing infection, oxidative stress, methylation issues etc.,, nor about the source of fatigue.
VO2 max can be used to determine VO2 max PEM , but not to diagnose ME and certainly not to inmply those who are normal on VO2 MAx are actually depressed..
I have had reactive deprsssion and possiblly endogenous depression, the latter due to immune mediated serotonin deficiency, possibly due to a brain blown for years out on TNF alpha and other physiologial factors and my problem has been fatigue/fatigability always. depression sometimes.
Appreciate your point but I think we have to be careful.
If I passed VO2max, I would still not fir depression.

 

[Richie]

Yes but Prehaps cfs is an abnormal form of depression (not in the sad sense, in the sense of altered brain chemistry) that cause misfire in hpa axis, mitochondria, immune system etc.....leading to poor physical state. A communicative neurotransmitter breakdown.

Trouble is , Greg, you can turn it round and say the opposite. Why not?
Why label CFS as abnormal depression and not depression as abnormal CFS?
As we stand the symptoms are different in that physical tiredness, post exercise malaise (with or without Vo2 max PEM) , POTS, muscle pain are absent , reactive or marginal in typical depression but are CENTRAL features of CFS/ME, whereas depression is generally much more melancholic (though not always). I fear it would not be helpful to call us another typeof " atypical depression".
Anyway, what we need is to understand cause, process, complications, and resolution..But we don't eve know who has what at the moment.

I think your point would be most relevant in burnout if what led to the burnout in one person might have led to depression in another. But burnout is still not depression as the symptoms are different and e.g it would be dangerous to give sb with adrenal burnout an antidepressant with adrenal suppressing qualities.

Whatever we have, whatever subgroup we are in we need serious, thought out, informed medicine.

 

[Snow Leopard]

Regarding cortisol levels: Isn't it generally understood on this forum that cortisol levels start off high when first becoming symptomatic but then get down-regulated? We are stuck in a stressed, pain state meaning high cortisol, but our bodies are not going to continue to produce high cortisol, which is why the down-regulation happens showing low cortisol.

In a word, no.

The above is a common speculation, but I've yet to see any evidence that suggests that it is true.

Those with depression/constant stress test with higher than normal cortisol, regardless of how long it has been going on for.

The cortisol levels don't magically drop from high to low for no reason. There is no evidence of damage/hypotrophy/hypertrophy or whatever to the adrenal glands. Adrenal gland function itself seems normal.

Except there is a tiny bit of evidence, though mixed that GCR/GR (receptors for cortisol) are upregulated in the body, therefore requiring a lower level of cortisol to function. In addition, GR can have physiological effects in the absence of cortisol, and so the shift towards more GR and less cortisol could be explained as a (desirable) response towards more of these direct GR functions. This too is speculative, but it shows you that there are multiple possibilities at play.

In any event, it is a mistake to assume that any particular measured abnormalities are themselves causative of symptoms, rather than as a useful adaptive response to underlying illness.

Why label CFS as abnormal depression and not depression as abnormal CFS?

Neither are applicable as neither are sensitive/specific enough to describe the disease. As I said, around 50% of patients are found to have depressive symptoms in population based studies. This is not sensitive enough for CFS to be considered a form of depression.

 

[A.B.]

Except there is a tiny bit of evidence, though mixed that GCR/GR (receptors for cortisol) are upregulated in the body, therefore requiring a lower level of cortisol to function. In addition, GR can have physiological effects in the absence of cortisol, and so the shift towards more GR and less cortisol could be explained as a (desirable) response towards more of these direct GR functions.

What are these direct GR functions?

 

[lansbergen]

In any event, it is a mistake to assume that any particular measured abnormalities are themselves causative of symptoms, rather than as a useful adaptive response to underlying illness.

Indeed.

 

[wastwater]

My Depression responds badly to exertion,and doesn't come in episodes(its constant) and is partially responsive to essential antidepressant treatment.Make of that what you will

 

[Sea]

Seriously, what's the fascination with trying to equate ME/SEID with depression? They have no similarities. None. Unless you believe mild "fatigue" is the core symptom of ME/SEID.

I don't believe ME/CFS is depression or related to depression, but I do think many do not fully understand what depression can do to a person.

