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Is there any solid evidence that the prevalence of depression is higher in CCC-defined ME/CFS patien

Discussion in 'General ME/CFS Discussion' started by Johannawj, Aug 1, 2016.

  1. Johannawj

    Johannawj

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    Is there any solid evidence that the prevalence of depression is higher in CCC-defined ME/CFS patients than A) the general population, and B) other patient groups with chronic organic diseases?

    What about Fukuda-defined CFS patients vs general population and other chronic diseases?

    Or is there instead misinformation stemming from Reeves, Oxford etc?

    Very grateful for your help, it could potentially help clear up a big mess here in Sweden.
     
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  2. Valentijn

    Valentijn The Diabolic Logic

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    Part of the problem is undoubtedly due to bad criteria. But bad questionnaires or other processes (DSM) are also usually used. Those questionnaires are used to diagnose depression or anxiety, not based on how people are feeling, but based on their behavior. Unfortunately they do not account for behavioral limitations which result from physical disability.

    Another problem, especially when using the bad questionnaires, is the lack of appropriate controls. If not being able to leave the house is going to count as depression, then the patients probably need to be compared with another group of patients with an acknowledged biological disease causing similar limitations.

    However, even with bad questionnaires and healthy controls, patients will only score a bit worse than normal populations or the healthy controls. The difference might be statistically significant, but the scores are typically still well below the threshold intended to diagnose depression or anxiety with that questionnaire. But the researchers will still treat it as being indicative of depression, or fudge a bit and say the patients are just "more depressed", etc.

    I don't think I've seen any research finding more depression in ME patients, without one or more of these fundamental problems. So it's really impossible to know if ME patients are more likely to meet the criteria for depression, though some increase would be expected as a result of the chronic illness itself. But that increase would be in line with what is seen with other highly-disabling multi-system chronic illnesses - or perhaps a bit higher due to the disbelief and related abuse ME patients frequently receive personally or as a group of patients.
     
    Last edited: Aug 1, 2016
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  3. Hip

    Hip Senior Member

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    Probably not the published evidence you are looking for, but a survey on this forum found that 36% of ME/CFS patients suffer depression. By comparison, 6.7% of the general population in the US suffer from major depression. Ref: 1

    Depression is mentioned in the CCC as a common comorbid condition of ME/CFS:

    But confusingly, in the CDC 1994 definition of chronic fatigue syndrome, a current and even past(!) diagnosis of major depressive disorder with psychotic or melancholic features excludes the possibility of a CFS diagnosis. Which is a bit silly really, as it implies if you had these types of major depression even say 20 years ago, you cannot have CFS now!

    However, the other CDC definition of CFS does not exclude a CFS diagnosis if you have or had major depression; rather, this definition states that depression, irritability, anxiety and panic attacks can be accompanying (ie, comorbid) symptoms of CFS.
     
    Last edited: Aug 1, 2016
  4. alex3619

    alex3619 Senior Member

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    Lets start with the obvious. There is no concrete evidence that depression is more than a symptom of other things. A depression diagnosis is basically a hodge-podge of many things with a range of similar symptoms. A CFS diagnosis is not a lot different though.

    The problem is that depression, as opposed to just feeling depressed, is a technical classification. Its similar for chronic fatigue in CFS. Its not one thing, its an amalgam.

    I think if you are talking about an occasional feeling of depression, I would be happy for anyone to say that is more common in CFS. We have so many things that are not happy making going on, some depression would be expected.

    So the question in the first post in this thread is asking what solid evidence is there for something for which there is never solid evidence as a general finding (though there is evidence in subgroups) in something else for which there is no solid evidence (though again there is evidence in subgroups).

    When a depression questionnaire is used they are looking for symptoms and experiences that are found in other conditions. When those symptoms are part of another condition, any depression is really presumed depression. Its not solid evidence at all.

    Some years ago Dr Komarof at Harvard found he could discriminate between depression and CFS using a spectral coherence EEG.
     
    Last edited: Aug 1, 2016
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  5. Hip

    Hip Senior Member

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    The "occasional feeling of depression" that you are talking about, which is something that almost everyone experiences from time to time, mainly as a result of psychosocial / life event factors, is different from the sort of depression that can be caused by neurological or immunological dysfunction affecting the brain.

    I often get bouts of quite significant depression as a comorbid condition to my ME/CFS. This depression appeared soon after I caught my ME/CFS-triggering virus, and it was quite clear to me it was not psychosocial / life event-induced depression, but rather the result of an organic disease or condition underpinned by the viral infection.

    Yes, the limitations imposed by the condition of ME/CFS could create some psychosocial / life event-induced depression; but I feel quite sure in my case that my depression is not psychosocial, it's primarily caused by organic brain dysfunction.



