Why do some of my symptoms sound like a typical depression and some dont?

[fatiguerre]

Like most people on this board i have been told by some docs the reason for my fatigue is simply that i have depression. But like most other people here from the beginning i felt there is a different reason.

but since my disease progressed and i have become more sad about this i have also become a bit unsure what now is the chicken and what the egg. i just want to be well again, regardless of what it is. and to be honest there are some symptoms that really sound like a typical depression and some others are quite typical for not having one. i also read of some people like ciara maclaverty who got well from severe ME with psychological stuff like MT.

so im confused. psychiatrists, as you might know, unfortunately are no help in finding out cos for them everybody with fatigue has depression, somatoform disorder or its just psychosomatic. but when i look at the symptoms of cfs and depression its hard to make a difference cos having cfs obviously leads to many classical symptoms of depression.

what makes me think i dont have depression:
- the first half year of my cfs i wasnt sad, only confident i would get better
- antidepressant st johns wort made me worse (now also all other drugs)
- i have neurologic symptoms like tingling, pain, twitching and myoclonus
- my sex drive and appetite are not reduced
- sometimes i feel extremely worse after too much walking
- vacation (with no activity) makes me feel better

what makes me think i could have depression:
- i often wake up early (sometimes also in the middle of the night)
- i sometimes feel better in the evening
- i cry a lot (sad about my disease and the lack of perpective)
- sometimes when i slept only very little at night I felt significantly better after afterwards
- i often blame myself for health/medical decisions that made me worse and think a lot about the past
- i dont want to meet friends anymore (cos i am so ashamed of being so sick)
- even small tasks require a lot of effort
- i dont have this flu-feeling anymore
- i enjoy sunlight

what do you think?

 

[adreno]

There is some similarity between atypical depression and CFS, but not so much between Major Depression (MDD) (the usual one) and CFS. So, if you have depression, I'd guess you have the atypical version.

Where MDD is usually characterized by having high cortisol levels, atypical depression and CFS has low cortisol levels. There really is no reason you can't have both depression and CFS/ME at the same time, though.

With low cortisol levels, inflammatory cytokines are high, and this inflammation is known to cause depression. Inflammation and depression go hand-in-hand.

Some crucial difference is that depression normally responds well to exercise, whereas CFS/ME usually doesn't. So if you have PEM/PENE, that would be an important pointer that you have CFS/ME.

Here is an article that explains some similarity and differences between depression and CFS:

Prog Neuropsychopharmacol Biol Psychiatry. 2011 Apr 29;35(3):784-94. Epub 2010 Jul 4.
An intriguing and hitherto unexplained co-occurrence: Depression and chronic fatigue syndrome are manifestations of shared inflammatory, oxidative and nitrosative (IO&NS) pathways.
Maes M.
Source

Maes Clinics @ TRIA, 998 Rimklongsamsen Road, Bangkok 10310, Thailand. dr.michaelmaes@hotmail.com
Abstract

There is a significant 'comorbidity' between depression and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Depressive symptoms frequently occur during the course of ME/CFS. Fatigue and somatic symptoms (F&S), like pain, muscle tension, and a flu-like malaise, are key components of depression. At the same time, depression and ME/CFS show major clinical differences, which allow to discriminate them with a 100% accuracy. This paper aims to review the shared pathways that underpin both disorders and the pathways that discriminate them. Numerous studies have shown that depression and ME/CFS are characterized by shared aberrations in inflammatory, oxidative and nitrosative (IO&NS) pathways, like systemic inflammation and its long-term sequels, including O&NS-induced damage to fatty acids, proteins and DNA; dysfunctional mitochondria; lowered antioxidant levels, like zinc and coenzyme Q10; autoimmune responses to neoepitopes formed by O&NS; lowered omega-3 polyunsaturated fatty acid levels; and increased translocation of gram-negative bacteria. Some IO&NS-related pathways, like the induction of indoleamine 2-3-dioxygenase, neurodegeneration and decreased neurogenesis, are more specific to depression, whereas other pathways, like the 2'-5' oligoadenylate synthetase/RNase L pathway, are specific to ME/CFS. Most current animal models of depression, e.g. those induced by cytokines, are not reminiscent of human depression but reflect a mixture of depressive and F&S symptoms. The latter symptoms, sometimes called sickness behavior, differ from depression and ME/CFS because the former is a (sub)acute response to infection-induced pro-inflammatory cytokines that aims to enhance recovery, whereas the latter are characterized by long-term sequels in multiple IO&NS pathways. Depression and ME/CFS are not 'comorbid' disorders, but should be regarded as 'co-associated disorders' that are clinical manifestations of shared pathways.

