This is so important. Whatever is going on in the immune system, the CSF, the microbiome, etc. the brain malfunction itself is what's really causing symptoms, imho. Not that immune, hormonal and energy metabolic systems are not coming into play. But fundamentally, it's all about the brain. If this research is on the right track -- and it seems to be -- the name of ME/CFS should probably be changed to something like, "Myalgic Demyelinating Encephalitis," or similar, to indicate the ongoing reduction in white and grey mater. This isn't a static condition! Reductions in BDNF are also commonly associated with depression, and a theory like this could be explanatory for those who persist in psychologizing ME and CFS. At least it would show that in those cases where antidepressants provide some benefit, it's likely because of the increase in BDNF they tend to create, not because the person is "just depressed." Of course, we would still need to know the cause of the demyelination, but ultimately that would be secondary to an effective treatment. As for me, I'm going to start researching and taking everything I can to increase BDNF, whether that be SSRIs, ALA, zinc, ginkgo, music, neurofeedback, meditation, or anything else I can find. At least maybe it's possible to slow the progression, if not start actually to reverse it. So glad Cort revisited this topic - i had forgotten all about the MRI studies (uh oh!! Lol) www.cortjohnson.org/blog/2014/08/22/insulted-midbrain-chronic-fatigue-syndrome-glial-cells/ Apologies if this has been posted elsewhere and I missed it. Feel free to merge if another thread on this topic exists, thank you.