Serotonin deficiency (atypical depression)

[Vladimir]

Hello everyone,

I know it's quite a condemned notion here but still time after time I am coming back to the idea that CFS is a variation of atypical depression.

What makes me think so? Well, here are some reasons. But first of all, I would like to note that I am quite a typical case of CFS - PEM, digestion issues, fibromyalgia, insomnia, anxiety, also in the past - severe neck pain and spasms, sore throat etc.

Nevertheless, here are my reasons.

1. I felt astonishingly better being on Sertraline or Mirtazapine for as long as I used them. Unfortunately, both led to severe urinal retention so I had to stop

Also, Phenibut (for a week) and Baclofen (for months) helped too. Benzo too, but I did not use it much to avoid a dependancy.

2. Many time when I travelled, I felt bad as usually for the first maybe couple of hours or so and then suddenly energy came and my body did not feel like it was 100 years old.

3. As it is for many, various BADs, diet changes or medicine temporarily worked for me - couple of days, week or so. Makes me thinking about psychosomatic even more.

4. My thoughts about anything unpleasant very often translate into the severe body (legs, arms, lower back) pain.

5. Reflecting on my past, I remember first signs of PEM when I was 18 years old. It was short but quite intense and almost always connected with some unpleasant experience - I had to smth. I didn't want or even hated to.

5. Children (till a certain age or circumstances) do not have it.

Yet, I can definitely say that I am not depressed (well, 95% or so of the time) - I know what depression looks and feels like.

I am not saying that CFS is a pure psychosomatic. On the contrary, I assume that CFS is caused by the genetic predisposition - mostly, by the over excitable nervous system.

And at some point in time, our nervous system just gets to that level of excitation where it cannot downregulate itself any more as it is caught in a vicious circle - the CFS symptoms are so bad it does not let our body recover (add here a bunch of the real life problems every grown up experience).

I. could write more but I better stop here to see what other have to say about it

Any feedback is welcomed.

Vladimir

 

[lenora]

Yes, I think depression is common among us....but what came first? The illness or the depression? Most of us are on low dose antidepressants as they've been found (like 35 yrs. ago) to help with pain.

Anxiety is also common among us, so yes there is probably some upregulation of the nervous system. Stress can make everything worse....but isn't that to be expected among a group of sick individuals? Is there a mind/body connection?....personally I believe there is, but many times (my case for example) I do have mechanical reasons for the problems I have. Brain surgery isn't done for nothing.....especially at a well-known hospital by a top neurosurgeon (no longer in practice, retirement).

All of this will take a lot of figuring out. Those who are wise will listen to both sides of the argument and relieve as much stress from their lives as possible. Physically we can only do the very best we can. Yours Lenora.

 

[heapsreal]

I think if one wants to try an antidepressant than go for it. Years ago i had some success with zoloft in small doses. Over time the effects on cfs symptoms like brain fog and energy disappeared and then my usual comments were that it made me feel better about feeling like crap. Sometimes thats what cfsers need for awhile too.

Last 2 years ive gone through triallingdifferent ADs for shingles headaches. I cant say i got any positive effects, i was hoping even if the snri didnt help pain it may give me some energy.

Im sounding negative about it but the only way one will know it helps is to try it. Tricyclics are well known to help sleep and maybe pain. Theres a few options to try.

 

[Vladimir]

The key word here is "atypical" - it does hurt our body not our mind (well, at least at first).

Yes, I think depression is common among us....but what came first? The illness or the depression? Most of us are on low dose antidepressants as they've been found (like 35 yrs. ago) to help with pain.

You are 100% right, for me CFS symptoms came first and then within 5 years I had a couple of depressive episodes caused by the illness and life limitation it causes.

My current approach to CFS is that it has the same or very similar root cause - some kind of serotonin imbalance which leads to the illness. For many people it causes classic depression with its symptoms, but for us it causes CFS symptoms.

Serotonin and its various receptors play huge role in various aspects of body functioning. We are just unlucky to have these CFS effects on us.

 

[Martin aka paused||M.E.]

My symptoms don’t have any correlation with how I emotionally feel. In fact it’s mostly the opposite of your experience. If I live, I crash.

You should consult a psychiatrist.

