Are endogenous depression and cfs close relatives?

[Jonathan Edwards]

I'd love to hear how neurotransmitters could cause swollen lymph nodes. You should ask your doctor friend about that and record the answer - it should be pretty hilarious

I don't think there is any particular difficulty in that Valentijn, since lymph nodes are innervated and a lot of lymphoid and supporting cells have receptors either for neurotransmitters or downstream signals. After all, neurotransmitters in the hypothalamus presumably produce the immune system changes that follow psychological stress - even if indirectly. At the Bristol ME meeting in September we had all sorts of eminent neurobiologists talking about efferent effects of the brain on immune function.

 

[gregh286]

yeah might do that and put it on youtube.
least we will be able to laugh at it.

 

[Richie]

Is it not entirely possible that a subset of ME/CFS patients suffer from depressive symptoms and ME symptoms/real neuroanatomical ME, originating from one aetiology?
Take Lyme as an example.
The symptom overlap with ME/CFS and fibro is great. It is a cause of real neuroanatomical encephalomyelitis, of encephalitis and of encephalopathy. One reason it is not "ME" despite being a cause of real neuroanatomical ME is that the cause is known.
It also causes psychosis and depression but not in all cases.
Th1 as in Lymes activity can deprive the brain of serotonin. (deprive rats of tryptophan and they will show altered behaviour, This might be vitamin B3 related but the flat denial of a link between serotonin and mood is probably simplistic).
CSF biomarkers and brain imaging in Lyme cases are, however, different from many USA CFS cases.

If ME is defined as not causing depression, then there can be no overlap. But is this exclusion justified? Is it impossible that encephalomyelitis might cause depression? Is this established? Is it establlished that depression and actual neuroanatomic myalgic encephalomyelitis never have the same aetiology? (Lyme cases scream no) And what of the cases of CFS which are not actualME, but are not primary or simple depression but e.g. TH1 activated states caused by autoimmunity or infection with serotonin deprived brains to boot?

Some CFS/ME and FM folk have no depression.
Some have both. Where both occur does the patient not have every right to ask whether there is a common biological root, (besides any reacive depression)?

On the other hand do non depressed ME/CFS or FM cases want to be labelled as "secretly depressed"? No. Is physical fatigue depression? No. Is exercise good for ME as for much depression. No.

There are competing interests among patient subgroups, here. So we are back to the need for proper lab research, proper patient investigation, proper diagnosis, biologically accurate nomenclature .......

 

[lansbergen]

Can low neurotransmitter cause biological symptoms? Pem......cold feet.....thirst and so on?

http://www.merriam-webster.com/dictionary/neurotransmitter
http://www.medicinenet.com/script/main/art.asp?articlekey=9973
http://dictionary.reference.com/browse/neurotransmitter
http://www.ncbi.nlm.nih.gov/books/NBK10960/
http://web.williams.edu/imput/synapse/pages/I.html

 

[Valentijn]

There are competing interests among patient subgroups, here. So we are back to the need for proper lab research, proper patient investigation, proper diagnosis, biologically accurate nomenclature .......

Depression and CFS have already been compared in many BPS research studies, and findings are generally the opposite in each group. For example, depression is associated with high cortisol, and CFS is associated with low cortisol. SSRI's can help with depression, yet many/most CFS patients aren't helped by them (for ME symptoms), and frequently react adversely to them.

Depression and ME/SEID have also been compared somewhat in CPET and other biological studies. Again, there's not really any similarities that have been found. Thus they're looking like pretty different illnesses so far, especially when the completely different sets of symptoms are taken into account. That said, it's not unexpected to have some co-morbid depression in any chronic illness, especially when the illness is associated with atrocious behavior toward the patients by society in general.

Maybe there's a few further avenues to explore in comparing the two, but nothing that seems particularly important or at all urgent. Especially when funding of biological ME/SEID research is so meager.

 

[snowathlete]

Nevertheless, between CFS and depression is a strong correlation

Where's the evidence to back up that statement?

