Are endogenous depression and cfs close relatives?

[Richie]

From my understanding is that pain and depression share the same neuro pathway? It would be interesting to know if people who also have FM are the ones experiencing depression? I've known 3 people personally with FM and all 3 suffer from depression as well.

I don't know but fibro people can "recruit" non pain transmitting nerves to transmit pain.

 

[ukxmrv]

From my understanding is that pain and depression share the same neuro pathway? It would be interesting to know if people who also have FM are the ones experiencing depression? I've known 3 people personally with FM and all 3 suffer from depression as well.

I developed FM after a serious road traffic accident. This was after having ME for over 20 years. Although I was in a lot of pain and for years i did not develop depression. I was examined by various doctors as part of a legal/medical case. This included one of the more infamous "malingering" doctors.

Maybe I'm just lucky. I have enormous sympathy for people who do have depression.

 

[Richie]

I tracked down the papers you were talking about, authored by Lucinda Scott.
http://www.ncbi.nlm.nih.gov/pubmed/10451910

The above study was unfortunately not properly gender matched (I would have done separate women or men comparisons as this was a common confounder of results back in 1999) and all subjects had already been selected due to having a reduced cortisol response to ACTH however the 'selected' nature of the participants is noted in the abstract and discussion.

I searched the citing articles on Google Scholar and no one seems to have published an attempted replication.

They hypothesised in the following paper that:
http://www.ncbi.nlm.nih.gov/pubmed/10403156




This was disproved in a later study by Lucinda Scott:
http://www.ncbi.nlm.nih.gov/pubmed/11104854

If the adrenal gland was atrophied, it would be expected that both DHEA and cortisol levels would be diminished. But it was found the DHEA levels were slightly higher (no statistical difference) at all time points before and after the ACTH stimulation test, but the cortisol response was diminished.

What about the stages of adrenal maladaptation? Global atrophy would lower both but what about atrophy or hypertrophy of one or other area during stages of maladaptation?

 

[Richie]

I developed FM after a serious road traffic accident. This was after having ME for over 20 years. Although I was in a lot of pain and for years i did not develop depression. I was examined by various doctors as part of a legal/medical case. This included one of the more infamous "malingering" doctors.

Maybe I'm just lucky. I have enormous sympathy for people who do have depression.

Sorry about your fibro. Maybe your immune system went into overdrive if it realised your spinal cord was in danger. That is one theory.
My first run in with depression was major despair at loss of health. This was not diagnosed as an illness as I had "good health" after routine bloods so there was nothing to be depressed about!!!! (though I was considered to need therapy for being a useless character)
Second run in was after 13 years of iatragenic "denial of actual sickness behaviour", leading to fibromyalgia and utter "spiritual" exhaustion. No batteries in much of my brain, on emight say. Seven years of a desert.
Third was coming out of the second state, but in an unstable way with an overshoot into agitation.
All hard to treat as either immediately reactive or long term adaptational or both. But I cannot exclude an immunigenic aspect also which might further encourage a poor/odd response to antidepressants.

 

[amaru7]

I seem to be an atypical CFS patient as I don't have an immune dysfunction (tested at the charité immune clinics in Berlin center of excellence) and no other obvious physical symptoms like throat swelling, cold extremities. Had OI but that seems to have dissolved on its own. My fatigue score is severe though, especially lately I'm not able to get out of bed, brushing my teeth to me is like climbing a mountain.

Also in the typical depression I don't fit in, because I'm very proactive in searching for possible treatments and I think about my health alot. Plus I don't have an obvious change in appetite..

Most of the tests I did came out normal except for the mitochondrial testing and neurotransmitters, which were both on the low end. Also anti phospholipid syndrome, low HDL, some minor infections like bartonella.

 

[Snow Leopard]

What are these direct GR functions?

