This article is a couple of years old, but I didn't see it discussed anywhere. The abstract is pasted below. Of 82 patients, 39% were responders to cognitive behavioral therapy (as measured with Clinical Global Impression scale) and 61% were non-responders. It's interesting because the authors identify a biomarker (low morning cortisol) for non-responders. This doesn't get the attention it deserves. By the way, I just started low-dose hydrocortisone last week and feel almost cured of any post-exertional symptoms so far. Cortisol for CBT responders & non-responders Does hypocortisolism predict a poor response to cognitive behavioural therapy in chronic fatigue syndrome? A. D. L. Roberts1,2, M.-L. Charler2, A. Papadopoulos3, S. Wessely1,2,3, T. Chalder1,2 and A. J. Cleare1,2,3* 1 Kings College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK 2 Chronic Fatigue Syndrome Research and Treatment Unit, Maudsley Hospital, London, UK 3 National Affective Disorders Unit, Maudsley and Bethlem Royal Hospitals, London, UK Background. There is evidence that patients with chronic fatigue syndrome (CFS) have mild hypocortisolism. The clinical significance of this is unclear. We aimed to determine whether hypocortisolism exerted any effect on the response of CFS to cognitive behavioural therapy (CBT). Method. We measured 24-h urinary free cortisol (UFC) in 84 patients with Centers for Disease Control and Prevention (CDC)-defined CFS (of whom 64 were free from psychotropic medication) who then received CBT in a specialist, tertiary out-patient clinic as part of their usual clinical care. We also measured salivary cortisol output from 0800 to 2000 h in a subsample of 56 psychotropic medication-free patients. Results. Overall, 39% of patients responded to CBT after 6 months of treatment. Lower 24-h UFC output was associated with a poorer response to CBT but only in psychotropic medication-free patients. A flattened diurnal profile of salivary cortisol was also associated with a poor response to CBT. Conclusions. Low cortisol is of clinical relevance in CFS, as it is associated with a poorer response to CBT. Hypocortisolism could be one of several maintaining factors that interact in the persistence of CFS.