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'''Depression''' or '''low mood''' and the more severe '''major depressive disorder''' ('''clinical depression''') are common but potentially serious mood disorders. Depression causes severe symptoms that affect how someone feels, thinks, and handles daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.<ref name="nimh">{{Cite web | url = https://www.nimh.nih.gov/health/topics/depression/index.shtml | title = Depression | last = | first = | authorlink = | date = | website = National Institute of Mental Health| archive-url = | archive-date = |url-status = | access-date=2021-03-24}}</ref> Depression as expressed in patients with [[ME/CFS]] is generally considered as secondary depression or reactive depression due to the debilitating effects of ME/CFS.<ref name="Castro-Marrero, 2017">{{Citation | last = Castro-Marrero | first1 = Jesus | author-link1 = | last2 = Sáez-Francàs | first2 = Naia | authorlink2 = | last3 = Santillo | first3 = Dafna | authorlink3 = | last4 =Alegre | first4 = Jose | authorlink4 = | title = Treatment and management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: all roads lead to Rome | journal = British Journal of Pharmacology | volume = | issue = | page = | date = 2017 | pmid = | doi = 10.1111/bph.13702}}</ref> Secondary or reactive depression is common in many chronic illnesses as well as [[cancer]], which may be an acute or chronic illness.<ref name="DeJean, 2013">{{Citation | last1 = DeJean | first1 =D. | author-link1 = | last2 = Giacomini | first2 = M. | authorlink2 = | last3 = Vanstone | first3 = M. | authorlink3 = | last4 = Brundisini | first4 = F. | authorlink4 = | title = Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis| journal = Ontario Health Technology Assessment Series | volume = 13 | issue = 16 | page = 1-33 | date = 2013 | url = http://www.hqontario.ca/Portals/0/Documents/evidence/reports/full-report-qualitative-patients-experience-depression-anxiety-cd-130906-en.pdf}}</ref> ==Misdiagnosis of ME/CFS== ME/CFS is often misdiagnosed as depression, as many symptoms can overlap. Older case definitions, such as the [[Fukuda criteria]] and the [[Holmes criteria]] do not differentiate enough between the symptomatic criteria of depression and [[chronic fatigue syndrome]] (CFS). ==Differences between depression and ME/CFS== Hawk, [[Leonard Jason |Jason]], and [[Susan Torres-Harding|Torres-Harding]] defined a number of key symptoms that were worse or different in ME/CFS compared to clinical depression without ME/CFS: *Significant [[post-exertional malaise]] (PEM) was found in ME/CFS patients<ref name="Laferney, 2008" /> ::PEM is now a required [[:Category:Definitions|diagnostic criteria for ME/CFS]] in most countries<ref name="CDCsymptoms" /><ref name="ng206">{{Cite web | url = https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group|first = | authorlink = | publisher = [[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> *[[fatigue]] lasts for a greater the percentage of the time in ME/CFS *[[unrefreshing sleep]] severity is higher *[[confusion|confusion–disorientation]] severity is higher *[[shortness of breath]] severity is higher *ME/CFS patients have less self-reproach (as scored on the [[Beck Depression Inventory]])<ref name="Hawk, 2006" /> Using the symptoms above list, Hawk, Jason, and Torres-Harding were able to report 100% correct classification between patients with major depressive disorder versus ME/CFS.<ref name="Hawk, 2006" /> LaFerney, a psychiatric clinical nurse specialist, adds: *'''Reason for depression:''' Individuals with major depressive disorder often cannot provide a reason or identify a loss to explain their depressed mood. ME/CFS patients are more likely to report feeling discouraged and depressed because of the inability to perform tasks, be employed, or engage in social functions due to ME/CFS symptoms.<ref name="Laferney, 2008" /> *'''No lack of interest in activities''': Depressed patients typically report a lack of interest in activities they previously enjoyed. ME/CFS patients say they would engage in favorite activities more if their illness would allow it.<ref name="Laferney, 2008" /> *[[Post-exertional malaise]]: Although both depressed and ME/CFS patients report fatigue, only [[ME/CFS]] report post-exertional malaise: with physical symptoms typically worsening 12 to 48 hours after an activity and lasting for days to weeks.<ref name="Laferney, 2008" /> *'''[[Antidepressant]]s don't help in ME/CFS:''' In depressed patients, the [[Cognitive dysfunction|diminished ability to think or concentrate]] should improve with [[antidepressant]] drugs or therapies. In patients with ME/CFS, antidepressants often do not improve concentration or memory.<ref name="Laferney, 2008">{{Citation | last1 = Laferney | first1 = Michael C. | author-link1 = | title = Depression or chronic fatigue syndrome?