Are endogenous depression and cfs close relatives?

[Snow Leopard]

But don't the stages of maladaptation show a passage from high cortisol thu low cortisol highwer DHEA to low both? I can't remember the various stages. Would that not be reflected hiistologically.?

If there is some sort of unusual/specific disease process causing that atrophy, sure.

Otherwise, no. These stages are just hypothetical, no one has actually demonstrated that they happen.

 

[Valentijn]

But without VO2 max how do we know and how do we know that we don't have encephalomyelitis even in VO2 max is normal? A sfar as I know this stuff is never looked at properly.

The symptoms of PEM are obvious. Even without a 2-day CPET, someone can look at their symptoms, their timing compared to exertion, and see if there's a connection. Other forms of exercise intolerance hit during or very quickly after exertion - this can be a bit confusing in ME/SEID, because most patients get both the faster OI exertion intolerance, and a delayed PEM reaction.

Encephalomyelitis isn't a required sign or symptom for any modern diagnosis of ME/SEID, as far as I know.

 

[Richie]

Good for you - I suggest you go get diagnosed by one, since a real professional would not diagnose it based primarily on fatigue and in the absence of PEM and associated immune and neurological symptoms.

But you do not get to redefine ME/SEID to fit with your perceptions, or your personal experiences.

Valentijn
To be fiar to Amaru ME cannot be defined. It is myalgic encephalomyelitis. All the criteria in the world cannot change that. it justis whai is.
We all think we have or are convinced we have ME but only those with the neuroimgaes to show it can say it for definite, whatever criteria we fit.

If there is some sort of unusual/specific disease process causing that atrophy, sure.

Otherwise, no. These stages are just hypothetical, no one has actually demonstrated that they happen.

Do you know that? Even if they are not consecutive stages adrenal output differs at times (not talking Addison's or Cushing's). if it differs and it is histologically apparent you are saying it must be " an unusual specific disease process". Some would say this is exactly what is going on in some ME/CFS cases. Is this never the case?

 

[Valentijn]

To be fiar to Amaru ME cannot be defined. It is myalgic encephalomyelitis. All the criteria in the world cannot change that.

Why can't it be defined? That is exactly what criteria do, for every illness.

A group of patients have a specific, unusual, and distinct symptom which is essentially not present in any other disease. Furthermore that symptom can be objectively measured by the two-day CPET. If that's not good enough to define a disease, I guess you just think that any patient who wants to can waltz into any disease diagnosis, even if they don't satisfy the basic criteria?

 

[Richie]

The symptoms of PEM are obvious. Even without a 2-day CPET, someone can look at their symptoms, their timing compared to exertion, and see if there's a connection. Other forms of exercise intolerance hit during or very quickly after exertion - this can be a bit confusing in ME/SEID, because most patients get both the faster OI exertion intolerance, and a delayed PEM reaction.

Encephalomyelitis isn't a required sign or symptom for any modern diagnosis of ME/SEID, as far as I know.

Then we are back to assertion. "ME is not really encephalomyelits, and some people assert it is to be reserved for a certain type of PEM, to be defined by a certain group of doctors and certain patients".
Meanwhile even if you have actual encephalomyelitis but the "wrong sort" of PEM, even if such PEM is incredibly debilittating and is PEM (after all why is delayed PEM PEM, whereas immediate PEM is not, PEM - same for SEID?) It's playing with terminology, at the risk of chucking organically ill subgroups without the "right" PEM out of the group, with suggestions that they are really depressed, where the psychiatristsare waiting.
No thanks.

 

[Richie]

Why can't it be defined? That is exactly what criteria do, for every illness.

A group of patients have a specific, unusual, and distinct symptom which is essentially not present in any other disease. Furthermore that symptom can be objectively measured by the two-day CPET. If that's not good enough to define a disease, I guess you just think that any patient who wants to can waltz into any disease diagnosis, even if they don't satisfy the basic criteria?

