Depression

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

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. Secondary or reactive depression is common in many chronic illnesses as well as cancer, which may be an acute or chronic illness.

Presentation

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). In 2006, Hawk, Jason, and Torres-Harding found that symptom occurrence variables as identified in the Fukuda criteria only correctly classified 84.4% of cases when comparing patients with major depressive disorder and ME/CFS.

Hawk, Jason, and Torres-Harding defined several symptoms in which ME/CFS patients experience differently than major depressive disorder patients. When the researchers used the percentage of time fatigue was reported, post-exertional malaise (PEM) severity, unrefreshing sleep severity, confusion–disorientation severity, shortness of breath severity, and fewer self-reproach items (as scored on the Beck's Depression Inventory), they were able to report 100% correct classification between patients with depressive disorder versus ME/CFS.

LaFerney, a psychiatric clinical nurse specialist, outlined several ways in which depression in major depressive disorder and ME/CFS differ:

1) 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.

2) Depressed patients typically report a lack of interest in activities they previously found pleasurable. ME/CFS patients say they would engage in favorite activities more if their illness would allow it.

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. 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.

3) Although both patients report fatigue, only ME/CFS report PEM typically worsening 12 to 48 hours after an activity and lasting for days to weeks.

4) In depressed patients, the diminished ability to think or concentrate should improve with antidepressant therapy. In patients with ME/CFS, antidepressants often do not improve concentration or memory.

Dr. Sarah Myhill identified an additional difference between depression and CFS. Exercise makes CFS patients much worse but can be positively therapeutic in pure depression.

Prevalence

• Katrina Berne reports a prevalence of 65-90% for depression.

Symptom recognition

• In the Holmes criteria, depression is an optional criteria for diagnosis, under the section Minor Symptom Criteria - Neuropsychologic Complaints.

Notable studies

• 2006, Differential diagnosis of chronic fatigue syndrome and major depressive disorder (Full Text)
• 2008, A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression (Full Text)

Learn more

• 2008, Depression or chronic fatigue syndrome? by Michael C. Laferney
• 2014, How to Prove to Your Doctor You’ve Got Chronic Fatigue Syndrome (ME/CFS) And Are Not Just Depressed by Cort Johnson

• 2016, Chronic Fatigue Syndrome vs. Depression: One Doctor's View: Lack of Energy or Lack of Desire? by Adrienne Dellwo

See also

• Mood swings
• St. John’s Wort

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.