 

[snowathlete]

Some of you who are adamant that you do not have this, I challenge you to ask a few of your close friends and family to rate your mood over the past 12 months from -10 to +10 with zero being neutral. You're not going to like the answer.

I think you are confusing two different things here: mood and depression. They are completely different, but people often confuse them.

People who have chronic illness are likely going to have different mood to if they were healthy and able to live the life they want to live. This is no different for ME than it is for MS or IBD.

This alone does not qualify a person for depression though.

I know firsthand what depression is as I had it a decade before I got ME when my first relationship broke up. My mental health was bad, and it took me time to get better.

My experience with ME is different on every single level. They are entirely different illnesses.

I thankfully have not got depression any more and haven't for many many years. I have a great mood despite being severely ill with ME. I don't want people to waste their time confusing the two because it means neither gets resolved.

Of course there is nothing that says you can't have both. Each are common. The IOM definition recognises this and one does not discount the other but it makes clear that they are different illnesses.

 

[Richie]

Depression and CFS have already been compared in many BPS research studies, and findings are generally the opposite in each group. For example, depression is associated with high cortisol, and CFS is associated with low cortisol. SSRI's can help with depression, yet many/most CFS patients aren't helped by them (for ME symptoms), and frequently react adversely to them.

Depression and ME/SEID have also been compared somewhat in CPET and other biological studies. Again, there's not really any similarities that have been found. Thus they're looking like pretty different illnesses so far, especially when the completely different sets of symptoms are taken into account. That said, it's not unexpected to have some co-morbid depression in any chronic illness, especially when the illness is associated with atrocious behavior toward the patients by society in general.

Maybe there's a few further avenues to explore in comparing the two, but nothing that seems particularly important or at all urgent. Especially when funding of biological ME/SEID research is so meager.

Valentijn
I think the question as to whether a single aetiological agent can cause both depression and CFS consistent symptoms is valid and borne out by Lyme. B12 deficiency would be another example and many people with CFS/ME diagnosis have B12 problems (as per Yasko, Richie van etc.)
I agree that low cortisol/high cortisol is a classic differential but it is not an absolute. I had both in 1998, and that after 13 years of illness. The high cortisol may have been iatrogenic/highly idiosyncratic and the low imo was largely down to dysbiosis, but nevertheless they both occurred in me when I was otherwise fully consistent for CFS/ME. High cortisol does not exclude CFS, unless one simply asserts that it does, in which case I must have had a high cortisol holiday from the illness, with no remission of other symptoms (I wish).

Of course I may not have ME or CFS or FM but I fit symptomatically and have as much right to he term as anyone else, as none of us are effectively tested and what tests I have had fit the CFS/ME picture (albeit TH1 rather than Th2 type when cortisol normal).

 

[Richie]

I think you are confusing two different things here: mood and depression. They are completely different, but people often confuse them.

People who have chronic illness are likely going to have different mood to if they were healthy and able to live the life they want to live. This is no different for ME than it is for MS or IBD.

This alone does not qualify a person for depression though.

I know firsthand what depression is as I had it a decade before I got ME when my first relationship broke up. My mental health was bad, and it took me time to get better.

My experience with ME is different on every single level. They are entirely different illnesses.

.

Snowathlete

My experience is as follows:


1) There has been recognisable reactive melancholy/despair common in CFS/ME Akin, I would think, to your depression, but loss consequent on CFS - job, identity, hope, future etc This is a very common reactive depression among us.
2) There has been an anergic and ahedonic state which arose from long term fatigue, especially as over exertion has was encouraged and practiced in my case.

These are both distinguishable from ME/CFS symptoms, 1) more psychological crisis and 2) more biological adaptation but not CFS/ME.


3) There is a form of depression in my case related to HPA dysfunction with high cortisol, interrupted sleep, heavy palpitations and coinciding with general worsening of physical ME/CFS symptoms, pain, fatigue, tinnitus, muscle twitching etc.. I am inclined to see this as part of the overall ME/CFS/whatever in my case, possibly an endogenous attempt to disinflame the system.