Copyright 2010 Elsevier Inc. All rights reserved.

PMID:
20609377

 

[ukxmrv]

What was the onset of your disease like?

and then some silly questions that patients often ask themselves to try and work this out

1. If you recovered tomorrow what would you do with your life? Quick response please.
2. If you won a large sum of money tomorrow what would you do with it? Once again quick response

and a not so silly question

A) when you exercise (like the walking you mentioned) how do you feel i) during ii) after ii)24-72 hours after

Hope this helps in some way

 

[fatiguerre]

The onset was a bronchitis but ive been tired before.

I know exactly without thinking what Id do if i would be well in a minute or win a million bucks: invite the members of this board for a (healthy i guess) drink. Seriously, i know what id do.
So these answers sound more like cfs, dont they?
When I walk more than 10 minutes I collapse immediately. Sometimes I recoversoon, sometimes Im knocked out for a week. Is this also typical for cfs?

 

[Waverunner]

The onset was a bronchitis but ive been tired before.

I know exactly without thinking what Id do if i would be well in a minute or win a million bucks: invite the members of this board for a (healthy i guess) drink. Seriously, i know what id do.
So these answers sound more like cfs, dont they?
When I walk more than 10 minutes I collapse immediately. Sometimes I recoversoon, sometimes Im knocked out for a week. Is this also typical for cfs?

I wouldn't waste my time to look into the depression direction. There are many studies that link depression to inflammation of the brain. With ME/CFS it is highly likely that some inflammatory processes take place so the depression would be a consequence of the underlying disease. If you do sports but collapse or even get worse mood this is a proof in my eyes that depression is not the cause of your situation.

Moreover it is very likely that a person with ME/CFS is not very happy about his/her situation, anything else would be abnormal. So again, the illness was first, the depression was second.

 

[Sallysblooms]

Seratonin goes down with illness and stress so that is normal. I had problems after my POTS started so my doctor started me on 5HTP. That is all it took in my case. Getting the seratonin up.

 

[taniaaust1]

Like most people on this board i have been told by some docs the reason for my fatigue is simply that i have depression. But like most other people here from the beginning i felt there is a different reason.

I dont know if I'd say "most people on this board", in my case all my symptoms have NEVER been put all down to depression and Ive been to at least 30 different doctors and not one has put all my symptoms down to that. Ive thou had a few bad doctors think "bipolar" or " somatoform disorder" along with "you have a virus" as Im generally happy but can have sudden temporary mood swings hence have been suicidal at times.

I'd like people to get away from that myth that most ME/CFS people the illness presents like depression can.. there are many different subgroups to this disorder and we all also present differently.
......

ME/CFS I personally believe is easy to tell one has rather then just having depression. It is clear from your post you dont just have depression "- sometimes i feel extremely worse after too much walking". That is the one big thing which shows you have more then just depression.

You will need to consider your life views on things to work out if that is you have coexising depression or not eg do you still enjoy things in life? If you cant think of things you still enjoy (with ME/CFS they may be very little things which give one enjoyment), you probably do have coexisting depression due to the illness.

How do you feel about your future? A non depressed ME person still maintains hope (not necessarily hope of a cure as that may not be found and may be unrealistic but realistic hopes of their life and future.. eg possibilities of one day finding a partner if single, possibilities of all kinds of various things... Hopes and dreams remain. If you feel your future is hopeless, I'd think you either have depression or adjustment issues to having this illness. (look at a person in a wheelchair.. just cause they are in a wheelchair their future isnt hopeless.. and yours shouldnt be either).

