Chronic Fatigue Syndrome vs. Depression: One Doctor's View

This point has been discussed a number of times over the last several years. It takes less than five minutes for a doctor to tell the difference between depression and CFS. People with CFS, or as I prefer ME, want to do everything but can’t. People with depression could probably do a lot but don’t want to. Of course some with ME will be depressed at any one time, so sometimes its a little complicated.

Anhedonia is the difference between Depression and ME/CFS. It’s the clinical term for not having interest in anything.

Any doctor who can’t tell the difference between someone unable to do something and who has no interest in things needs their licensed checked.

All you are saying is that depression is different from CFS. I agree. But I do believe this illness has an emotional cause. Of course, symptoms also cause sadness, frustration, depression and more, but it is certainly my experience (and of many others) that the symptoms of CFS go together with anxiety and/or fear (and there are a lot of other emotions buried underneath, too). So, it is the emotions that “cause” symptoms, and the solution therefore, is to deal with the emotions underlying the symptoms.
Even if I’m wrong, it won’t hurt anyone to deal with the stress related to their illness and heal their life’s major traumas using simple tecniques like EFT and TAT. That can take a lot of the burden off and also alleviate or even do away with the symptoms. That’s my experience and it may not apply to everyone. Find out and see for yourself.

I agree with what this doctor said. I have been sick with Myalgic Encephalomyelitis (M.E.) for 25 years. It has not been easy, but I have continued to have an interest in my family, my environment, and progress toward treatment for the illness. Like many other people, I know people who are depressed; they share none of my interest in getting our lives back.

I disagree with an earlier commenter who said: “Even if I’m wrong, it won’t hurt anyone to deal with the stress related to their illness and heal their life’s major traumas using simple tecniques like EFT and TAT. ”

Although it does not hurt to deal with stress and heal life traumas, by whatever means they choose which might or might not include simple techniques like EFT and TAT, those techniques, which I have personally tried, did absolutely NOTHING to help the physical illness from which I suffer. The harm is in giving doctors, especially psychiatrists, and other health professionals, the impression that these techniques are all we need. Would anyone dare to suggest such an idea to cancer or AIDS patients? The illness from which I suffer is just as real and just as devastating as cancer and AIDS. M.E. kills people, and I have seen them die from it. I have seen my life destroyed by M.E. People who push meditation, yoga, stress relief techniques and techniques such as EFT and TAT and Lightning Process are DANGEROUS to M.E. patients because they convince medical professionals and researchers and those who fund research that we need nothing more. This gives them an easy reason to deny the funding for research which is desperately needed for this all-too-real physical illness which is destroying so many lives and costing an enormous amount of money.

This perception needs to be changed and it needs to be changed NOW. We do not need more stress relief–not any more than cancer or AIDS patients need it. What we really need is treatment and cure, and that requires more research money.

If you became ill from anxiety, and have been “cured” via the lightning process, eft, etc. etc. then in all likelihood you never had CFS. CFS is characterized by severe immune dysfunction, resulting in chronic viral and bacterial infections, low-grade fever, enlarged lymph nodes, and abnormal natural killer cell function. There are plenty of biomarkers available to diagnose CFS, if anyone bothers to look. It is outrageous that those who are depressed or have other psychiatric illnesses are being tossed into the CFS patient cohort, and are skewing study results. No treatment for true CFS will ever be found if this continues, and maybe that’s the point.

I have had ME for 4 years, though I did not know it for the first 6 months or so. There have been times during those 4 years when I have felt depressed about what I have lost, depressed about I cannot do and depressed about the treatment of this disease by many professionals and especially the UK medical establishment

However 90% of the time, despite my persistent pain, illness, brain fog and complete exhaustion I am far from depressed. I have a young family that I love to play with, a loving wife that I love spending time with and sharing those activities I can still manage. I enjoy my work on the odd days i am able to do it effectively and so many more things.

Most critically of all, I was in no way depressed before I got this disease, nor for the first 6 months to a year while I believed it was just a short term thing. If this condition is caused by depression or even is depression, how can one account for the illness I suffered for those first 6 months?

As has been stated previously the differences between depression and ME are well known and well documented for anyone who chooses to look. The differences are not just subjective measures such as self-rated anhedonia, they also include a number of clear biological differences.

Even the psychiatrists who wield so much influence in the higher echelons of the UK medical establishment are not foolish enough to suggest we are depressed, instead they have invented a purely hypothetical condition whereby we “choose” to propagate our own illness through “false illness beliefs”.

If those with most to gain from claiming we are depressed, such as psychiatrists seeking funding, insurance companies looking to reduce their liability and governments seeking to reduce their benefit bill still don’t claim we are depressed it should not be too hard for anyone to believe.