I have several friends with depression and in particular have supported 2 people with Major Depressive Disorder. In those 2 people, their fatigue is extreme, their cognitive difficulties pronounced and their response to exercise similar to ME/CFS as well as the symptoms we would more readily associate with depression. It is impossible to say their symptoms do not overlap ME/CFS. One recovered after a suitable antidepressant regime was found (after 5 years and with a combination of 3 meds), so I don't think it could be argued that depression wasn't the right diagnosis. The other is ongoing and so far on her 4th trial of different meds.

I don't think it's helpful to look at the overlap of symptoms and say they must have the same cause, but neither is it helpful to say there is no overlap. We overlap with many conditions and exploring associations may be helpful for research. I believe depression is as much a biological illness as ME/CFS is.

 

[Richie]

And perhaps it's the result of alien abduction

Creating a vague explanation to support a pet hypothesis seems rather pointless. Especially when the pet hypothesis has been pretty well disproven, and alternative illness models are strongly supported by a large body of medical research.

Seriously, what's the fascination with trying to equate ME/SEID with depression? They have no similarities. None. Unless you believe mild "fatigue" is the core symptom of ME/SEID.

Valentijn
I agree with a the basic premise that CFS/ME is not depression It is wrong and dangerous to equate ME and CFS with depression and it is stupid as the patients are not complaining of depression. That said, so many conditions can have sth in common on one level and be quite different on another and individuals will be different. None of this is unique to CFS and overlap between depression and CFS is a legitimate topic. If there were no overlap there would be no confusion in diagnosis, so better elucidate it imo..

Simply put no intention to patronise), because the brain is an organic part of the neuroimmune system but is majorly involved in conditions of the mind, it would not be surprising if some of us develop mental symptoms as part of our neuroimmune illness. Parkinson's is not depression but PD patients do get depressed and their depression is closely related to their organic illness, not just reactive. Can you say this is never the case in ME/CFS people? This does not imply any equation of ME/CFS or PD with depression..

Three areas of brain inflammation were found in the Japanese research - some more depressed, some more pain (FM type) some more fatigue - all CFS by Japanese standards, could even be from one cause, but still different areas of inflammation and some different symptoms incl depression..

Some report stress prior to illness. Perhaps they developed a neuroimmune problem resulting in CFS/ME whereas someone with a different genetic makeup might have developed depression. Some recall only infection. Some have no idea, some were bitten by a tick. Some have deficiencies. Any of these can cause both bodily and mental symptoms. we can be so different on on level and very similar on another. We can differ, as I have done over the years.

There is also patient experience.

We have messed up nervous systems, messed up neuroendocrine systems, messed up lives, messed up immune systems and are symptomatically diagnosed. In these regards we overlap with many endogenously depressed patients. Many of the areas affected in depression are affected in us - but differently. A lot of us have experience of reactive depression too, and immune activity can cause endogenous depression both in ME/CFS and in non CFS/ME. Many are very stressed as a result of illness, and in illnesses such as Parkinson's stress will make neuro symptoms worse.

We are probably not a single group anyway, but we do not divide along e.g. VO2 max PEM vs. depression or low cortisol vs depression either. That is far too simplistic and should be understood by our friends in the medical community.. With such variety some of us are going to consider the role of depression in our condition - whether it is "just" reactive or an immune mediated part of the illness - , which fortunately many are spared. This is also clinically essential so that any psychologising doctors who consider us to have depression rather than CFS/ME understand that we can differentiate between symptoms , that we are not Cartesian dualists, that we do not despise the mentally ill , that we are not benighted by llittle knowledge/understanding,and that we probably know more about alternative tryptophan pathways in infection than they ever will!!!!!!!! But then, you tell some of them all this and they just conclude "it's not depression, it's obsession". Sometimes we can't win, which is why you naturally baulk at psychiatric talk.........

 

[Richie]

My Depression responds badly to exertion,and doesn't come in episodes(its constant) and is partially responsive to essential antidepressant treatment.Make of that what you will

From my reading and experience as a patient
Exercise can stimulate the immune system and immune stimulation can cause depression. If you are too unwell or deficient for the level of exercise the experience in itself may be depressing. If you are carrying an infection and you stimulate your immune system you might be made to feel worse but actually be fighting the bug!
Do you have any history of over exercise/overtraining? This can cause neurochemical brain based fatigue/depression.
I wonder if people carrying gut infections lie candida feel worse if exercise promotes absorption from gut. How are you after meals?

