The presence of co-morbid mental health problems in a cohort of adolescents with CFS

[Hip]

It is not in dispute that some ME patients have depression, anxiety, or both. What is doubtful is that any findings of depression or anxiety in ME patients are provable.

I can't see any difficulty in working out whether an ME/CFS patient might have depression. The simplest thing would just be to ask the patients. Major depression is not something that goes unnoticed in people that suffer it: if you have major depression, you are going to know about it.

For me, there's a hierarchy: CFS = Primary and Anxiety = Secondary

There isn't really a hierarchy, because ME/CFS is classed a different condition to say generalized anxiety disorder (GAD). The only hierarchy that might appear is the disease severity. For example, if you suffer from severe GAD (which is incredibly debilitating) but only mild ME/CFS, then you'd probably see your GAD as the primary problem, and the ME/CFS as the secondary issue.

 

[alex3619]

Major depression is not something that goes unnoticed in people that suffer it: if you have major depression, you are going to know about it.

Agreed. But many patients might say yes if their psych convinces them using psychobabble.

 

[alex3619]

if you suffer from severe GAD (which is incredibly debilitating) but only mild ME/CFS, then you'd probably see your GAD as the primary problem, and the ME/CFS as the secondary issue.

This could easily happen. Having ME as a comorbid condition with GAD is likely to make the GAD experience worse too.

 

[ebethc]

There isn't really a hierarchy, because ME/CFS is classed a different condition to say generalized anxiety disorder (GAD). The only hierarchy that might appear is the disease severity. For example, if you suffer from severe GAD (which is incredibly debilitating) but only mild ME/CFS, then you'd probably see your GAD as the primary problem, and the ME/CFS as the secondary issue.

my anxiety showed up AFTER cfs did.... the biological stress of being sick taxed my adrenals and messed w my HPA axis, etc. (more cortisol pumped out to lower inflammation, as one example) Additionally, the psych stress of losing everything or drastically altering expectations compounds the problem, and a weakened immune system makes your body less able to achieve homeostasis...

I'm not talking about a classification system designed for insurance cos. or for medical (which is organized by specialties vs organized for multi-system illnesses).. I'm talking about my experience and conclusions based on my own illness, ie, CFS first, Anxiety second...totally respect that there are other experiences, conclusions.

 

[Hip]

In my case, it was the other way around: the virus that triggered my ME/CFS first produced very significant generalized anxiety disorder symptoms (not only in me, but also in a few others who caught the same virus from me); and then ME/CFS appeared quite a bit later and more gradually.

I also managed to successfully treat my generalized anxiety disorder using the supplements detailed on the following thread: Completely eliminated my severe anxiety symptoms with three supplements!

However, this anxiety treatment did not improve my ME/CFS symptoms.

 

[Hip]

My virus by the way was likely coxsackievirus B4 (based on my blood tests and its acute symptoms). Although in the medical literature elevated titers to cytomegalovirus are linked to anxiety, I could not find any known link between coxsackievirus B and anxiety.

However, recently I came across a possible mechanism of how coxsackievirus B4 may produce anxiety symptoms. This is my own theory of how coxsackievirus B may cause generalized anxiety disorder:

This paper says that:

It has been also proposed that molecular mimicry between protein 2C of coxsackievirus B4 and the autoantigen glutamic acid decarboxylase (GAD65) are playing role in the pathogenesis of insulin-dependent diabetes, which is an autoimmune disease.

So coxsackievirus B4 may trigger an autoimmune attack on the GAD65 enzyme. Now it just so happens that in the brain, GAD65 converts the stimulatory neurotransmitter glutamate into the calming and relaxing neurotransmitter GABA.

Thus if GAD65 is being deactivated because of an autoimmune attack, you will get a build up of glutamate and a shortage of GABA.

Excess glutamate in the amygdala (one of the "anxiety circuits" of the brain) is known to cause anxiety symptoms, and lack of GABA (which is the counterbalancing neurotransmitter to glutamate) will likely further exacerbate these anxiety symptoms.

So this is how a coxsackievirus B4-induced autoimmune attack on GAD65 may lead to generalized anxiety disorder, in my own theory.

Interestingly enough, in diabetes, where autoantibodies to GAD65 may be found, 14% of diabetic patients meet the criteria for generalized anxiety disorder, and 40% of diabetic patients have elevated symptoms of anxiety. Ref: 1



Thus the above GAD65 mechanism might explain why my Coxsackie B4 virus triggered major anxiety symptoms in myself and a few others who caught it. I also think GAD65 autoimmunity may be one of the mechanism by which ME/CFS patients experience anxiety, as coxsackievirus B is a virus frequently found active in ME/CFS patients, and thought to be a major cause of ME/CFS.