The last thing I need is a psychologising doctor who says 3) is all psychological and asks me about my dreams, or another from the opposite camp, who denies that this phenomenon has anything to do with CFS/ME because it causes high cortisol and is therefore by definition "not ME".

 

[cmt12]

Those who are upset by all of this are likely to continue to be so. Unfortunately there are enough of us presenting with ME as well as depression that this "myth" isn't going anywhere.

Right, I get the notion many have of the politics and perception of ME being of primary importance and wanting to separate from those who get labeled as 'depressed', but it can backfire when it comes at the expense of the truth. It is possible to take the position that ME is more than just depression without saying that it is unrelated.

I agree with the person that said it is a spectrum; I disagree with the person that said they are two different spectrums. The spectrum is wide enough that experiences and symptoms can make them seem unrelated.

Regarding cortisol levels: Isn't it generally understood on this forum that cortisol levels start off high when first becoming symptomatic but then get down-regulated? We are stuck in a stressed, pain state meaning high cortisol, but our bodies are not going to continue to produce high cortisol, which is why the down-regulation happens showing low cortisol. I mean, this is where that entire (mistaken) theory of adrenal fatigue comes from right?

 

[lansbergen]

extreme lethargy (PEM),

PEM is extreme lethargy??????

 

[Sushi]

Isn't it generally understood on this forum that cortisol levels start off high when first becoming symptomatic but then get down-regulated?

I'd say no, not to my understanding. The recent study found this true of certain cytokines but I don't remember a study showing that cortisol is high in the early stages of this illness.
More typical, I think, is a reverse cortisol curve--low in the a.m. and rising a bit in the evening.

We are stuck in a stressed, pain state meaning high cortisol,

I never had the experience of being stuck in a stressed, pain state at any time in this illness, though others may have.

Sushi

 

[cmt12]

More typical, I think, is a reverse cortisol curve--low in the a.m. and rising a bit in the evening.

Which is the opposite from ideal from what I understand. So maybe it's more accurate to look at cortisol levels through the perspective of imbalance/disfunction.

It was a while ago since I dove into all this, but I do remember coming across enough evidence to feel comfortable that some type of down regulation was also occurring beyond the imbalances but I could be wrong.

The point is trying to use cortisol levels as a diagnostic tool or differentiator seems not great to me.

 

[Sidereal]

Cortisol levels can't be used to differentiate ME/CFS from depression since not everyone with ME/CFS has low cortisol and people with atypical depression can also present with hypocortisolemia.

 

[snowathlete]

Snowathlete

My experience is as follows:


1) There has been recognisable reactive melancholy/despair common in CFS/ME Akin, I would think, to your depression, but loss consequent on CFS - job, identity, hope, future etc This is a very common reactive depression among us.
2) There has been an anergic and ahedonic state which arose from long term fatigue, especially as over exertion has was encouraged and practiced in my case.

These are both distinguishable from ME/CFS symptoms, 1) more psychological crisis and 2) more biological adaptation but not CFS/ME.


3) There is a form of depression in my case related to HPA dysfunction with high cortisol, interrupted sleep, heavy palpitations and coinciding with general worsening of physical ME/CFS symptoms, pain, fatigue, tinnitus, muscle twitching etc.. I am inclined to see this as part of the overall ME/CFS/whatever in my case, possibly an endogenous attempt to disinflame the system.

The last thing I need is a psychologising doctor who says 3) is all psychological and asks me about my dreams, or another from the opposite camp, who denies that this phenomenon has anything to do with CFS/ME because it causes high cortisol and is therefore by definition "not ME".

Honestly, I think they are different Richie. The impact of losing those things as a consequence of my ME/CFS was a blow, I had an absolutely great life, and a lot of it was stolen away, but it just seems completely different to what I experienced when I had depression years ago.