 

[Sidereal]

I don't believe ME/CFS is depression or related to depression, but I do think many do not fully understand what depression can do to a person.

I have several friends with depression and in particular have supported 2 people with Major Depressive Disorder. In those 2 people, their fatigue is extreme, their cognitive difficulties pronounced and their response to exercise similar to ME/CFS as well as the symptoms we would more readily associate with depression. It is impossible to say their symptoms do not overlap ME/CFS. One recovered after a suitable antidepressant regime was found (after 5 years and with a combination of 3 meds), so I don't think it could be argued that depression wasn't the right diagnosis. The other is ongoing and so far on her 4th trial of different meds.

I don't think it's helpful to look at the overlap of symptoms and say they must have the same cause, but neither is it helpful to say there is no overlap. We overlap with many conditions and exploring associations may be helpful for research. I believe depression is as much a biological illness as ME/CFS is.

I agree. Depression and ME/CFS are separate diseases but I get the impression most here have not seen people with very severe depression who are in a critical condition - catatonic, unable to drink or eat, unaware of what's going on around them, dying. Severe depression can be every bit as severe as severe ME/CFS and there is no reason to think it's anything other than an organic illness. To say there is no overlap or only mild overlap in symptomatology is not accurate.

 

[ukxmrv]

It's pointless to suggest an overlap unless there is a shared mechanism though I think.

We would have ME and the MS overlap or ME and the RA overlap based on shared symptoms. It would be a big list.

Unless we can prove that ME and depression have similar proven mechanisms that create any joint features then it's only a theory like all the other diseases that share similar symptoms.

 

[Richie]

It's pointless to suggest an overlap unless there is a shared mechanism though I think.

We would have ME and the MS overlap or ME and the RA overlap based on shared symptoms. It would be a big list.

Unless we can prove that ME and depression have similar proven mechanisms that create any joint features then it's only a theory like all the other diseases that share similar symptoms.

It is so not pointless.
A clinical situation
I have CFS for 30 years. No diagnosis for 13
I get tests ca 2000. TH1 activation clearly shows. Organic immune disturbance in fatigued patient (CFS/ME consistent over years)
Some reactive depression and natural anguish.
TH1 activity can deprive brain of tryptophan therefore causing endogenous depression, sleep probs etc. Armed with this knowledge of overlap I can request antidepressants (albeit in microdoses) without in any way conceding that I have depression rather than CFS/ME and allowing that the underlying cause of both may be the immune activation and/or autoimmune or infective processes underlying the immune activation, and NOT NECESSARILY STRESS RELATED..
Knowing the overlaps empowers us in the argument for physical causality and refutes who claim we are dualists , have no understanding of stress etc.

 

[amaru7]

Illness behavior
A lack of support, or the reinforcement of illness behavior by social networks, may be associated with delayed recovery for some patients.[26]

Mood disorders
There are clinical overlaps and differences between CFS and clinical depression. Current mood disorders occur in 18.9% of CFS patients compared to 3.9% of the general population.[31] Previous psychiatric disorders or shared risk factors for psychiatric disorders may have an etiological role in some cases of CFS.[32] The presence of multiple comorbid disorders could be a marker for psychological influences on etiology.[33] Neuropsychological impairments could be involved in CFS,[34] and neuroendocrine studies and brain imaging have confirmed the occurrence of neurobiological abnormalities in most patients with CFS.[35] Findings of increased autoimmune antibodies against phospholipids (phosphatidyl inositol) in CFS and depression may underpin the similarities and comorbity between the two disorders.[36]

http://en.wikipedia.org/wiki/Pathophysiology_of_chronic_fatigue_syndrome

 

[Richie]

In a word, no.

The above is a common speculation, but I've yet to see any evidence that suggests that it is true.

Those with depression/constant stress test with higher than normal cortisol, regardless of how long it has been going on for.

The cortisol levels don't magically drop from high to low for no reason. There is no evidence of damage/hypotrophy/hypertrophy or whatever to the adrenal glands. Adrenal gland function itself seems normal.
.

