Depression: Difference between revisions

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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=|last2=|first2=|authorlink2=|date=|website=National Institute of Mental Health|archive-url=|archive-date=|url-status=|access-date=2021-03-24}}</ref>
'''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
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>
| last1  = Castro-Marrero   | first1 = Jesus                   | authorlink1 =  
| 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.                   | authorlink1 = | 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==
==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).  
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==
==Differences between depression and ME/CFS==
In 2006, Hawk, [[Leonard Jason |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.<ref name="Hawk, 2006">{{Citation
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:
| last1  = Hawk                  | first1 = C          | authorlink1 =  
*Significant [[post-exertional malaise]] (PEM) was found in ME/CFS patients<ref name="Laferney, 2008" />
| last2  = Jason                | first2 = L          | authorlink2 = Leonard Jason
::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>
| last3  = Torres-Harding        | first3 = S          | authorlink3 = Susan Torres-Harding| title   = Differential diagnosis of chronic fatigue syndrome and major depressive disorder
*[[fatigue]] lasts for a greater the percentage of the time in ME/CFS
| journal = International Journal of Behavioral Medicine  | volume = 13  | issue = 3 | page = 244-51| date   = 2006| pmid    = 17078775
*[[unrefreshing sleep]] severity is higher
| doi    = 10.1207/s15327558ijbm1303_8
*[[confusion|confusion–disorientation]] severity is higher
| url    = http://www.healthrising.org/wp-content/uploads/2014/04/Hawk.-Jason.-Differential-Diagnosis-of-Chronic-Fatigue-Syndrome-and-Major-Depressive-Disorder.pdf
*[[shortness of breath]] severity is higher
}}</ref>
*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" />  


Hawk, [[Leonard Jason |Jason]], and [[Susan Torres-Harding|Torres-Harding]] defined several symptoms in which ME/CFS patients experience differently than major depressive disorder patients:
LaFerney, a psychiatric clinical nurse specialist, adds:
*percentage of time [[fatigue]] was reported
*'''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" />
*[[post-exertional malaise]] (PEM) severity
*'''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" />
*[[unrefreshing sleep]] severity
*[[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" />
*[[confusion|confusion–disorientation]] severity
*'''[[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> 
*[[shortness of breath]] severity
Dr. [[Sarah Myhill]] adds an additional difference between depression and [[Chronic fatigue syndrome|CFS]]:
*and fewer self-reproach items (as scored on the Beck's Depression Inventory)<ref name="Hawk, 2006" />
*'''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>
Using this symptom list, Hawk, [[Leonard Jason, and Torres-Harding were able to report 100% correct classification between patients with depressive disorder versus ME/CFS.<ref name="Hawk, 2006" />  
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"/>


LaFerney, a psychiatric clinical nurse specialist, outlined several differences between depression in major depressive disorder and ME/CFS:<ref name="Laferney, 2008" />
===If I was cured tomorrow...===
*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" />
{{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}}
*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.<ref name="Laferney, 2008" />
*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.<ref>http://www.forgottenplague.com/upload-your-dream/</ref>
*Although both groups of patients report fatigue, only [[ME/CFS]] report [[post-exertional malaise]]: with symptoms typically worsening 12 to 48 hours after an activity and lasting for days to weeks.<ref name="Laferney, 2008" />
*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.          | authorlink1 = | 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]] identified an additional difference between depression and [[Chronic fatigue syndrome|CFS]]:
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>
*[[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 |author-link =Sarah Myhill |website =Dr Myhill|access-date=2021-03-24}}</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==
==Prevalence==
*[[Katrina Berne]] reports a prevalence of 65-90% for depression.<ref>{{citation |last= Berne |first= Katrina |date= 1 Dec 1995 |title= Running on Empty: The Complete Guide to Chronic Fatigue Syndrome (CFIDS), 2nd ed. |url= https://www.amazon.co.uk/Running-Empty-Complete-Chronic-Syndrome/dp/0897931912/ |publisher= Hunter House |page= 60 |isbn= 978-0897931915}}</ref>
*[[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==
==Symptom recognition==
*In the [[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]].
*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==
==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)]
*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.           | authorlink1 =
*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)]
| 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==
==Possible causes==
Depression in ME/CFS patients may be caused by:
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'''  
* 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'''  
* 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
* 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 https://me-pedia.org/wiki/Depression?veaction=edit<nowiki/>depression) but cause depression or worsen depression in people without bipolar disorder.  
* 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==
==Potential treatments==
* [[Antidepressant]]
* [[Antidepressant]]s
* Cognitive behavioural therapy for depression (CBT)
* Cognitive behavioral therapy for depression (CBT)
* [[Mindfulness and meditation|Mindfulness and Meditation]]
* [[Mindfulness and meditation|Mindfulness and Meditation]]


Line 74: Line 67:
* 2008, [http://www.mdedge.com/currentpsychiatry/article/62979/depression-or-chronic-fatigue-syndrome Depression or chronic fatigue syndrome? by Michael C. Laferney]
* 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]]
* 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]]
*2016, [https://www.verywell.com/chronic-fatigue-syndrome-vs-depression-one-doctors-view-3972997 Chronic Fatigue Syndrome vs. Depression: One Doctor's View: Lack of Energy or Lack of Desire?] by [[Adrienne Dellwo]]