You talk of waltzing.
Good criteria describe symptoms and underlying biology with appropriate wording.
ME with the association/implication of myalgic encephalomyelitis, is not imo good scientific wording, especially if one type of PEM becomes the defining criterion. It is good practical clinical sense to keep the name ME fot the oment, but no group has the right, to use yur phrase, to waltz in and declare "ME is now this or that type of neroimmune PEM and nothjing else", especially if in some case the sth else includes actual encephalomyeklitis. That is my point.
If ME is no longer encephalomyelitis, then it is a heritage name which may cover various organic aetiologies/states As such it is not right for one group of pateints to grab it and say "ME is what have, i.e with out tyoe of PEM" This is just assertion. Why can we not work on the basis of subgroups with a heritage name which keeps us all out of the hands of psychologisers?

 

[Valentijn]

Then we are back to assertion. "ME is not really encephalomyelits, and some people assert it is to be reserved for a certain type of PEM, to be defined by a certain group of doctors and certain patients".

Myalgic Encephalomyelitis is the name. It's not a required symptom. PEM is a required symptom, and it doesn't have to be related to encephalomyelitis. I really don't understand your hang-up with encephalomyelitis. Does Lupus have to involve turning into a wolf?

Meanwhile even if you have actual encephalomyelitis but the "wrong sort" of PEM, even if such PEM is incredibly debilittating and is PEM (after all why is delayed PEM PEM, whereas immediate PEM is not, PEM - same for SEID?) It's playing with terminology, at the risk of chucking organically ill subgroups without the "right" PEM out of the group, with suggestions that they are really depressed, where the psychiatristsare waiting.
No thanks.

PEM is a very specific symptom. It's one subtype of exercise intolerance. If someone doesn't have it, then they don't have ME/SEID. That doesn't mean that they are depressed, but they don't have an inherent right to change the definition of ME/SEID just because they don't fit the actual criteria. It does mean that they probably need to get further medical investigation to figure out what is really going on. It helps no one when patients are misdiagnosed.

Non-delayed PEM is not PEM because PEM must be delayed. If it isn't delayed, and doesn't feature in a certain manner, it's not PEM, but may still be a different form of exercise intolerance. In which case the source of that exercise intolerance should be identified and treated. In many cases, it's simple orthostatic intolerance. Take a pill, wear support stockings, learn some leg exercises, drink more electrolytes and fluids, and bam, they're able to live normal lives again. Or they can cling to a diagnosis which they don't fit, and not get the appropriate treatments, and continue struggling to function.

 

[Valentijn]

Good criteria describe symptoms and underlying biology with appropriate wording.

Myalgic Encephalomyelitis is still a name, not a criteria. And for historical reasons, many diseases have inaccurate or irrelevant or otherwise non-descriptive names. When the only alternative is "chronic fatigue syndrome", ME looks pretty damned good, regardless of the accuracy.

ME with the association/implication of myalgic encephalomyelitis, is not imo good wording, especially if one type of PEm becomes the defining criterion. That is my point.
If ME is not encephalomyelitis it is a heritage name which may cover variuos organic aetiologies/sataes.

Um, alright, you don't like "ME". Personally I can take it or leave it, and am warming up to SEID, or ME/SEID. But the modern definitions remain, and focus on PEM. If someone literally has documentation of encephalomyelitis with myalgia, but no PEM, then well, sucks to be them? Hopefully there is a disease classification to which they apply, and hopefully a doctor will treat their symptoms regardless of diagnosis. But it would be quite silly to include such a patient in ME/SEID research.

And since encephalomyelitis is a symptom, it certainly can be present in more than one disease. Requiring PEM for a disease often labeled as ME does not suggest that people without PEM cannot have encephalomyelitis with myalgia.

As such it is not right fro one group of pateints to grab it and say "ME is waht we have, i.e with out tyoe of PEM" This is just assertion. Why can we not work on the basis of subgroups with a heritage name which keeps us all out of the hands of psychologisers?

Because those groups have different symptoms, require different treatments, and the members of one group react very badly to treatments advocated for other patients. Then many patients are not being helped, and some are being badly harmed.

 

[acer2000]

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....

