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Treatment for paediatric CFS/ME and comorbid depression:systematic review

Discussion in 'Latest ME/CFS Research' started by Kati, Oct 11, 2016.

  1. Kati

    Kati Patient in training

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    This article is open access and open review. Please read both in order to get further insight.

    BMJ Open 2016;6:e012271 doi:10.1136/bmjopen-2016-01227
    Treatment for paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) and comorbid depression: a systematic review
    1. Maria E Loades1,
    2. Elizabeth A Sheils1,
    3. Esther Crawley2
    Paper: http://bmjopen.bmj.com/content/6/10/e012271.abstract
    Reviewers' comments: http://bmjopen.bmj.com/content/6/10/e012271.reviewer-comments.pdf

    Abstract

    Objectives

    At least 30% of young people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) also have symptoms of depression. This systematic review aimed to establish which treatment approaches for depression are effective and whether comorbid depression mediates outcome.

    Setting

    A systematic review was undertaken. The search terms were entered into MEDLINE, EMBASE, PsycInfo and the Cochrane library.

    Participants Inclusion and exclusion criteria were applied to identify relevant papers. Inclusion criteria were children age <18, with CFS/ME, defined using CDC, NICE or Oxford criteria, and having completed a valid assessment for depression.

    Results

    9 studies were identified which met the inclusion criteria, but none specifically tested treatments for paediatric CFS/ME with depression and none stratified outcome for those who were depressed compared with those who were not depressed. There is no consistent treatment approach for children with CFS/ME and comorbid depression, although cognitive–behavioural therapy for CFS/ME and a multicomponent inpatient programme for CFS/ME have shown some promise in reducing depressive symptoms. An antiviral medication in a small scale, retrospective, uncontrolled study suggested possible benefit.

    Conclusions

    It is not possible to determine what treatment approaches are effective for depression in paediatric CFS/ME, nor to determine the impact of depression on the outcome of CFS/ME treatment. Young people with significant depression tend to have been excluded from previous treatment studies.
     
  2. RogerBlack

    RogerBlack Senior Member

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    The reviewers comments were really quite negative - and should have lead to publication being refused.
    The authors say 'null results are important to publish' - this study seems to be more a lobbying attempt to generate funding for studying CFS/ME/co-morbid depression - probably with the oxford/NICE criteria.
     
    Jan, Countrygirl, Cinders66 and 7 others like this.
  3. hixxy

    hixxy Senior Member

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    Oh look at that. Another biopsychosocial study from the UK. I'd be happy for the UK's research funding to drop to zero if it would end this endless barrage of rubbish research papers.
     
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  4. Glycon

    Glycon World's Most Dangerous Hand Puppet

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    My God! Someone (Booth) actually believes that psychological factors play a role in ME/CFS and at the same time thinks that Crawley's work is sub-par! :p

    EDIT: Alison Bested... sigh... :rolleyes:
     
    Last edited: Oct 11, 2016
  5. snowathlete

    snowathlete

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    Under General Comments:

    "I am not persuaded that this manuscript has a real positive value."

    That pretty much sums it up. It's completely valueless, as is everything I've seen them produce.

    The only value here is to Crawley and co who are producing weak shit like this so they can point to it when they apply for funding for things like depression, obesity, and so on where there are funds available, that's all this crap is for.

    They know they have nothing of value to add to the disease, and now that CBT and GET are dead as failed treatments, they're looking for other revenue streams.
     
    Jan, Effi, Kati and 2 others like this.
  6. UKmum

    UKmum

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    A timely read. Just looked at Booths comments and am feeling bolstered for my teenage sons skype appointment with his CFS therapist. He is only managing 1 lesson per week at school and I know we will be encouraged to increase this. Of course he'd love to increase it but it makes him crash! We are with Dr Crawleys service and I am nervous after reading comments on this site. I must say though we have not been encouraged to exercise at all and in fact were warned not to over do it when he wanted to do a little swimming ( sitting on the edge of the pool mostly). I do remember much being made out of the fact in his initial assessment that he wasn't displaying much emotion- now I know what its called Alexithymia. I think he was just too tired to engage with an adult asking lots of questions after a 2 hour drive.
     