Take care with normal depression questionaires which doctors may give as they arent designed for actually physically sick patients, the ones for those who are bedridden or chronically ill are far more accurate to help diagnose depression cause depression questionaires which ask "do you do less then you used to be able to do?" and "Do you feel tired" can end up making it look as if one has depression when one hasnt.

"i dont have this flu-feeling anymore"

Many of us get that feeling more in the early years of the illness. The illness usually shifts and symptoms often change with time.


Of cause it is very possible you have both depression and ME/CFS

.......

" what makes me think i dont have depression:
- i have neurologic symptoms like tingling, pain, twitching "
be aware that those symptoms can be in depression esp if the person also has anxiety.

" my sex drive and appetite are not reduced "
It is quite possible to still be okay with those things yet have depression.

" - vacation (with no activity) makes me feel better"

Many depressed patients may feel better on vacation (its a good distraction to them while away)


You cant use any sleep issues to distinguish if depression is in a ME/CFS person as sleep issues pf all sorts are part of ME/CFS anyway. So they became irrelevant in working out if you have depression or not.

blaming oneself and crying if it was at nothing or small things (not things anyone would cry over).. could go towards showing you have some depression. If you are crying all the time for no good reason (eg a non depressed reason to cry could be physical pain) .. you probably do have depression or need some counselling to help you to deal with having a chronic illness eg issue with situational depression due to struggling to adapt to having illness (you cant bandaid that up with just drugs if that is the case.. therapy is needed too with someone who understands that ME is a real illness and not just psych)..

If the reason why you arent seeing friends no more is due to feeling "ashamed at your sickness" I wouldnt count that as a depression symptom.

Depressed people dont hang out with their friends cause they "just dont feel like doing so" they dont want to... they havent really got a real reason for not wanting to hang out. A ME/CFS person really wants to be hanging out with friends but just "cant" for various reasons be it knowing it will make one sicker or whatever.
If you arent hanging out with friends due to being ashamed that you are sick, that is more a case of probably needing some counselling to help see the illness differently and that you have no need to feel shame over having ME/CFS. If others dont understand the illness, the issue is with them and not you. (Feeling ashamed of having this illness can come from having poorly supportive of that you have a physcial illness doctors).

"- i enjoy sunlight"

That isnt a sign of depression. Yes sunlight can help depression but even a non depressed person can enjoy the sunlight.

 

[*GG*]

When I walk more than 10 minutes I collapse immediately. Sometimes I recoversoon, sometimes Im knocked out for a week. Is this also typical for cfs?

I don't think this was answered yet. I think it is typical for most sufferers, there are exceptions.

GG

PS I like your idea of inviting everyone out for a drink, not possible, but I like it!

 

[Sparrow]

In my non-expert opinion and based on my own experiences, what you've described here, in the original post and in your follow-up answers, makes me believe strongly that you definitely have ME/CFS issues. ...And that if you do have some elements of depression, they are probably mild.

I was initially diagnosed with depression because of that symptom overlap you're describing. Was put on many different antidepressants and natural depression cures that all made me worse. There is a lot of overlap in symptoms of ME/CFS and many other illnesses (including depression, but also many others). It's the unique elements and the combination that set us apart.

I know exactly what you mean about being worn out after doing something and then sometimes also having a delayed or ongoing crash as a result of it. As I understand it, that is very typical for ME/CFS. And that's the one thing that psychologists kept pointing to as not fitting with depression at all. They said if I was feeling okay about the activity, then I should feel better by doing more, not worse. Secondary to that was that I could still enjoy things when I was able to do them, and that there were things that I missed doing and was frustrated that I couldn't do. I would say don't second-guess yourself too much. If you are having any traces of depression, I imagine they're brought on by the limitations of the illness or complications due to it, which is perfectly normal (but not the root cause of your physical problems).

 

[SickOfSickness]

You probably have some depression BECAUSE of the illness. It would be totally normal, from what I see, we especially get depressed when we realize we are ill, and then every time we have our hopes up (because of some treatment or new doctor) and then it doesn't work. All your sleep symptoms could be from the illness only, almost all of us have disturbed sleep cycles and are alert at different times than healthy people.

 

[Rand56]

There is some similarity between atypical depression and CFS, but not so much between Major Depression (MDD) (the usual one) and CFS. So, if you have depression, I'd guess you have the atypical version.