Sure, I'll give you that depression is a symptom that can occur as a result of inflammation in the brain and ME/CFS also has inflammation in the brain. But there are some important differences beyond that.

I'm not suggesting depression isn't an organic illness. I think it is. But I think there is value in measuring the unique features of different illnesses so that more focused research can be done. Every illness involves inflammation of something...

 

[Richie]

Good criteria describe symptoms and underlying biology with appropriate wording.
ME with the association/implication of myalgic encephalomyelitis, is not imo good wording, especially if one type of PEm becomes the defining criterion. That is my point.

Myalgic Encephalomyelitis is the name. It's not a required symptom. PEM is a required symptom, and it doesn't have to be related to encephalomyelitis. I really don't understand your hang-up with encephalomyelitis. Does Lupus have to involve turning into a wolf?

PEM is a very specific symptom. It's one subtype of exercise intolerance. If someone doesn't have it, then they don't have ME/SEID. That doesn't mean that they are depressed, but they don't have an inherent right to change the definition of ME/SEID just because they don't fit the actual criteria. It does mean that they probably need to get further medical investigation to figure out what is really going on. It helps no one when patients are misdiagnosed.

Non-delayed PEM is not PEM because PEM must be delayed. If it isn't delayed, and doesn't feature in a certain manner, it's not PEM, but may still be a different form of exercise intolerance. In which case the source of that exercise intolerance should be identified and treated. In many cases, it's simple orthostatic intolerance. Take a pill, wear support stockings, learn some leg exercises, drink more electrolytes and fluids, and bam, they're able to live normal lives again. Or they can cling to a diagnosis which they don't fit, and not get the appropriate treatments, and continue struggling to function.

Encephalomyelitis is not symptom. it is a neuro degenerative state or process. it would only be seen as a mere symptom if the neurodegenerative process were seen as just a marker of an illness rather than the/a part of illness itself, causing symptoms in itself. In some cases. maybe it is just a marker. I don't know.

How can you say that sb with myalgia and encephalomyelitis in the absence of another diagnosis (e.g. late stage Lyme) does not have myalgic encephalomyelitis i.e ME? This diagnosis has existed for decades, in alll probability includes some actual encephalomyelitis cases, certainly includes other neuroinflamed states e.g. dorsal root ganglionitis, and I do not think anyone has the right to throw such people out of the ME classification of they do not have delayed PEM. This would be absurd in terms of nomenclature, high handed and cruel. Some of the most severely affected with or without actual encephalomyelitis may bt be up to VO2 max testing anyway.

PEM needs to be delayed only by definition. It is an assertion, no more. Better call it "delayed PEM" as PEM may be immediate, and coincident with many neuroimmune abnormalities common in historic ME/CFS, with no alternative diagnosis. Why is one the PEM of ME and the other not?

What you say of OI may be equally applied to delayed PEM. Find out the cause, of course. But this does not imply that OI accompanied by other ME consistent symptoms but no delayed PEM is not ME and PEM accompanied by many ME consistent symptoms but no OI is ME.
To assert the one is ME and the other is not is just arbritrary labelling.
Why not think up another name for your group?

 

[Richie]

Myalgic Encephalomyelitis is still a name, not a criteria. And for historical reasons, many diseases have inaccurate or irrelevant or otherwise non-descriptive names. When the only alternative is "chronic fatigue syndrome", ME looks pretty damned good, regardless of the accuracy.

Um, alright, you don't like "ME". Personally I can take it or leave it, and am warming up to SEID, or ME/SEID. But the modern definitions remain, and focus on PEM. If someone literally has documentation of encephalomyelitis with myalgia, but no PEM, then well, sucks to be them? Hopefully there is a disease classification to which they apply, and hopefully a doctor will treat their symptoms regardless of diagnosis. But it would be quite silly to include such a patient in ME/SEID research.

And since encephalomyelitis is a symptom, it certainly can be present in more than one disease. Requiring PEM for a disease often labeled as ME does not suggest that people without PEM cannot have encephalomyelitis with myalgia.


