From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

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
  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