    It is of course very important to be able to distinguish ME/CFS from major depression, because some doctors can mistake ME/CFS for depression.

    One of the important differences is that exercise tend to improve depression, but significant exercise tends to worsen ME/CFS. So that is a useful differential diagnosis. The full version of the CCC mentions this:

    However, although doctors need to be careful not to misdiagnose ME/CFS as major depression, it also has to be borne in mind that depression can be a comorbid condition in ME/CFS.
     
  6. Forbin

    Forbin Senior Member

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    In a 2010 Q&A session, Dr. Anthony Komaroff was asked how patients with depression compared to those with chronic fatigue syndrome. His answer below asserted that PEM differentiated CFS not just from depression, but from any other disease he had encountered.
    The quote comes at 18:22 [Section 26]
    https://www.masscfids.org/images/videofiles/Questions/Questions.html

    [He then concludes his talk by mentioning the immune system in the gut and wishing that someone would study that.]

    The entire lecture can be seen here:
    https://www.masscfids.org/more-resources-for-me-cfs/221-the-latest-research-on-cfs-video
     
    Last edited: Aug 1, 2016
  7. alex3619

    alex3619 Senior Member

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    Major depression can be comorbid with any other condition. Any two conditions can occur together as long as its physically possible.

    I do think that even circumstantial depression is inherently biological. Psychosocial is a label, and can be valid in terms of triggers I suspect, but the underlying issue is still biological.
     
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  8. Hip

    Hip Senior Member

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    I agree that there may be a biological disposition to depression that is stronger in some people than others, such that an adverse life event in one person may only trigger a few weeks of low mood before they start to recover; whereas in a biologically more susceptible person, a similar adverse life event might trigger major depression that lasts for years.
     
  9. alex3619

    alex3619 Senior Member

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    To me everyone has a disposition, that is the biological mechanisms that create depression, but its not always switched on. The disposition part is really about the likelihood of it being turned on. I see no reason not to consider depression as physical. Experiences, including internal experiences, may trigger it, but it involves profound changes in chemistry.
     
  10. Hip

    Hip Senior Member

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    I think that's taking it to an extreme, because by the same logic, you could argue that a broken leg is merely a disposition of the bones that is not switched on, and has nothing to do with the fact that a truck ran over you legs. The truck merely "switches on" the break in the bone.

    There is no getting away from the fact that adverse life events can be very severe, and can "break" someone's mind/brain, leading to conditions such as major depression or PTSD, especially in those who have some brain vulnerability to these conditions.

    However, I think it is very important to make sure you have good evidence that adverse life events can trigger a mental health condition before you ascribe causality to such life events. Psychologists are far too quick to look at life event factors, and don't look enough at biology.

    Although adverse life events can play an important role in major depression or PTSD, I think conditions such as schizophrenia, autism and bipolar are likely primarily caused by dysfunctional biology, with little involvement of life event / psychosocial factors.
     
  11. daisybell

    daisybell Senior Member

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    I think a big part of the issue is the use of depression screens on which most people with significant ME/CFS will score at a level at which 'depression' is a concern. That's simply a result of the limitations placed on our lifestyle by our illness, not necessarily depression. We'd love to enjoy all sorts of activities but we can't! Depression screens in my opinion should only be used on people who are physically fit and well to avoid skewing the results.
     
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  12. Hip

    Hip Senior Member

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    I just found this study (full paper here) which observed that 47% of ME/CFS patients suffer from depression.

    The study was conducted by well-known ME/CFS experts including Nancy Klimas, Daniel Peterson, Lucinda Bateman and Susan M. Levine, so presumably their methodology would have been appropriate for ME/CFS patients.
     
  13. alex3619

    alex3619 Senior Member

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    This is not a relevant analogy. Depression is a normal function of the brain. Its only abnormal if its excessive or excessively prolonged - in other words something extra goes wrong. Broken bones are a natural consequence of severe impact, but its not a normal part of functioning. Depression is a normal brain function.

    Now this I agree with.
     
  14. Sea

    Sea Senior Member

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    From the paper:
    Nearly 60% of our participants reported the emergence of mental health symptoms (depression, anxiety, PTSD, and/or bipolar disorder), which is strikingly similar to other published reports addressing clinic- and community-based samples. The prevalence of mental health diagnoses in our sample is somewhat lower than a prospective study of CFS patients by Wessely and colleagues and higher than a recent report from a Belgian sample of CFS patients.

    The mental health diagnoses reported by participants were not necessarily determined by diagnostic criteria or structured interviews, but the high prevalence is sobering.