Because those groups have different symptoms, require different treatments, and the members of one group react very badly to treatments advocated for other patients. Then many patients are not being helped, and some are being badly harmed.

ME as a name is OK until it is made to equate with delayed PEM. Why is delayed PEM ME, when actual encephalomyelitis but without PEM is not? Absurd .Of course maybe all actual M encep cases will have PEM. Who knows?

Why not just call your illness "delayed PEM"? I think you probably want to keep an established name and research money. It is politically useful But other patients with unproven/without delayed PEM or recovered from VO2 max PEM but still immune activated and ill may fthey want the name too. I say good luck to them.

Why should myalgic encephalomyelitis money all be targeted at delayed PEM syndrome when it is being "sold" as ME? That's false marketing imo. No one subgroup has the right to take historical name in principle. In practice most of us may have delayed PEM. But really only those hwo have actual encephalomyelitis can claim the term ME as theirs.

But I guess we will not agree.

 

[Richie]

Sure, I'll give you that depression is a symptom that can occur as a result of inflammation in the brain and ME/CFS also has inflammation in the brain. But there are some important differences beyond that.

I'm not suggesting depression isn't an organic illness. I think it is. But I think there is value in measuring the unique features of different illnesses so that more focused research can be done. Every illness involves inflammation of something...

I agree.

 

[Valentijn]

How can you say that sb with myalgia and encephalomyelitis in the absence of another diagnosis (e.g. late stage Lyme) does not have myalgic encephalomyelitis i.e ME?

We have ME as a name of our disease. It is not a required symptom of that disease, ironically, and someone with that symptom/process/whatever is not required to be labeled with the disease ME. And if they have that symptom/process/whatever, it does not preclude them from being labeled with some other disease. You seem to be arguing some rather ridiculous semantics.

PEM needs to be delayed only by definition. It is an assertion, no more. Better call it "delayed PEM" as PEM may be immediate, and coincident with many neuroimmune abnormalities common in historic ME/CFS, with no alternative diagnosis. Why is one the PEM of ME and the other not?

PEM is delayed by definition, because the definition is used to describe reality. There are patients who share a group of symptoms. One of those symptoms which they share is PEM - a delayed form of exercise intolerance feature exacerbation of immune, neurological, and other core disease symptoms.

If you can't understand why a disease requires a specific symptom, which is similar (but not the same) compared to other symptoms, yet not include those similar symptoms, then you aren't capable of understanding the concepts of disease or diagnosis.

To assert the one is ME and the other is not is just arbritrary labelling.
Why not think up another name for your group?

Yup, it's just labeling. Just like every other disease in existence. And like every other disease in existence, it's described based on its characteristics.

Why is it that you think an ME/SEID description should accommodate every "fatigue" based illness, or every illness featuring some form of exercise intolerance? There are many illnesses involving substantial fatigue, or exercise intolerance, and they are all pretty well proven to be distinct from each other. Should we give them all the same name and same treatment, even though it's different underlying problems which respond to different treatments?

 

[Richie]

We have ME as a name of our disease. It is not a required symptom of that disease, ironically, and someone with that symptom/process/whatever is not required to be labeled with the disease ME. And if they have that symptom/process/whatever, it does not preclude them from being labeled with some other disease. You seem to be arguing some rather ridiculous semantics.

PEM is delayed by definition, because the definition is used to describe reality. There are patients who share a group of symptoms. One of those symptoms which they share is PEM - a delayed form of exercise intolerance feature exacerbation of immune, neurological, and other core disease symptoms.

If you can't understand why a disease requires a specific symptom, which is similar (but not the same) compared to other symptoms, yet not include those similar symptoms, then you aren't capable of understanding the concepts of disease or diagnosis.

Yup, it's just labeling. Just like every other disease in existence. And like every other disease in existence, it's described based on its characteristics.

Why is it that you think an ME/SEID description should accommodate every "fatigue" based illness, or every illness featuring some form of exercise intolerance? There are many illnesses involving substantial fatigue, or exercise intolerance, and they are all pretty well proven to be distinct from each other. Should we give them all the same name and same treatment, even though it's different underlying problems which respond to different treatments?