Ah, it seems I am probably wrong, there was speculation that GR could bind with NF-kB (in certan states) directly, blocking transcriptional function, but most of the transcriptional or blocking transcriptional functions seem to rely on the trans-location of the receptor from the cytoplasm (cortisol is lipophilic, so easily moves through the cellular membrane) to the nucleus which occurs after hormonal binding.

Of note however, iIn the cytoplasm, GR are complexed with several proteins including hsp70, hsp90 (chaperones). Dysregulation of these proteins have been shown after exercise by several different research groups.

Side note:, the following review has some interesting observations, of interest, the effects of the following pathways on GR activity: MAPK, NF-kB, The Phospholipase/COX/Prostaglandin Pathway. Well interesting to me anyway as the expected direction for depression is the opposite to what I'd predicted for ME for a particular hypothesis...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820632/

 

[amaru7]

@amaru7, before this conversation goes much further, would you kindly define what you mean by "CFS"?

In a nutshell as a core symptom debilitating/disabling fatigue/exhaustion with any minimal physical and/or mental exertion somatic problems optional. And absolutely they're two different diseases, but the clinical appearence in some cases is similar. Being bedbound/housebound, too disabled to be active in social and work life. Brain fog, memory issues, low energy, somatic symptoms.

Here are visuals which show that could be typical for both MDD and CFS, this condition over a 6months+ period

 

[Valentijn]

I seem to be an atypical CFS patient as I don't have an immune dysfunction (tested at the charité immune clinics in Berlin center of excellence) and no other obvious physical symptoms like throat swelling, cold extremities. Had OI but that seems to have dissolved on its own. My fatigue score is severe though, especially lately I'm not able to get out of bed, brushing my teeth to me is like climbing a mountain.

Do you have PEM? That usually features the immune and neurological symptoms (swollen lymph nodes, ataxia, dysautonomia, etc) pretty heavily.

 

[amaru7]

Do you have PEM? That usually features the immune and neurological symptoms (swollen lymph nodes, ataxia, dysautonomia, etc) pretty heavily.

I don't know for sure, all I can say is that after a strong physical/mental exertion, I do seem to take longer than normal to recover.

 

[Snow Leopard]

Are we one cohort?

Depends on the criteria. If we are talking about Oxford/Fukuda CFS, then probably not.

My aunt and neighbor both have FM. Neither seem depressed - both stay busy with work/volunteering, family, pets, etc, and are typically upbeat when I talk to them.

You never can really tell though. Some people are just good at hiding their depression.

What about the stages of adrenal maladaptation? Global atrophy would lower both but what about atrophy or hypertrophy of one or other area during stages of maladaptation?

I'm not sure. http://en.wikipedia.org/wiki/Adrenal_gland#/media/File:Adrenal_cortex_labelled.jpg

The Zona fasciculata and Zona reticularis are adjacent layers, for one layer to have very high or very low function compared to the other, would require a very interesting explanation.

 

[Valentijn]

I don't know for sure, all I can say is that after a strong physical/mental exertion, I do seem to take longer than normal to recover.

It's a mandatory symptom for the ME/SEID diagnoses. If you just fit Oxford criteria, that really isn't a specific diagnosis of anything and you might want to get some additional examination to see if something else is going on.

New ME/SEID patients often miss out on noticing PEM because of the delay ... but the symptoms themselves are pretty unmistakable. For example, many of us thought we were having weekly bouts of the flu for a while. The symptoms are prominent, but the connection between the symptoms and activity is what takes a while to click.

If you aren't sure if you're having PEM, despite knowing what it is and about the delay, then it seems pretty unlikely that you have it. Many other diseases feature non-PEM forms of exercise intolerance, and most are treatable to some extent.

 

[Valentijn]

You never can really tell though. Some people are just good at hiding their depression.

I lived with my aunt for about a year. She might have Issues, but depression was not among them

 

[amaru7]

@Valentijn No I didn't know about the delay but I know that my fatigue is fluctuating between bad to terrible. I have to add that my sleep and rest isn't refreshing.

