Could exertion cause depression/low mood in ME?

Having noticed a recent drop in mood accompanying PEM-type symptoms after a fairly-strenuous day, I have been trying to figure out why, and thought it might be of interest to others if I put my thoughts down here.

As usual, I have pulled together bits of info I have already gleaned which may relate to a chain of causation here.

The idea of physical activity causing low mood probably sounds absurd to people without knowledge of ME. After all, it is reported to improve mood in most people. However, a very quick search for scientific papers on this link did not produce any convincing-looking hits. Maybe a longer search would.

So, here goes with a very rough, simplistic theory for exertion causing depression/low mood in ME.

This paper

http://jap.physiology.org/content/82/2/571

which I have referred to in other blogposts, reports that exertion increases intestinal permeability.

It states:

“Compromised barrier function may produce an inflammatory response and initiate a cytokine cascade...”

The authors also refer to bacterial endotoxins (aka lipopolysaccharides/LPS) entering the systemic circulation from the gut via increased gut wall permeability.

This paper

http://ini.sagepub.com/content/17/3/302

states that LPS trigger production of interferons.

Interferons can induce depression/low mood, as reported in numerous papers including this one:

http://www.jad-journal.com/article/S0165-0327(07)00332-1/abstract?cc=y

Why do people with ME get this adverse effect from exercise, yet others don't?

Perhaps it is due to our abnormal/inadequate HPA axis activity, which means that we can’t produce enough cortisol to dampen down the interferon activity (the link before last discusses cortisol and interferon signalling).

And/or maybe it’s because we switch to anaerobic ATP production too quickly, leading to excessive lactate levels/acidosis?

And/or maybe we don’t produce enough endorphins to combat adverse effects?

I’m keeping this post short as I have to get on with other stuff and am quite tired, but would welcome any comments.

Comments

Same here. Low mood is a sign of exhaustion. I think it is due to low HPA axis reserves. At the end of the day, cortisol production is low. If you were active during the day, your reserves will also be low. To me it also feels similar to the feeling of exhaustion cortisone can ameliorate. Cortisone is also known to improve mood.
 
Yeah if I have had a pronounced dip I will get a horribly low mood for a day a couple of days afterwards.

I'm not expert, but this quote interested me:

"Perhaps it is due to our abnormal/inadequate HPA axis activity, which means that we can’t produce enough cortisol to dampen down the interferon activity"

Rather than too little cortisol, perhaps it could also be that glucocorticoid receptors have begun desensitised through chronic exposure to cortisol? I guess if your adrenals were to crash following this desensitisation then you're in for a long journey to get this system working properly again.

Just a though!
 
> Rather than too little cortisol, perhaps it could also be that glucocorticoid receptors have begun desensitised through chronic exposure to cortisol?

ME/CFS is associated with mild hypocortisolism. This is one of the few abnormalities that is observed relatively consistently.
 
Not very scientific, but surely there would be an obvious correlation between feeling ill and being unhappy, particularly if you'd done something you might have thought better than to do?
 
Re worldbackwards -

"Not very scientific, but surely there would be an obvious correlation between feeling ill and being unhappy, particularly if you'd done something you might have thought better than to do?"

Instinctively one might expect that, but it doesn't seem to correlate in my case.
 
There is widespread belief that hypocortisolism can arise from chronic elevation of cortisol, e.g. due e.g. to stress. It's also widely disputed. I don't know what to think.
 
When I was tested for cortisol a dozen years ago by my CFS doctor, the results surprised both of us in that my cortisol levels were slightly higher than normal. He interpreted this to mean that my adrenals were working too hard, and prescribed low-dose hydrocortisone - just as he would for someone with low cortisol levels. It worked - I felt somewhat more energetic immediately. I've occasionally tried going off the hydrocortisone, but I can feel the difference and I quickly go back on it.

As for depression, it makes sense to me that this could accompany PEM, though I haven't experienced it. Certainly the papers you cite could be possible mechanisms, and there could be others as well, since ME/CFS is so complex. And there's this tremendous variation from one person to another.

A.B.'s comment about low cortisol makes a lot of sense to me. In my experience, hydrocortisone acts fairly quickly. Perhaps if you were able to take a small dose (2.5 or 5 mg) when you experienced PEM, that might help.
 
Thanks, zzz, but it's not a major problem for me. The mood drop is not extreme and I don't think it always happens. I am taking 5-HTP for a life-event-associated lowering of mood that I had since about a year ago, and it helps enormously. I take it in the evening, and I think my mood tends to be good after taking it, and for much of the rest of the time.

I'm not keen on taking corticosteroids unless unavoidable.

The blogpost was meant to be more of a general musing, suggesting possible mechanisms that might be generally applicable and adding to the knowledge and theories we have.
 
My point of view is cemented in, because when I ask my wife if she can take a shot walk together & she has to decline because "it depletes her energy", it will follow that walking isn't helpful for her. Come to think of it, it kicks my rear end ,too.
 
I have noticed that a crash always encompasses the physical, cognitive and emotional for me. Not only do I feel exhausted and unwell, unable to think clearly, but my emotions do a nosedive... When I was being recklessly over treated for my overactive thyroid, I went through the same roller coaster emotionally as my hormones altered so quickly. I often feel transiently suicidal during a crash.
 
Just a quick update as it may be important - have stopped 5-HTP (over a month ago?) and nebivolol (yesterday), and started felodipine (today). Had apparent nasty effects from something, or it may have been unrelated.
 

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