Can't the same be said of PEM ? Maybe it has multiple causes? Why subsume all cases of PEM under one ME?
What about patients who share many ME criteria, many abnormalities historically associated with ME diagnosis and also used by patients as rule of thumb differentials e.g. low cortisol, but do not show delayed PEM.? Why do they not have ME? You are just asserting that one group has the right to the name whereas the other does not. some may be in a transition toward delayed PEM others in recovery but still stricken with many ME associated problems.

My problem is why one particular symptom should be used i..e delayed PEM esp as this might exclude genuine encephalomyelitis. so your criticism is misconceived.
Why do you say I think that ME/SEID should accommodate every fatigue based illness, Nowhere have I sugested that.

We will not agree any time soon, and now you are accusing me of thinking things I do not think and have not said, which is where I quit. I will end by repeating my point:-
If, many with or without encephalomyelitis, who on the basis of. let us say Canadian or ICC are ME consistent and have the diagnosis but do not have delayed PEM are deprived of the term ME on those grounds, then .we may be doing a grave injustice in chucking them out of the ME tent..

and by a conciliatry (I hope) thought:-
if most historically diagnosed ME cases with or without encephalomyelitis do indeed have delayed PEM, then research and treatment of delayed PEM will help most ME patients.
We could share that hope, despite our disagreements.

 

[Snow Leopard]

Some would say this is exactly what is going on in some ME/CFS cases. Is this never the case?

It might be, but it is just an idea, not even a hypothesis.

 

[Valentijn]

Can't the same be said of PEM ? Maybe it has multiple causes? Why subsume all cases of PEM under one ME?

Maybe it does. Hopefully research into tightly-defined groups requiring PEM will help clarify that. Whereas dding non-PEM patients into the group would muddy things considerably.

What about patients who share many ME criteria, many abnormalities historically associated with ME diagnosis and also used by patients as rule of thumb differentials e.g. low cortisol, but do not show delayed PEM.? Why do they not have ME? You are just asserting that one group has the right to the name whereas the other does not. some may be in a transition toward delayed PEM others in recovery but still stricken with many ME associated problems.

Many CFS criteria used in the sloppy criteria are present in countless other diseases as well. Fatigue is pretty useless, pain as well - they're present in hundreds of disease. And low cortisol is certainly not unique to ME/SEID.

My problem is why one particular symptom should be used i..e delayed PEM esp as this might exclude genuine encephalomyelitis. so your criticism is misconceived.
Why do you say I think that ME/SEID should accommodate every fatigue based illness, Nowhere have I sugested that.

PEM is used to define the disease because PEM defines the disease. Yes, it's circular, but it takes one group of people out of a huge group of people. People with a very unusual and precise symptom are much more likely to have the same disease, especially when compared to everyone who has pain and fatigue.

Please stop fixating on encephalomyelitis. If you have the acute version which the medical profession recognizes, you probably need to go to the emergency room. If we have it, which is just rather tentatively suggested thus far, it's a very mild version which many medical professionals would label as something else. Once again "Myalgic Encephalomyelitis" is the name. It is not a specific symptom of any modern ME/SEID definition. Please stop ignoring this point.

 

[Richie]

1) If you want to investigate delayed PEM, then not including other types of PEM or non PEM is fine, Absolutely. I agree. But the same could be said of any other parameter. The advantage of studying delayed PEM is that it may well be both common in and unique to ME.But that does not make it the unique, necessary identifier of ME, nor is it yet proven to be unique to ME, and only universal by assertion.

More immediate PEM may be experinced by a subgroup otherwise consistent with CC/ICC. People may change over time. Is testing for delayed PEM reliable? Are there false negatives?

If we disagree here, then, we disagree.