Where MDD is usually characterized by having high cortisol levels, atypical depression and CFS has low cortisol levels. There really is no reason you can't have both depression and CFS/ME at the same time, though.

With low cortisol levels, inflammatory cytokines are high, and this inflammation is known to cause depression. Inflammation and depression go hand-in-hand.

Some crucial difference is that depression normally responds well to exercise, whereas CFS/ME usually doesn't. So if you have PEM/PENE, that would be an important pointer that you have CFS/ME.

Here is an article that explains some similarity and differences between depression and CFS:

Being that I am fairly new to this forum I have been spending time trying to read thru some not so current threads to try to understand more on how all this relates to my own situation. Reading this made me curious to ask some questions from this particular statement.....

"Where MDD is usually characterized by having high cortisol levels, atypical depression and CFS has low cortisol levels"

I am not doubting what is said here in this statement. If this is the case, then I have to assume that the majority of people here in this forum would be like myself in having "low" cortisol? What I am trying to get a greater understanding of is the relationship of all the co-factor supps <I'm not talking of the adnB12, methylB12, and methylfolate> as far as needed for total healing particularly at some of the dosages recommended when it is known that some of those can lower cortisol. I know that high dose Vit C and high dose fish oil can lower cortisol. I even read a study about 25mg of zinc can lower cortisol. One question I have is...do people with low cortisol have to suffer from even more plummeting of cortisol levels in order for more total healing to be on course? There is nothing worse than crashing cortisol lower when your baseline levels are already low to begin with. The other question is....without someone constantly monitoring their cortisol levels and potassium levels for that matter...if someone feels worse, how would they actually know if they feel worse is from plummeting cortisol or low potassium? If them feeling more like dirt is from even lower cortisol and they "think" it might be low potassium, and they replenish with more potassium, I see this as maybe a disaster in the making if they aren't low in potassium and take too much of it.

I'd really like to know if lowering cortisol even more with people already with low baseline cortisol is actually necessary for more total healing to take place, or can people back down <maybe way back down in some cases> on some of the particular co-factor supps that are known to lower cortisol, and still be on course for healing?

Help!!!! LOL. Just confused here and trying to understand!!

 

[adreno]

Being that I am fairly new to this forum I have been spending time trying to read thru some not so current threads to try to understand more on how all this relates to my own situation. Reading this made me curious to ask some questions from this particular statement.....

"Where MDD is usually characterized by having high cortisol levels, atypical depression and CFS has low cortisol levels"

I am not doubting what is said here in this statement. If this is the case, then I have to assume that the majority of people here in this forum would be like myself in having "low" cortisol? What I am trying to get a greater understanding of is the relationship of all the co-factor supps <I'm not talking of the adnB12, methylB12, and methylfolate> as far as needed for total healing particularly at some of the dosages recommended when it is known that some of those can lower cortisol. I know that high dose Vit C and high dose fish oil can lower cortisol. I even read a study about 25mg of zinc can lower cortisol. One question I have is...do people with low cortisol have to suffer from even more plummeting of cortisol levels in order for more total healing to be on course? There is nothing worse than crashing cortisol lower when your baseline levels are already low to begin with. The other question is....without someone constantly monitoring their cortisol levels and potassium levels for that matter...if someone feels worse, how would they actually know if they feel worse is from plummeting cortisol or low potassium? If them feeling more like dirt is from even lower cortisol and they "think" it might be low potassium, and they replenish with more potassium, I see this as maybe a disaster in the making if they aren't low in potassium and take too much of it.

I'd really like to know if lowering cortisol even more with people already with low baseline cortisol is actually necessary for more total healing to take place, or can people back down <maybe way back down in some cases> on some of the particular co-factor supps that are known to lower cortisol, and still be on course for healing?

Help!!!! LOL. Just confused here and trying to understand!!

Just make sure that you are not deficient in anything, and you should do fine. At least that is how I see it.

 

[Rand56]

Just make sure that you are not deficient in anything, and you should do fine. At least that is how I see it.

hi adreno

That's the way I'm starting to see it too. I wonder how many people on this board might be crashing their cortisol levels and mistaking it as low potassium. I guess the worst part would be if you are low on both.