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  7. Cinders66

    Cinders66 Senior Member

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    So the reviewers either specify the need to separate out the studies because of the difference in criteria or don't like the criteria anyway, argue for biomedical research rather than hypothetical models (if I read booth correctly) & don't think the paper contributes much. They don't like aspects of the NICE guidelines ( 30mim resting - crazy)! or criteria. Crawley however initially lumps all studies defined differently together, uses 2 of the weakest and U.K. only criteria going (I guess there's lots of oxford studies and depression?) defends the cbt model of maintainance and seems to be angling for more research studying CFS in kids and depression. I guess as a pediatrician that type of research is more easy for her to do, fair enough I suppose she isn't going to be doing spinal fluid analysis is she, but she puts undue emphasis on behavioural factors in CFS (she uses ME term but doesn't study it) such as mood and obesity and activity and not enough on understanding why her kids are poorly, or perhaps her kids are tired rather than sick.

    For me the best thing was reading Norman booths comment and the fact he came. From Oxford uni , home of sharpe I believe, although I'm not sure of the weight he was putting on stress. I like how he spoke against putting emphasis on kids academic attendance and achievement, I regret the balance of my life as I declined.

    The worst was seeing Crawley defend the cbt model and thinking oxford criteria fine for a CFS Study .
     
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  8. JohnM

    JohnM Senior Member

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    I'm not convinced that they believe CBT and GET are dead .. my bolding and formatting for an easier read?

    In response to Norman Booth's reference to mention of a 2011 paper by Kawatani, Minzuo et al. on cognitive dysfunction and mental fatigue, which "found effects that correlate cognition with fMRI in regions of the brain, and which correlate with cerebral energetics and oxidative stress and their cellular and subcellular consequence."

    "We have not altered the paper in response to this comment as models such as those proposed by Browne & Chalder (ref 36) are of value to both patients and clinicians in working with CFS/ME as they describe the cognitive and behavioural maintenance of CFS/ME.

    This provides an increased understanding of symptom maintenance which enables the development of better management/treatment strategies.

    Empirical evidence continues to emerge for the components of the model (e.g. Knoop et al, 2010; Wiborg et al, 2011; Heins et al, 2013)."

    As for their (further) complete dismissal of Norman's observation "Regarding the treatment of children and young people, it is my personal experience that there should be no pressure to return to school – this just increases the existing stress .." as ".. personal anecdotal experience."

    How does this differ from their observations (or should that be fiction), that they put forward as 'scientific' evidence? How on earth can the BMJ continue to publish this nonsense in light of recent developments with the PACE trial?

    We continue to witness the same use of self-referencing **** that is the BPS school of (ill) treatment; such a tangled web they weave, and I think it more likely they will try to continue to develop CBT and GET under a different guise.
     
    Luther Blissett and Effi like this.
  9. snowathlete

    snowathlete

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    I should have said terminally ill, rather than dead. I don't believe CBT and GET are dead yet either. And you're right of course that they are going to continue selling the same stuff re-branded and repacked, but I think they are going after new revenue streams as a means of doing this.
     
    Luther Blissett, JohnM and Effi like this.
  10. JohnM

    JohnM Senior Member

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    True enough @snowathlete, not unlike the CBT/GET studies being undertaken with Arthritis UK if memory serves me well?

    An example of re-branding already underway perhaps?
    http://forums.phoenixrising.me/inde...c-me-cfs-research-on-act-get-in-sweden.37482/

    Thinking on the BPS school of adherents and your response, I'm reminded of the Golden Fleece and Hydra's teeth in the film Jason and the Argonauts (the classic 1963 version) for some reason ... apologies, going off with the pixies again, sure they can find a suitable label for that.

    I think that E Crawley's, et al, response(s) to peer reviews of this paper provides further evidence of

    1] Her/their inability to understand or accept our illness is a biological disease - an ongoing biological disease process which is responsible for our continued illness - not our supposed cognitive and behavioural maintenance of CFS/ME following an initial illness, as alluded to in her/their responses.

    2] Why E Crawley, and others who share her view, should have no involvement whatsoever in the MEGA project.
     

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