    Depression as a co- morbid condition is notably high in patients with chronic illness (15–25%) compared to healthy primary care patients (5–10%), and the highest rates (40–50%) are in patients with neurological illness.
     
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  15. Valentijn

    Valentijn The Diabolic Logic

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    It depends on the type of depression questionnaire. Obviously ill people can be depressed and need to have a method for diagnosis. But in that case, the "gotcha" questionnaires, which forgo asking people how they feel (perhaps in the belief that they will lie) and instead ask how they behave, are certainly inappropriate.

    But there are still good questionnaires which do ask how people actually feel. Those ones are completely appropriate with disabled and chronically ill people, which is probably why the biopsychosocial quacks prefer to avoid them. Of course, they justify using the "gotcha" behavioral questionnaires by saying that we are in denial regarding our feelings, but their only proof of that is the questionnaires which conflate physical disability with mood disorders :confused:

    It gets rather circular, with there being no way to disprove their theory - making it inherently unscientific.
     
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  16. Valentijn

    Valentijn The Diabolic Logic

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    Fukuda criteria were used, and there is no mention of PEM being a mandatory symptom for the study participants.

    It's also impossible to evaluate the accuracy of the co-morbid diagnoses made, since the study was not doing the actual diagnosing. Instead, they were compiling all of the diagnoses made for those patients by other doctors or therapists. In the case of ME, many doctors will unfortunately misdiagnose the disease itself as a primary mood disorder, and often treat it accordingly. This study does not clarify if the patients agreed with their external diagnoses, or if those external diagnoses were reasonable based upon their symptoms.

    Additionally, there's a huge difference in the rate of depression and anxiety co-morbidity between the centers. Utah and Florida have diagnostic percentage rates nearly twice as high Nevada and New York for anxiety, and also with a pretty huge gap between the same centers regarding depression. Do ME patients in Utah and Florida have more mood disorders than in Nevada and New York? Do actual mood disorders not get diagnosed appropriately in Nevada and New York? Or have doctors in Utah and Florida been conflating orthostatic intolerance with anxiety, and physical limitations with depression?

    There's no way to know what's going on with the diagnostic processes. At the very least, it indicates a need to conduct a similar study with defined diagnostic methods, before any conclusions could be reached. And as a retrospective study, it is especially important to use appropriate controls.
     
    Last edited: Aug 2, 2016
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  17. JohnCB

    JohnCB MEow

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    Does this have any relevance? It is a short piece in today's The Times. I'm afraid I do not have the capacity to followup the journal that is the source at present.

     
  18. Snow Leopard

    Snow Leopard Hibernating

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    There have been no population based studies using CCC or ICC and comparing to the (diagnosed) prevalence in similarly disabling chronic illnesses. Questionnaire based results are not valid for this comparison, because they are designed for able bodied people with depression and not those with severe chronic illnesses.
     
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  19. PennyIA

    PennyIA Senior Member

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    As far as I can tell - folks with ME/CFS often get sad.

    Sad is not the same as depressed (though depending on your questionnaire answers it won't always show that way).

    Sad is the normal response of someone grieving the loss of their previously healthy self. Or upset by lack of treatment options. Or upset as a result of life changes that they do not have control over and isn't the type of change you WANT. Or upset because we're sick and at best we are treated by doctors as they have no options for us - so no hope of recovery in the near future.

    Depression is long-term excessively severe or pro-longed sadness that doesn't improve when situations change.

    Ummmm... so if our situation doesn't change we MAY be categorized as being depressed. Because our life... well, it basically sucks. And we are often sad about it.

    That said. I'm unhappy about my medical situation, but not depressed. I've been unhappy about my medical situation for a good 11 years (since I got ill)... but I'm not depressed.

    I know I'm not depressed because I'm living my life with joy... I participate in hobbies I love and I spend time with the people I love. I'm happy about all of the good things that have and are happening in my life.

    Doesn't mean I'm happy about being ill.

    To my mind, a common sign of depression is the inability to seek out fun and joy ... and being too low to enjoy it when good things happen as theirs actually an issue with the neurotransmitters that doesn't allow that connection to work correctly.

    One key question I haven't seen asked on any depressive questionnaires is:

    If you could physically do anything without any negative concequences, what would you do?

    If you were depressed there would be a very small, limited list of things you'd want to do.
    If you were ill and sad about being incapable of doing all the things you want to do? You'd have an enormous list of things you can't wait to do, but know you can't do it today because of physical, health limitations.
     
  20. mango

    mango Senior Member

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    In a recent comment on a article @JaimeS wrote:
    What studies are you referring to, @JaimeS? Links, please? :)
     
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