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Depression
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==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>
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