 

[Valentijn]

@Valentijn No I didn't know about the delay but I know that my fatigue is fluctuating between bad to terrible. I have to add that my sleep and rest isn't refreshing.

Fatigue and bad sleep aren't sufficient to diagnose ME/SEID. I think you're having trouble separating ME symptoms from depression symptoms because you don't have, or understand, or believe in ME symptoms.

 

[amaru7]

@Valentijn thanks, but I prefer to be diagnosed by professionals

 

[Valentijn]

@Valentijn thanks, but I prefer to be diagnosed by professionals

Good for you - I suggest you go get diagnosed by one, since a real professional would not diagnose it based primarily on fatigue and in the absence of PEM and associated immune and neurological symptoms.

But you do not get to redefine ME/SEID to fit with your perceptions, or your personal experiences.

 

[SOC]

@Valentijn thanks, but I prefer to be diagnosed by professionals

By what professionals and by what criteria? What expertise do they have with the neuroimmune illness ME/CFS? Did they use Oxford, Fukuda, CCC, ICC, or "I'm assuming that since you are fatigued you must have Chronic Fatigue Syndrome" criteria to diagnose you?

Many, many doctors who are not ME/CFS experts misdiagnose chronic fatigue as Chronic Fatigue Syndrome. That doesn't make the diagnosis correct; it means they don't understand the illness. Chronic fatigue, the symptom, can be the result of many and varied conditions. It is NOT the same thing as the neuroimmune illness ME/CFS.

Then there's the "CFS is a psych condition" crowd who use Oxford or other criteria to diagnose what they call CFS, but is actually MDD, or other mental illness. What they choose to diagnose as CFS may very well be MDD or closely related.

PEM is not the same thing as exercise intolerance. Like chronic fatigue, exercise intolerance is a symptom of multiple conditions and is NOT diagnostic for ME/CFS.

The problem here is that you are claiming endogenous depression and CFS are related based on your experience. However, your experience apparently doesn't include immune dysfunction, OI, neurological symptoms as listed in the ICC, or (it appears) PEM. So extending conclusions about your illness to those of us with the symptoms described in the ICC is unwarranted.

 

[Richie]

I seem to be an atypical CFS patient as I don't have an immune dysfunction (tested at the charité immune clinics in Berlin center of excellence) and no other obvious physical symptoms like throat swelling, cold extremities. Had OI but that seems to have dissolved on its own. My fatigue score is severe though, especially lately I'm not able to get out of bed, brushing my teeth to me is like climbing a mountain.

Also in the typical depression I don't fit in, because I'm very proactive in searching for possible treatments and I think about my health alot. Plus I don't have an obvious change in appetite..

Most of the tests I did came out normal except for the mitochondrial testing and neurotransmitters, which were both on the low end. Also anti phospholipid syndrome, low HDL, some minor infections like bartonella.

Is bartonella minor? Whch immune tests did you have?

 

[Richie]

Depends on the criteria. If we are talking about Oxford/Fukuda CFS, then probably not.



You never can really tell though. Some people are just good at hiding their depression.



I'm not sure. http://en.wikipedia.org/wiki/Adrenal_gland#/media/File:Adrenal_cortex_labelled.jpg

The Zona fasciculata and Zona reticularis are adjacent layers, for one layer to have very high or very low function compared to the other, would require a very interesting explanation.

But don't the stages of maladaptation show a passage from high cortisol thu low cortisol highwer DHEA to low both? I can't remember the various stages. Would that not be reflected hiistologically.?

 

[Richie]

If you aren't sure if you're having PEM, despite knowing what it is and about the delay, then it seems pretty unlikely that you have it. Many other diseases feature non-PEM forms of exercise intolerance, and most are treatable to some extent.

But without VO2 max how do we know and how do we know that we don't have encephalomyelitis even in VO2 max is normal? A sfar as I know this stuff is never looked at properly.