 

[JES]

1. Some people with ME/CFS have a positive response to antidepressants, although not that many. Abilify, which is an antipsychotic, has helped more people, but I don't think we can use antidepressant effect as classifying a disease since they are used for all kinds of conditions these days like chronic pain.

2. That happened to me a couple of times. I would travel in a car, nod off and then feel very refreshed at end of the journey. Could be hundreds of factors at play here, but it's interesting for sure.

3. It's very common in ME/CFS to get a response to a drug or supplement and then having it stop working a few weeks later. I wouldn't say that is proof of a psychosomatic condition (or placebo response) unless you react that way to all supplements. I certainly don't. I get a positive response from less than 10% of the things I decide is worth trying.

4. Interesting, I think this is rather atypical for ME/CFS. I never had thoughts translate into body pain.

5. Children generally don't have ME/CFS indeed, but children don't get many other chronic diseases as well, so not sure it's much relevant.

To me the whole mind/body discussion isn't that interesting and usually involves misunderstandings. It is clear that you can influence your body with your mind to some extent, as in reacting to a stressful situation by raising your pulse. The real question mark is the extent of which your conscious thoughts can impact the unconscious activities, which is what most of your brain is busy with and again to what extent those can impact your body and chronic diseases. I think we don't know or there is currently a lack of evidence is a fair answer.

The psychosomatic discussion is a whole other level, which I think is easier to answer. It is pretty clear that ME/CFS is not a condition like electromagnetic hypersensitivity, as in the whole disease is maintained by the belief that you have ME/CFS. If that was the case, you would easily be able to reverse at least some cases via therapy and all those papers highlighting CBT/GET for ME/CFS would have reported much better results.

 

[Vladimir]

To me the whole mind/body discussion isn't that interesting and usually involves misunderstandings. It is clear that you can influence your body with your mind to some extent, as in reacting to a stressful situation by raising your pulse. The real question mark is the extent of which your conscious thoughts can impact the unconscious activities, which is what most of your brain is busy with and again to what extent those can impact your body and chronic diseases. I think we don't know or there is currently a lack of evidence is a fair answer.

The psychosomatic discussion is a whole other level, which I think is easier to answer. It is pretty clear that ME/CFS is not a condition like electromagnetic hypersensitivity, as in the whole disease is maintained by the belief that you have ME/CFS. If that was the case, you would easily be able to reverse at least some cases via therapy and all those papers highlighting CBT/GET for ME/CFS would have reported much better results.

Thanks for the great response.

I am trying not to focus on what causes this serotonin (and dopamine too) imbalance (it can be pure genetic, acute viral infection, psychological stress etc. in different combinations) but rather on how it manifests in people. Some people "feel sad", other feel pain and total lack of energy.

And the fact that Abilify works for many, in my opinion, also suggests that CFS has a significant portion of psychological factor.

3. It's very common in ME/CFS to get a response to a drug or supplement and then having it stop working a few weeks later. I wouldn't say that is proof of a psychosomatic condition (or placebo response) unless you react that way to all supplements. I certainly don't. I get a positive response from less than 10% of the things I decide is worth trying.

That is interesting. I think it worked same for me and I have two explanations for that. 1. Poor digestion causes malabsorption of those 10% of the supplements that work as a result. 2. Our mind consciously or subconsciously assesses every supplement and makes a decision of whether it may work at all hence the low rate of placebo effect. I know it's quite a stretch but who knows

4. Interesting, I think this is rather atypical for ME/CFS. I never had thoughts translate into body pain.

I attribute this to the chronic herpes sitting in my sciatic nerves - I feel real pain exactly there. Also, when I am Valtrex it's getting almost negligible.

It is very strange, but I also feel real pain in my sciatica when I see someone gets hurt. And because of that I cannot tolerate that kind of "funny" videos on YouTube

 

[Vladimir]

My symptoms don’t have any correlation with how I emotionally feel. In fact it’s mostly the opposite of your experience. If I live, I crash.

You should consult a psychiatrist.

I did consult one just because my neurologist told me he cannot help me anymore. Expectedly, nothing wrong psychologically-wise was discovered.

I too crash if I live both physically or emotionally, and it does not depend much wether it was a positive or negative living experience - any excessive neural system load leads to a crash.

Again, I am not saying that CFS is an "all in our mind"-disease. At least, when speaking about the root cause as said above. I am just focusing on those facts that supports the serotonin-dopamine imbalance theory.