2) PEM may correspond to numerous causes, so, in itself,it is just as vulnerable to attack as many other abnormalities which are not unique to ME sufferers. The causes may not yet be identified, so delayed PEM sufferers may constitute a good group to study. But what if some have a certiain virus? And what if some without (verified) delayed PEM, who are consistent with ICC/CC ,also have said virus? And what if all the "ME " research money has gone on mechanisms of PEM - coz that's reall "ME" -and none on virology - coz that would include some non PEM ergo non ME" folk? Who will that have helped? Some delayed PEMers, maybe.
The implications for research and care of tying down "ME" to verified PEM may not be good.

The answer, for you, would be to limit virology studies to identified delayed PEM types. But why not do that under the explicit banner of delayed PEM? Remembering also that they might have numerous conditions causing the PEM, which might be found by studying PEm, which might give them a diagnosis of that condition anyway, which puts them in the same camp as other ME sufferers, who might have God knows what!! This is the problem of confusing a symptomatic diagnosis with one feature and it is just as much a problem, in principle, if the feature is PEM as it is if the feature is encephalomyelitis.

3) This for example http://www.meassociation.org.uk/201...ia-journal-of-internal-medicine-20-july-2011/ defines the disease. It takes account of PEM and VO2 MAx but does not tie the whole thing down to pne parameter, measurable by one test.

4) For myself, I could not look someone with myalgia and real encephalomyelitis (or possibly former suspected), in the absence of another diagnosis, still symptomatic but without delayed PEM in the eye and say "you do not have ME and may never have had it". Speaking for myself, I couldn't do that.. You may speak for your self.

Beyond that.I am pleased not to fixate on encephalomyelitis. Please understand this.. I am not equating ME with myalgic encepjalomyelitis. I only to say that one group consistent with, say, CC or ICC and showing delayed PEM according to one or another test WITH OR WITHOUT encephalomyelitis, does not have the right to claim the name and kudos of "ME" plus the charities and the equation with the WHO category"ME/myalgic encephalomyelitis" at the expense of another group consistent with CC/ICC on a whole range of parameters but displaying different fatigue/fatigability. Can't you see how potentially unfair as well as illogical this is,
When has acircular argument been a good one?
ICC/CC WITH OR WITHOUT encephalomyelits. That leaves room for all CC/ICC consistent cases. ICC/CC caters for various fatigue/fatigability and PEm types. it does not begin and end with one type of PEM, but they do include it.

Your approach will ensure that delayed PEM are not conflated with others for research. That is sound logic. Same could be said of any other parameter included in the criteria. It does not mean that ME = delayed PEM or that only those with one type of PEm measured in one way have the righ to the name ME, in my opinion.

We just disagree, but you have resorted to accusing me of fixation,thinking ME should accommodate all fatigue etc. I don't like to argue about things I have not said or done. I have no wish to defend points of view or attitudes which are not my own.

Let's disagree but we can both hope research into delayed PEM will be conducted thoroughly and to the benefit of many ME cases. IF MOST CC/ICC consistent patients have over the long term delayed PEM of your type, then this dispute will have been largely academic.. Let's see. But I personally do not want people left out in the cold. for the sake of a circular argument.

On my reading CC and ICC would accommodate varieties of fatigue and fatigability as long as there are enough other symptoms and preferably backed by labs on immune disturbance, mito respiration probs, HPA probs etc. Perhaps we just understand these documents differently.

 

[wastwater]

Looks like M vs E here

 

[amaru7]

Depression and Fatigue: A Vicious Cycle
Written by Michael Kerr
Medically Reviewed by George Krucik, MD


Learn about how depression affects fatigue, and vice versa. Find out what you can do to help treat both depression and fatigue.

In today’s fast-paced world, it’s not uncommon for people to feel fatigued, and to chalk it up to simply working too many hours and sleeping too little.


Since depression often interrupts sleep habits, a sufferer may not even realize that his or her fatigue is related to an illness until other symptoms start to emerge. It’s important to recognize that constantly feeling tired and sleeping poorly is not normal, and that there are ways to improve sleep—even if your fatigue is caused by an underlying problem such as depression.