For instance, I didn't experienced anhedonia as a result of my ME/CFS but I very much did when I had depression - in a big way. The two illnesses are just miles apart from my personal experience. It makes me wonder, if I hadn't have had depression back then, might I mistakenly think that how you feel about having ME/CFS is depression? That seems likely to me. Maybe it's a language thing; I wouldn't call the feelings from ME/CFS as depression, just mood affecting or something like that. A substantially more minor impact, at least in my case. As i said before, its possible some people with the disease also get true comorbid depression, but id think the numbers would be fairly low.

I'm not sure what you mean by point 3, but to me a lot of those symptoms don't look related to depression but are just common ME/CFS symptoms - HPA dysfunction, interupted sleep, heavy palpitations, pain, fatigue, musle twitches, etc. I get all of those, it's just part of the ME/CFS as far as I'm concerned. I never really got any of those symptoms when i was depressed; its hard to recall because it was along time ago but I'm not sure ihad any physical symptoms from being depressed except perhaps nausea and sleep dificulties.
Maybe that's what you were saying too? Not sure.

 

[Richie]

Snowathlete
I went undiagnosed for years, during which I became suicidal as I saw no future. This is my main experience of despair and melancholic depression.
I chose to accept life as it was and I think I used my anguish to "fuel" an overdrive state. This proved feasible for about 6 years after which I fell into a state of emotional deadness with little pleasure or motivation but little despair or melancholia. Reactive depression again I would say but different from the despair/melancholia.
The other stuff has immediate physical correlates but also entails a very unpleasant state of mind which I cannot label as sadness or any other emotion, or lack of emotion, but is nevertheless not itself a physical pain or discomfort in itslef. Almost lie being poisoned.
Guess we are all different.

 

[acer2000]

Several studies have shown that ME/CFS can be objectively measured using exercise testing. V02 and Anaerobic threshold are low compared to sedentary controls and go lower if tested a second time after exercise. This corresponds with an exacerbation of symptoms including brain fog, GI symptoms, headaches, flu like feeling, etc.. In depression and anxiety disorders, people feel tired but they don't score low on exercise testing. They also don't score worse the second test and their symptoms are typically improved by vigorous exercise, not increased by it.

 

[IreneF]

Part of the problem here is semantic. Both depression and CFS/SEID are typically diagnosed by asking the patient questions about symptoms. (Blood tests are usually done to rule out other disorders that might cause those symptoms.) Both depression and CFS can be described using the same terminology: "I'm tired; I can't sleep, and I don't feel any better if I do sleep; I can't get anything done; my life is falling apart, I can't keep up. . . ." Most docs are tuned into recognizing depression, not CFS, so that's what they will diagnose.

How many people have actually been diagnosed using 2-day exercise testing?

 

[gregh286]

Several studies have shown that ME/CFS can be objectively measured using exercise testing. V02 and Anaerobic threshold are low compared to sedentary controls and go lower if tested a second time after exercise. This corresponds with an exacerbation of symptoms including brain fog, GI symptoms, headaches, flu like feeling, etc.. In depression and anxiety disorders, people feel tired but they don't score low on exercise testing. They also don't score worse the second test and their symptoms are typically improved by vigorous exercise, not increased by it.

Yes but Prehaps cfs is an abnormal form of depression (not in the sad sense, in the sense of altered brain chemistry) that cause misfire in hpa axis, mitochondria, immune system etc.....leading to poor physical state. A communicative neurotransmitter breakdown.

 

[Valentijn]

Yes but Prehaps cfs is an abnormal form of depression (not in the sad sense, in the sense of altered brain chemistry) that cause misfire in hpa axis, mitochondria, immune system etc.....leading to poor physical state. A communicative neurotransmitter breakdown.

And perhaps it's the result of alien abduction

Creating a vague explanation to support a pet hypothesis seems rather pointless. Especially when the pet hypothesis has been pretty well disproven, and alternative illness models are strongly supported by a large body of medical research.

Seriously, what's the fascination with trying to equate ME/SEID with depression? They have no similarities. None. Unless you believe mild "fatigue" is the core symptom of ME/SEID.