My experience is that infection can knock out cortisol even in periods of garte biological stress. Isn't there much work on stages of adrenal failure, showing that eventually cortisol production can fail despite ongoing stress stimulation?

Didn't Louisa Scott fiind adreanl hypotrophy in her patients at Kings (albeit under Wessely. I think)? Dr Wrightt showed me her paper and he was no frioend of the psychologisers.

I was being facetious in asking why if CFS is called abnormal depression, depression should not be called abnormal CFS.

 

[DanME]

Could we please stop this once and for all?!

ME is not depression! Both are two complete distinct entities. The symptom patterns are remarkably different and quite easy to distinguish (except you like the Oxford criteria). Of course there is some overlap. Depressed patients can develop severe fatigue and sleep disruption. But this doesn't mean anything. MS patients can develop the same, but do we have therefore MS? No!! People with autoimmune hepatitis suffer from crushing fatigue. Do we have that, because of an overlap in one core symptom? No!! I could go on and on...

To make things even clearer:

Patients with depression have no PEM, no OI, no ataxia, no severe vertigo, no gastro paresis, no heat intolerance, no sore throat, no tender lymph nodes etc.

Also ME patients usually want to get back on their feet as fast as possible and want to study, work or meet friends etc. Most of us even know that activity will backfire with a crash (or better PEM), but do it anyways. Why? Because we have an intact will and still hope.

Severly depressed patients don't want to do much and cannot see any sense in their life. If you push them for any activity and especially sports it won't backfire at all. Usually it will improve the severe feelings of hopelessnes.

I don't stigmatize depression or any other mental disease. These patients have a horrible disease and deserve good care and treatment. The problem, the treatment, which helps depressed patients, doesn't work or is even harmful for us, like GET or CBT. It is like people don't treat depression with heavy immunosupressive drugs, because depression has some symptom overlap with MS. It's just nonsense.

 

[Valentijn]

Illness behavior
A lack of support, or the reinforcement of illness behavior by social networks, may be associated with delayed recovery for some patients.[26]

Mood disorders
There are clinical overlaps and differences between CFS and clinical depression. Current mood disorders occur in 18.9% of CFS patients compared to 3.9% of the general population.[31] Previous psychiatric disorders or shared risk factors for psychiatric disorders may have an etiological role in some cases of CFS.[32] The presence of multiple comorbid disorders could be a marker for psychological influences on etiology.[33] Neuropsychological impairments could be involved in CFS,[34] and neuroendocrine studies and brain imaging have confirmed the occurrence of neurobiological abnormalities in most patients with CFS.[35] Findings of increased autoimmune antibodies against phospholipids (phosphatidyl inositol) in CFS and depression may underpin the similarities and comorbity between the two disorders.[36]

http://en.wikipedia.org/wiki/Pathophysiology_of_chronic_fatigue_syndrome

Illness behavior isn't a "behavior". It's the body's physiological reaction to being sick.

I'm afraid that you and that wikipedia entry are quoting a bunch of notorious psychobabblers (Wessely, the Nijmegen group, etc) who are known to heavily spin their research and use chronic fatigue patients, rather than ME/SEID patients.

As an example: "Do you still enjoy doing things you used to enjoy?" is equated with depression - even if you're no longer physically able to do those things, but now enjoy doing different things instead.

 

[Richie]

Dan
I have had the list of symptoms you note. Iwas undiagnosed for 13 years bof 30. I have done the "do it even though it will backfire thing" for 13 years. I had to or I would have killed myself as the Drs would do 000000. For me. i do the same now as I want a life. Ruinously I was unable to study further. But I have also had some endogenous depression.

I have had a severely serotonin depleted system (if urinary evidence is reliable and I think in my case it is)..
I suspect the serotonin depletion is related in my case to TH1 activation of pathways away from serotoiinin production and towards neurotoxins also found in my urine. This is imo likely to be part of the organic illness , causing some depression and contributing to sleep difficulties.
In my case I believe there is an organic overlap between my CFS and serotonin depletion and conssequent depressive features, sleep problems etc.

Possibly the serotonin depletion is entirlely incidental, possibly. I doubt it.
Possibly I have Lyme or any other TH1 activating condition, possibly fibromyalgia, but I am symptom wise taken over 30 years, as well as having had several of the test abnormalities others on this board have, well within CFS/ME.