Serotonin and dopamine are those substance predominantly operated by our brain, which makes it very hard to analyze. Probably, this is why there is still no a definitive CFS marker.

 

[Consul]

Maybe its a problem with dopamine rather than serotonin since LDA appears to help alot of pwme? Up to 3/4 patients helped.

From the paper below:

Dopamine D2 receptor agonists have been shown to mediate neuroinflammation, microglial activation, and cell death in animal models and humans [4,5,6]. This suggests that dopamine-modulating drugs like aripiprazole may lead to clinical improvement in fatigue and cognitive symptoms in ME/CFS.

https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02721-9

 

[Vladimir]

It's probably both serotonin and dopamine. This also explains difference in symptoms and meds response - some people have a more serious imbalance of serotonin and others of dopamine.

As for the fact that ADs often do not work or stop working with time for CFS, it is the same for a classical depression - ADs are not the panacea and it often make things even worse.

 

[Martin aka paused||M.E.]

I did consult one just because my neurologist told me he cannot help me anymore. Expectedly, nothing wrong psychologically-wise was discovered.

I too crash if I live both physically or emotionally, and it does not depend much wether it was a positive or negative living experience - any excessive neural system load leads to a crash.

Again, I am not saying that CFS is an "all in our mind"-disease. At least, when speaking about the root cause as said above. I am just focusing on those facts that supports the serotonin-dopamine imbalance theory.

Serotonin and dopamine are those substance predominantly operated by our brain, which makes it very hard to analyze. Probably, this is why there is still no a definitive CFS marker.

Then I don’t understood why you use the term “depression” at all. The both molecules have multiple functions in the body and the mode of action in ME is not clear at all.

 

[andyguitar]

And the fact that Abilify works for many, in my opinion, also suggests that CFS has a significant portion of psychological factor.

Perhaps "neurological" could be used instead of "psychological"? Might be a bit nearer to the what is going on.

 

[The Bard]

Conspicuously absent from your atypical depression rationale is any citation to authority. Moreover, how would studies even strive to measure something as amorphous as PEM being the resultant effect of “unpleasant experience(s)?”

Children are indeed annihilated by this dreadful condition, and too often, child protection proceedings are erroneously initiated against families managing these harrowing circumstances. Even a cursory glance at the story of young Ean Proctor will disabuse the children don’t get it narrative. The relative scarcity of children visible in ME advocacy/conversations is likely attributable to the fact that they’re … children.

Even the most incorrigible defenders of a psychogenic framing of ME rejected the notion that the condition is atypical depression. It seems profligate, especially so considering the limited faculties and energy of ME patients, to revisit a dormant and long discredited hypothesis.

 

[lenora]

I know people undergoing cancer treatments. Many, many drugs today are used for multiple purposes, including many used in chemotherapy. It just hasn't filtered down to us yet (that I know of).

I do know that gabapentin an old drug used for seizures, definitely helped the pain of my FM, which was rather intolerable. I now take it's child, lyrica, and the same thing occurred again. Often the doses are what's messed up in the first instance. The doctors are learning along with us....as a matter of fact, we're often the sacrificial lambs being learned on. I just know what life was like before this drug....and what it's like after. Doses are totally individual, mine is quite low and others have to take high doses to reach the same limit.

So use what's available and if it doesn't work after approx. 2 wks. chances are it's not going to or the dose has to be adjusted. Nothing is a one size fits all model, but then we've known that for a very long time. I can assure you that life was pretty grim before it was found that these drugs actually do help. Perfect is a state that we'll probably never reach. What's attainable is at least moderate. Wishing you health. Yours, Lenora.

 

[Living Dead]

And at some point in time, our nervous system just gets to that level of excitation where it cannot downregulate itself any more as it is caught in a vicious circle - the CFS symptoms are so bad it does not let our body recover (add here a bunch of the real life problems every grown up experience).

What you describe is an actual illness, but it is not ME/CFS. It is called neurasthenia. You should try treatments that help with stress.

 

[gm286]

What you describe is an actual illness, but it is not ME/CFS. It is called neurasthenia. You should try treatments that help with stress.

« Neurasthenia » is an anachronistic diagnosis. It has been abandoned. There is nothing contemporary about the diagnosis and is today seen as being a part and parcel of dysautonomia. Dysautonomia and ME/CFS do have lots in common.