Tired vs. Depressed
Depressed patients often report feeling disconnected from everything, with a lack of enthusiasm for the things they once held so dear. Feeling constantly tired is a common, if unhealthy, part of a too-busy life, but feeling listless and apathetic for weeks, months, or years at a time can be a sign of depression.

Sleepiness can also play a part in aggravating the symptoms of depression, as patients can suffer insomnia or interrupted sleep on a regular basis. This naturally would lead to a feeling of constant fatigue, but it can also exacerbate depression symptoms, as lack of sleep eventually takes a toll on the mind and body.

If you’re suffering from insomnia, be sure to mention your depression symptoms to your doctor along with your sleep troubles, and vice versa—when discussing depression with your doctor, be sure to bring up your sleep problems.

A Vicious Cycle
A European study showed that depression and fatigue fuel each other in a vicious cycle, with patients suffering from depression being four times more likely to suffer fatigue. Patients suffering from fatigue are three times more likely to become depressed. While the researchers were quick to point out that the two conditions have separate causes, they appear to feed off of each other in a cycle that can be difficult to break.

For patients suffering fatigue and/or depression, exercise may help. Since physical activity has been proven to help ease the symptoms of both conditions—exercise is thought to release endorphins, which can positively alter your brain chemistry, in addition to many other benefits. It may help break the cycle.

Effects of Fatigue
Over time, fatigue can have a negative impact on brain chemistry. Researchers have, in fact, found a noticeable drop in activity in the frontal lobes of the brain in overly tired patients. The study showed a drop in hormone secretion, with patients suffering a noticeable decrease in cognitive ability over time.

Depression has been linked to a reduction in the size of the hippocampal region of the brain, but that region of the brain remained the same in tests of the effects of fatigue.

Chronic Fatigue Syndrome and Depression
Chronic fatigue syndrome can often go undiagnosed, as it shares many of the symptoms of and tends to coexist with depression.

The difference between chronic fatigue syndrome and depression is that with chronic fatigue syndrome, patients do not have thoughts of suicide. But since fatigue can often cause depression and depression can often cause fatigue, both conditions often exist together to various degrees.

In a study of patients with chronic fatigue syndrome, researchers found that thirty-six percent of those with chronic fatigue syndrome (CFS) also suffered depression, with self-esteem being lower in CFS patients who were also depressed. Depression incidents were higher in female patients, as well as in lower income patients and those for whom pain limited physical activity.

This brought to the scientific community’s attention the correlation between CFS and depression and made it clear that physicians should watch for signs of depression among patients with CFS.

Fatigue and depression can exist in an endless cycle that may seem unbreakable, but by treating both conditions and exerting more physical activity, patients may be able to lessen symptoms of both fatigue and depression.

Most of all, research lets the medical community know that both conditions do often exist together and should be treated simultaneously.

Source: http://www.healthline.com/health/depression/fatigue#1

 

[amaru7]

Fatigue as a Residual Symptom of Depression
Steven D. Targum, MD

and Maurizio Fava, MD
Author information ► Copyright and License information ►
This article has been cited by other articles in PMC.
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Introduction
It is well recognized that many patients with major depressive disorder (MDD) do not achieve a full response to antidepressant medications despite adequate dose and duration of the treatment. One of the most common residual symptoms of a partially resolved depression is fatigue. Broadly defined, symptoms of fatigue can affect physical, cognitive, and emotional function, impair school and work performance, disturb social and family relationships, and increase healthcare utilization. Furthermore, some of the medications we use to treat MDD can induce symptoms of fatigue as side effects. Given the importance and complexity of fatigue occurring in patients with MDD, I discussed this topic with Maurizio Fava MD, Slater Family Professor of Psychiatry at the Harvard Medical School. Dr. Fava is also Executive Vice Chair of the Department of Psychiatry, Executive Director of the MGH Clinical Trials Network and Institute (CTNI), and Director of the Depression Clinical and Research Program at the Massachusetts General Hospital, in Boston, Massachusetts.