| journal = Current Psychiatry | volume = 7 | issue = 1 | page = 91-94 | date = 2008| url = https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/0701CP_Pearls1.pdf}}</ref> Dr. [[Sarah Myhill]] adds an additional difference between depression and [[Chronic fatigue syndrome|CFS]]: *'''Response to [[exercise]]''': Exercise makes CFS patients much worse, but can be positively therapeutic in pure depression<ref>{{Cite web | url = http://drmyhill.co.uk/wiki/CFS_or_depression_-_what_are_the_differences| title = CFS or Depression: What are the differences? | last = Myhill | first =Sarah | authorlink = Sarah Myhill |website =Dr Myhill|access-date=2021-03-24}}</ref><ref name="OxfordBrookesSurvey">{{Cite web | url = https://www.meassociation.org.uk/wp-content/uploads/NICE-Patient-Survey-Outcomes-CBT-and-GET-Final-Consolidated-Report-03.04.19.pdf | title =Evaluation of a survey exploring the experiences of adults and children with ME/CFS who have participated in CBT and GET interventional programmes. FINAL REPORT | last = Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS)|location=Oxford Brookes University | date = Feb 27, 2019}}</ref><ref name="ng206">{{Cite web | url = https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group|first = | authorlink = | publisher = [[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref><ref name="CDCsymptoms">{{Cite web | url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]] | date = Jan 27, 2021|access-date = 2021-02-25}}</ref> Clinical trials and patient evidence have both shown that: *[[Cognitive behavioral therapy]] aimed at ME/CFS symptoms is ineffective and often harmful, and can harm mental health,<ref name="OxfordBrookesSurvey" /><ref name=Smith2016>{{cite journal| vauthors = Smith ME, Nelson HD, Haney E, Pappas M, Daeges M, Wasson N, McDonagh M | title = Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome No. 219| journal = Evidence Report/Technology Assessment | pages = 1–433 | date = Dec 2014 |pmid =30313001 | doi = 10.23970/AHRQEPCERTA219 |url = https://www.ncbi.nlm.nih.gov/books/NBK379582/ | publisher = Agency for Healthcare Research and Quality (US) | doi-access = free }}</ref> but is an effective evidence-based treatment for depression *'''most ME/CFS patients do not have depression''', although in common with other chronic illness a significant number of patients develop [[depression#reactive_depression|reactive or secondary depression]]<ref name="ICC2011primer"/> * Many [[abnormal findings in ME/CFS|physically abnormal findings]] that are not present in depression, but many of these findings are not from the standard diagnostic tests and no single finding can yet act as a [[diagnostic biomarker]] for ME/CFS. Physical abnormalities in ME/CFS indicate immune, neurological, energy transportation, and other findings that cannot be explained by depression, [[medically unexplained physical symptoms|somatization]], [[deconditioning]], [[health anxiety]], or other psychological or behavioral factors<ref name="ICC2011primer"/> ===If I was cured tomorrow...=== {{Cquote|text=One question that can differentiate the two groups is to ask the patient, "If you were cured tomorrow, what would you do?" Depressed patients typically can not answer the question without forethought. ME/CFS patients typically can list an abundance of activities without prompt. | author = Michael LaFerney}} The [[Forgotten Plague]] Facebook page had a "If I was cured tomorrow..." campaign encouraging ME/CFS patients to upload their dreams to highlight this difference from depression.<ref>http://www.forgottenplague.com/upload-your-dream/</ref> ===Fukuda criteria === In 2006, Hawk, [[Leonard Jason |Jason]], and Torres-Harding found that the CDC's [[Fukuda criteria|Fukuda ME/CFS criteria]], which is now retired from use, only correctly classified 84.4% of patients when comparing patients with major depressive disorder and to patients with ME/CFS.<ref name="Hawk, 2006">{{Citation | last = Hawk | first1 = C | author-link1 = | last2 = Jason | first2 = L | authorlink2 = Leonard Jason | last3 = Torres-Harding | first3 = S | authorlink3 = Susan Torres-Harding| title = Differential diagnosis of chronic fatigue syndrome and major depressive disorder | journal = International Journal of Behavioral Medicine | volume = 13 | issue = 3 | page = 244-51 | date = 2006 | pmid = 17078775 | doi = 10.1207/s15327558ijbm1303_8 | url = http://www.healthrising.org/wp-content/uploads/2014/04/Hawk.-Jason.-Differential-Diagnosis-of-Chronic-Fatigue-Syndrome-and-Major-Depressive-Disorder.pdf}}</ref> ==Prevalence== *[[Katrina Berne]] reports a prevalence of 65-90% for depression.<ref>{{citation | last = Berne | first = Katrina | date = Dec 1, 1995 | title = Running on Empty: The Complete Guide to Chronic Fatigue Syndrome (CFIDS)|edition= 2nd |url= https://www.amazon.co.uk/Running-Empty-Complete-Chronic-Syndrome/dp/0897931912/ | publisher = Hunter House | page = 60 |isbn= 978-0897931915}}</ref> ==Symptom recognition== *In the 1988 [[Holmes criteria]], depression is an optional criteria for diagnosis, under the section ''Minor Symptom Criteria - Neuropsychologic Complaints''.<ref>[http://www.cfids-me.org/holmes1988.html The 1988 Holmes Definition for CFS]</ref> It is not a diagnosable symptom in the current [[Systemic Exertion Intolerance Disease|CDC criteria]], the [[Fukuda criteria]], the [[Canadian Consensus Criteria]] or the [[International Consensus Criteria]] although secondary depression is recognized as a possible symptom and comorbidity of ME/CFS in the International Consensus Criteria.