==See also==
==See also==
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*[[Fibromyalgia#depression|Depression in fibromyalgia]]
*[[Fibromyalgia#depression|Depression in fibromyalgia]]
==References==
==References==
<references />
{{Reflist}}


[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
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[[Category:Potential comorbidities]]
[[Category:Potential comorbidities]]
[[Category:Mental disorders]]
[[Category:Mental disorders]]
[[Category:Long COVID signs and symptoms]]

Latest revision as of 13:42, July 25, 2023

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.[1]

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.[2] Secondary or reactive depression is common in many chronic illnesses as well as cancer, which may be an acute or chronic illness.[3]

Misdiagnosis of ME/CFS[edit | edit source]

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[edit | edit source]

Hawk, Jason, and Torres-Harding defined a number of key symptoms that were worse or different in ME/CFS compared to clinical depression without ME/CFS:

PEM is now a required diagnostic criteria for ME/CFS in most countries[5][6]

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.[7]

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.[4]
  • 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.[4]
  • 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.[4]
  • Antidepressants don't help in ME/CFS: In depressed patients, the 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.[4]

Dr. Sarah Myhill adds an additional difference between depression and CFS:

  • Response to exercise: Exercise makes CFS patients much worse, but can be positively therapeutic in pure depression[8][9][6][5]

Clinical trials and patient evidence have both shown that:

If I was cured tomorrow...[edit | edit source]

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.

—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.[12]

Fukuda criteria[edit | edit source]

In 2006, Hawk, Jason, and Torres-Harding found that the CDC's 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.[7]

Prevalence[edit | edit source]

Symptom recognition[edit | edit source]

Depression is also a potential symptom of Long COVID in the World Health Organization's definition.[16]

Notable studies[edit | edit source]

  • 2006, Differential diagnosis of chronic fatigue syndrome and major depressive disorder[7] (Full Text)
  • 2008, A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression[17] (Full Text)

Possible causes[edit | edit source]

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[11]
  • Someone with ME/CFS may have depression unrelated to their ME/CFS symptoms, known as primary depression[11]
  • 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[11]
  • 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[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. "Depression". National Institute of Mental Health. Retrieved March 24, 2021.
  2. Castro-Marrero, Jesus; Sáez-Francàs, Naia; Santillo, Dafna; Alegre, Jose (2017), "Treatment and management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: all roads lead to Rome", British Journal of Pharmacology, doi:10.1111/bph.13702
  3. DeJean, D.; Giacomini, M.; Vanstone, M.; Brundisini, F. (2013), "Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis" (PDF), Ontario Health Technology Assessment Series, 13 (16): 1-33
  4. 4.0 4.1 4.2 4.3 4.4 Laferney, Michael C. (2008), "Depression or chronic fatigue syndrome?" (PDF), Current Psychiatry, 7 (1): 91-94
  5. 5.0 5.1 "Symptoms | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. January 27, 2021. Retrieved February 25, 2021.
  6. 6.0 6.1 NICE Guideline Development Group (October 29, 2021). "Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline". National Institute for Health and Care Excellence.
  7. 7.0 7.1 7.2 7.3 Hawk, C; Jason, L; Torres-Harding, S (2006), "Differential diagnosis of chronic fatigue syndrome and major depressive disorder" (PDF), International Journal of Behavioral Medicine, 13 (3): 244-51, doi:10.1207/s15327558ijbm1303_8, PMID 17078775
  8. Myhill, Sarah. "CFS or Depression: What are the differences?". Dr Myhill. Retrieved March 24, 2021.
  9. 9.0 9.1 Oxford Clinical Allied Technology and Trials Services Unit (OxCATTS) (February 27, 2019). "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" (PDF). Oxford Brookes University.
  10. Smith ME, Nelson HD, Haney E, Pappas M, Daeges M, Wasson N, McDonagh M (December 2014). "Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome No. 219". Evidence Report/Technology Assessment. Agency for Healthcare Research and Quality (US): 1–433. doi:10.23970/AHRQEPCERTA219. PMID 30313001.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  12. http://www.forgottenplague.com/upload-your-dream/
  13. Berne, Katrina (December 1, 1995), Running on Empty: The Complete Guide to Chronic Fatigue Syndrome (CFIDS) (2nd ed.), Hunter House, p. 60, ISBN 978-0897931915
  14. The 1988 Holmes Definition for CFS
  15. 15.0 15.1 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7–115, doi:10.1300/J092v11n01_02
  16. Soriano, Joan B.; Allan, Maya; Alsokhn, Carine; Alwan, Nisreen A.; Askie, Lisa; Davis, Hannah E.; Diaz, Janet V.; Dua, Tarun; de Groote, Wouter; Jakob, Robert; Lado, Marta; Marshall, John; Murthy, Srin; Preller, Jacobus; Relan, Pryanka; Schiess, Nicoline; Seahwag, Archana (October 6, 2021), A clinical case definition of post COVID-19 condition by a Delphi consensus, World Health Organization (WHO) clinical case definition working group on post COVID-19 condition, World Health Organization
  17. Griffith, J.P.; Zarrouf, F.A. (2008), "A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression", Primary Care Companion to The Journal of Clinical Psychiatry, 10 (2): 120–128, doi:10.4088/pcc.v10n0206, PMC 2292451, PMID 18458765