 

[Rand56]

I also hope Freddd and Rich read this and could give their inputs. This whole topic might have been brought up before in some previous thread but I think it's an important enough topic to be commented on again.

 

[SOC]

You might want to get a sleep study done. From your list of symptoms, I think your symptoms might be explained by a serious sleep disorder. That also can cause depression and extreme fatigue.

While many of us have sleep disorders as part of our ME/CFS, it is also possible to have a sleep disorder without ME/CFS. If treating the sleep disorder improves your symptoms, you may not be cursed with ME/CFS. :victory:

It's a good idea to get your doctor to do a differential work-up to eliminate other causes of your symptoms. Quite a few other conditions have symptoms that appear superficially to be the same as ME/CFS. If the condition is treatable -- and most are -- you could get well, rather than being stuck with ME/CFS.

Any GP in the US should be able to do the differential work-up for "CFS" -- the CDC lists conditions to be ruled out before assigning a CFS diagnosis. Not all GPs will then give the diagnosis, but that's okay, at least they'll have ruled out a bunch of treatable conditions.

In the UK and some other countries, I wouldn't even mention ME or CFS to ask for a differential work-up, but you might want to ask for tests, like a sleep study, thyroid tests, etc, that might show a different reason for your symptoms.

Good luck!

 

[taniaaust1]

BI know that high dose Vit C and high dose fish oil can lower cortisol. I even read a study about 25mg of zinc can lower cortisol. One question I have is...do people with low cortisol have to suffer from even more plummeting of cortisol levels in order for more total healing to be on course?

Hi, Ive had quite a few 24 hr urine cortisol tests which came back showing my cortisol out of normal range (low). I myself find that thou I do have low cortisol, vit C makes me feel a little healthier (and I get less problems with allergies when Im regularlly taking it eg 3-4g daily). The low cortisol in my case dont seem to be relevent to my symptoms anyway as supplementation of it didnt improve my symptoms at all.

*Note.. not all who have ME/CFS do have low cortisol... I think one study found that 25% of women with CFS had low morning cortisol (my morning cortisol is fine.. its my complete 24hr level which is low so mine is low at other times).

From my own observations of the ME/CFS community.. some do have high cortisol esp I believe in those who havent had this illness long term. (the low cortisol may be coming in more the longer one has this illness).

 

[ukxmrv]

Tania,
I did a literature search for cortiol and CFS around the time that Simon Wessely published on the topic. The low cortisol or blunted cortisol response was the main one that I found then. Numbers of patients studied were low.

Although there was a theory about high cortisol changing to low in the course of the illness I've never been able to find any research to back this idea up. Individuals patients do report this finding on groups but I can't see this being reported in research.

Simon Wessely wasn't able to repeat the results of low or blunted cortisol which was the reason I looked at the earlier papers. This suggests that maybe his patients are different in some way or something.

In one of his papers on cortisol and CBT he reported that 29/82 had low morning cortisol and this small number may reflect that his patients may be different once again. To quote this figure as being an adequate sample for CFS may be controversial.

 

[Sallysblooms]

My cortisol is fine on all of the supplements. You can just get saliva tests to find out. Everyone is different.

 

[Rand56]

My cortisol is fine on all of the supplements. You can just get saliva tests to find out. Everyone is different.

Hi Sally

Yes I realize one could get a saliva test. My point was people with low baseline cortisol levels to begin with could possibly be lowering their cortisol levels even more from a particular dosage of a co-factor supplement that is known to lower cortisol. Then, they might mistake them feeling worse thinking that it might be a low potassium symptom.

 

[ukxmrv]

I think that the lowering of the already low cortisol was a factor in the change in the simplified methylisation protocol from p-serine to lethicin (or something similar).

I'm have a bad brain day today. Sorry to be vague.

As I already knew I had low cortisol this stood out for me when I first read it. Didn't assume that it was related to potassium but it's so hard when one has a bad reaction to a drug, supplement etc to know exactly why it is. Sometimes the "herx" reaction is attributed and in the past I've had bad reactions and told that over time they will get better as it is "just a herx". For me that nevers seems to happen so need to know as much as I can.