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Dr. Fava, how often do we observe symptoms of fatigue in MDD?
Dr. Fava: We see prominent symptoms of fatigue in the majority of patients with depression. In fact, fatigue is one of the most prevalent presenting symptoms of MDD, the second most prominent residual symptom of MDD, and is often associated with impaired concentration, irritability, and reduced productivity.1–3 Further, up to one-third of MDD patients who have achieved remission or response stiH continue to experience some symptoms of fatigue.1,2 In one recent study, more than 90 percent of patients with MDD had severe fatigue despite the fact that more than 80 percent of these patients were already taking antidepressant medications.4 In this study of 66 patients with MDD, 81.5 percent were taking antidepressant medications: 48.2 percent were taking selective serotonin reuptake inhibitors (SSRIs) and 33.3 percent were taking serotonin norepinephrine reuptake inhibitors (SNRIs).

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How do you define fatigue in depression?
Dr. Fava: Fatigue is one of the identified symptoms of MDD listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria where it is defined as physical fatigue or loss of energy. However, in my opinion, fatigue is much more than that. We see apathy and considerable emotional disturbance occurring as a consequence of fatigue. We have also seen high rates of diminished focus, word finding difficulties, and recall problems in fatigued patients with MDD.2 Recently, Arnold5 described three distinct categories of fatigue that commonly occur within a population of MDD patients: physical, cognitive, and emotional symptoms. The physical symptoms of fatigue include reduced activity, low energy, tiredness, decreased physical endurance, increased effort to do physical tasks, general weakness, heaviness, slowness or sluggishness, nonrestorative sleep, and sleepiness. The cognitive symptoms include decreased concentration, decreased attention, decreased mental endurance, and slowed thinking. The emotional (affective) symptoms of fatigue include decreased motivation or initiative (apathy), decreased interest, feeling overwhelmed, feeling bored, aversion to effort, and feeling low. Given the broad range of related, comorbid symptoms, it can be difficult to differentiate between independent symptoms of fatigue from symptoms directly related to MDD.

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What are the consequences of residual symptoms of fatigue in MDD?
Dr. Fava: The key point is that patients with residual fatigue are more likely to get depressed again despite continued prophylactic treatment. There is a much greater likelihood that patients with MDD who have residual symptoms like fatigue will also have work, school, and/or social difficulties. As you know, there is a very high medical comorbidity associated with depression as well. Therefore, we need to identify these symptoms and intervene as early as possible.

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How do you assess the symptoms of fatigue in MDD?
Dr. Fava: First, I want to confirm that the patient actually has a diagnosis of MDD. There may be some patients who complain of many symptoms of fatigue but do not have MDD, or there may be some patients with comorbid illnesses that include some depressive symptoms and fatigue, but are not truly MDD. Second, it is really important to differentiate between symptoms of fatigue that have been caused by the drugs we are using to treat the MDD in contrast to symptoms that are present as residual symptoms of MDD.

I begin my assessment by obtaining a careful, detailed history of all of the symptoms that existed prior to the initiation of treatment, followed by identifying any symptoms that have persisted despite treatment, and then I ask about any new symptoms that have emerged during treatment. Treatment-emergent symptoms may or may not be caused by the medications we are using, but it is important to differentiate whether these symptom are new or were preexisting to the treatment. Obviously, it is also important to explore whether the residual symptoms are more or less severe than they were before treatment commenced.

…patients with residual fatigue are more likely to get depressed again despite continued prophylactic treatment. There is a much greater likelihood that patients with MDD who have residual symptoms like fatigue will also have work, school, and/or social difficulties.

I may also have the patient fill out a comprehensive psychopharmacological history scale, such as the Massachusetts General Hospital (MGH) Antidepressant Treatment Response Questionnaire (MGH-ATRQ), as this type of tool is useful for this assessment.6 It is helpful to know whether previous medications have had the same effects or caused different symptoms.

Based upon both my review of symptoms past and present and my psychopharmacological review, I can often pinpoint whether the identified fatigue symptoms are truly residual symptoms of MDD or side effects of treatment.

I also try to quantify the severity of the fatigue symptoms as a baseline for subsequent intervention.