My other theory on how viruses may cause generalized anxiety disorder is detailed in this post (the theory is that chronic microglial activation in the brain is known to release lots of glutamate, and I think in the amygdala this excess glutamate may induce anxiety symptoms).

 

[ebethc]

In my case, it was the other way around: the virus that triggered my ME/CFS first produced very significant generalized anxiety disorder symptoms (not only in me, but also in a few others who caught the same virus from me); and then ME/CFS appeared quite a bit later and more gradually.

I also managed to successfully treat my generalized anxiety disorder using the supplements detailed on the following thread: Completely eliminated my severe anxiety symptoms with three supplements!

However, this anxiety treatment did not improve my ME/CFS symptoms.

I wonder what the biological cascade it? ie, the symptoms show up after the cascade starts, but do not show up in a uniform way...

Now, when I get the flu, etc., it can trigger anxiety... that can be the first symptom.... I just don't have a lot of vitality so any biological stressor (high histamine, allergies, too..) can trigger anxiety... I think if I had good baseline vitality, my body could achieve homeostasis better.....One of the benefits of interval training is that the "stress-relax" cycle "trains" your body to achieve homeostasis better.... I don't have the energy to do any interval training, BUT yoga works on the same principle so I should start that up again


Positive effects on insulin resistance for subjects trying HIIT (high intensity interval training)
https://www.ncbi.nlm.nih.gov/pubmed/24509992

YOGA - the CFS-friendly version of interval training?
Furthermore, yoga helps to improve the cardiovascular efficiency and homeostatic control of the body and results in improvements in autonomic balance, respiratory performance, and overall well-being.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193654/

 

[ebethc]

My other theory on how viruses may cause generalized anxiety disorder is detailed in this post (the theory is that chronic microglial activation in the brain is known to release lots of glutamate, and I think in the amygdala this excess glutamate may induce anxiety symptoms).

this absolutely makes sense to me.. thanks for sharing..

I just added high dose DHA (actually, DHA:EPA at a 2:1 ratio)... Most fish oil preparations are the other way around, 2:1 of EPA : DHA... The high dose DHA is soothing and I feel less achey & anxious.. I take 1-2 grams a couple times a day... Molecularly distilled is a must, so no bad taste or stomach problems... I use a brand called nature's way

 

[Mithriel]

I can't see any difficulty in working out whether an ME/CFS patient might have depression. The simplest thing would just be to ask the patients. Major depression is not something that goes unnoticed in people that suffer it: if you have major depression, you are going to know about it..

Trudie Chalder is one of the original biopsychosocial people, an exnurse who got her foothold working with SW.

They might have changed their ways, but they used standardised questionnaires to diagnose depression. These questions often include things like "are you fatigued?" or "has your sleep pattern changed?"

Some researchers found that 100% of CFS patients were depressed! A study done in the 80s found that it all depended on the questions that were asked. If you took out the ones which were actually CFS symptoms the number dropped right down.

Denying you have depression is often seen as a sign you actually have depression, as is denying you have anxiety. The danger is that they will want to cure your "depression" by CBT and GET (it is not called the Calder fatigue scale for nothing)

Once again, there is nothing that will help us here as they are not working to help us. We can't get help with our mental health until they believe we have a physical disease. (At a pain clinic a psychologist - sneaked that up on me - kept asking what I wanted to do with my life and when I told her, kept saying "Why don't you do it?" Idiot. She was not willing to help me cope with the problems in my life, which were many at that point, while experiencing a severe disease she just wanted to convince me my problems were mental and self inflicted because I would not face up to them.)

We give them the benefit of the doubt and they kick us in the teeth, over and over.

 

[FMMM1]

How do you validate such a psych interview with ME or even CFS? Until we have diagnostic markers for both depression and ME then we have no validated methods. Anxiety in an ME patient might be fully justified, it depends on the details.

Check out Maureen Hanson's presentation at the recent Symposium on the Molecular Basis of ME/CFS at Stanford. She presented data showing that mental health in people with ME/CFS was the same as people who were well.

As you say how can you perform a study linking two diseases without biochemical diagnosis. In terms of ME/CFS perhaps it would help if they demonstrated clonal expansion (T cell)/altered mitochondrial metabolism (Seahorse) and prolonged fatigue.

 

[ebethc]

Check out Maureen Hanson's presentation at the recent Symposium on the Molecular Basis of ME/CFS at Stanford. She presented data showing that mental health in people with ME/CFS was the same as people who were well.

the symposium in august?

 

[FMMM1]

Yes i.e. August 2017; you'll find it on you tube.

 

[wastwater]

I revisited the Stanford symposium and noticed the presentation on mice and the HOX genes they developed OCD and microglial problems
Is gene therapy to replace missing genes in humans reality
Do they use deactivated retroviruses to replace genes
With my luck I’d probably end up with glow in the dark genes added