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | author-link5 = Gordon Broderick | last6 = Mitchell | first6 = T | author-link6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = Donald Staines | last8 = Powles | first8 = ACP | author-link8 = A C Peter Powles | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 = N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012 | isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="canadianconsensus-CCC">{{Citation | last = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 =Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref><ref name="canadianconsensus-CCC">{{Citation | last = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 =Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | author-link5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | author-link6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | author-link8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf }}</ref> Depression is also a potential symptom of [[Long COVID]] in the [[World Health Organization Long COVID diagnostic criteria|World Health Organization]]'s definition.<ref name="WHO-longcovid-criteria">{{citation | title = A clinical case definition of post COVID-19 condition by a Delphi consensus | date =Oct 6, 2021 | publisher = [[World Health Organization]] | others = World Health Organization (WHO) clinical case definition working group on post COVID-19 condition | first1 = Joan B. | last1 = Soriano | first2 = Maya | last2 = Allan | first3 = Carine | last3 = Alsokhn | first4 = Nisreen A. | last4 = Alwan | authorlink4 = Nisreen Alwan | first5 = Lisa | last5 = Askie | first6 = Hannah E. | last6 = Davis | author-link6 = Hannah Davis | first7 = Janet V. | last7 = Diaz | first8 = Tarun | last8 = Dua | first9 = Wouter | last9 = de Groote | first10 = Robert | last10 = Jakob | first11 = Marta | last11 = Lado | first12 = John | last12 = Marshall | first13 = Srin | last13 = Murthy | first14 = Jacobus | last14 = Preller | first15 = Pryanka | last15 = Relan | first16 = Nicoline | last16 = Schiess | first17 = Archana | last17 = Seahwag | ref = WHO reference number: WHO/2019-nCoV/Post_COVID-19_condition/Clinical_case_definition/2021.1 | url = https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1}}</ref> ==Notable studies== *2006, Differential diagnosis of chronic fatigue syndrome and major depressive disorder<ref name="Hawk, 2006" /> [http://www.healthrising.org/wp-content/uploads/2014/04/Hawk.-Jason.-Differential-Diagnosis-of-Chronic-Fatigue-Syndrome-and-Major-Depressive-Disorder.pdf (Full Text)] *2008, A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression<ref name="Griffith, 2008">{{Citation | last1 = Griffith | first1 = J.P. | author-link1 = | last2 = Zarrouf | first2 = F.A. | authorlink2 = | title = A Systematic Review of Chronic Fatigue Syndrome: Don’t Assume It’s Depression| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292451/| pmc =2292451| journal = Primary Care Companion to The Journal of Clinical Psychiatry | volume = 10 | issue = 2 | page = 120–128| date = 2008 | pmid = 18458765 | doi = 10.4088/pcc.v10n0206 }}</ref> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292451/ (Full Text)] ==Possible causes== Depression in ME/CFS patients may be caused by: * The impact of living with a poorly understood chronic illness, known as '''reactive depression''' or '''secondary depression'''<ref name="ICC2011primer" /> * Someone with ME/CFS may have depression unrelated to their ME/CFS symptoms, known as '''primary depression'''<ref name="ICC2011primer" /> * People with ME/CFS typical lose the natural benefit of [[exercise]], which means a person who previously used exercise to improve their mood is no longer able to do this<ref name="ICC2011primer" /> * Depression is a potential side effect of some drugs, particularly a class of drugs known as mood stabilizers, which are used for bipolar depression (manic depression) but cause depression or worsen depression in people without bipolar disorder. ==Potential treatments== * [[Antidepressant]]s * Cognitive behavioral therapy for depression (CBT) * [[Mindfulness and meditation|Mindfulness and Meditation]] ==Learn more== * 2008, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292451/ A Systematic Review of Chronic Fatigue Syndrome: Don’t Assume It’s Depression] * 2008, [http://www.mdedge.com/currentpsychiatry/article/62979/depression-or-chronic-fatigue-syndrome Depression or chronic fatigue syndrome? by Michael C. Laferney] * 2014, [http://www.healthrising.org/blog/2014/04/26/prove-doctor-youve-got-chronic-fatigue-syndrome-mecfs-just-depressed/ How to Prove to Your Doctor You’ve Got Chronic Fatigue Syndrome (ME/CFS) And Are Not Just Depressed] by [[Cort Johnson]] ==See also== *[[Mood swings]] *[[St. John’s Wort]] *[[Anxiety]] *[[Fibromyalgia#depression|Depression in fibromyalgia]] ==References== {{Reflist}} [[Category:Signs and symptoms]] [[Category:Psychological signs and symptoms]] [[Category:Diagnoses]] [[Category:Potential comorbidities]] [[Category:Mental disorders]] [[Category:Long COVID signs and symptoms]]
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