Thanks so much brilliantly written, I don’t think I have ever felt depessed, just grumpy LOL very grumpy and upset I have had to ask for help all the time even after 19 years of complete constant pain, fatigue, life being nothing like it was. good way actually of describing my life, nothing…unlike the previous brilliant comments I can’t get my head around writing .
ps being older, I have barelyany friends left , they all having died from older age related illnesses. so I am very happy in spite of IT being still alive..

The 2 are not the same. I’ve had both. Depression is an illness in itself, and has biological components (chemical imbalances). So does Fibro and CFS. I cannot cure myself. I have tried almost everything under the sun to get better. My depression is being treated, thankfully, but I am still not functioning like I used to or like I should be. I want my life back, I want to do things. I am simply unable. It has nothing to do with handling stress or emotions better. CFS and fibro is physically crippling.

Excellent post! Very true.

I encourage Doc forthepeople to speak out further publically under her real name. We desperately need doctors and scientists to stand up for us and the truth in public!

How about finally changing the name of this section to “ME” or at the very very least “CFS.” Naming this website “chronicfatigue.about.com” and calling ME “chronic fatigue” as you do just adds to the confusion with depression and Idiopathic Chronic Fatigue. I have asked this of you several times over the years. Take some responsibility for your own actions.

excellent post…wholeheartedly agree.

Just went with my daughter to doc b/c she started having joint pain and inflammation after a course of antibiotics for tonsilitis. Guess what they offered, pain management and cymbalta! Hello! The abx brought out an underlying infection like lyme. Six month wait for a rheumy. To think my daughter now has to go through what I’ve been dealing with for 17 years make me sick. I will be taking her to see Dr. Enlander the first change we get!

I have had ME for nearly 47 years. The majority of that time has been spent battling against it, because of all the things I want to do. The only time I have not been interested in trying, was when I finally, finally, gave in to years of badgering & let the Drs prescribe anti-depressants. I was truly not myself whilst on these drugs, I didn’t feel things as I usually would have – like true compassion when others were going through devastating times. I have now taken myself off all drugs, barring asthma inhalers which I do seem to need in order to keep breathing At least I am wanting to do things again, if even if still can’t put my plans into action.

I have ME, the only emotional part of this illness is my sadness at times at not being able to participate in normal activities. It is clear from most patients history that they don’t suffer from clinical depression that is a totally different illness. My best friend suffers from depression and wishes she had my positive outlook on life despite my being able to little physically. Until the medical profession are able to distinguish truly depressed patients from ME patients, claims will continue to be made for the success of treatments like CBT, pacing and things like the Lightening Process, these will not cure an illness that brings symptoms like vertigo, dizziness, light and sound sensitivities, an inablity to perform simple daily tasks never mind exercise which will inevitably bring on post exertion symptoms,just as they wouldn’t cure MS, HIV heart failure, diabetes etc . Until that time we will not get the right diagnosis never mind treatment or the possibility of a cure.

I had a very successful career before I got ME at age 34. I am married to a wonderful husband. Being married to him makes me feel like I won the lottery. We have a 1. 5 year old daughter who is extremely cute and engaging. During the pregnancy and for a few months after that, my ME symptoms were gone (as is typical and points to an auto-immune component in ME). I took my daughter on walks for miles every day. I took her on play dates, to the park, to the store, to visit friends, etc., until ME returned. It’s now worse than ever. I had no reason to get depressed–not when I first got sick and again not after our daughter was born. In fact, during the postpartum period, when many new mothers struggle with postpartum depression, I was on cloud 9, extremely grateful to have a healthy daughter and to have beaten ME or so I thought.

Even though my life is very, very narrow due to ME, I am not depressed. I count my blessings every day, several times a day. We are financially secure. My husband has a lot of flexibility with his job and he takes great care of me and our daughter. If I wasn’t ill, we would be traveling the world. We passed on an all-paid for business class trip to China this year because I am too sick. I have family and friends in Europe whom we would love to visit. I would love to take photography and other classes. I would love to write and go to the gym every day, like I used to. I would love to take our daughter to the beach or to swimming classes or on play dates. I would love to have a second career, maybe get another degree. These are the things I dream of and if I was healthy, the sky would be the limit for us. Things in my life couldn’t be better if it wasn’t for ME. Depression does not fit this picture at all.

Lehari,

I wonder where you got your insights. Are you are clinician or a researcher who has treated ME patients? If so, how many patients have you cured of their ME symptoms by addressing their emotional issues and how many of those actually had ME instead of major depressive disorder? If not, what on earth could have caused you to just make stuff up? How does it serve you and your emotional needs to spout off unfounded and plain wrong theories? Science has proven you wrong time and time again, so what’s in it for you, emotionally, to ignore that?

Have you once considered how damaging the regurgitation of the psychological-cause theory is to a severely ill patient population? If not, maybe you want to read Patricia Carter’s comment above carefully.

I agree with all of the above comments except Lehari. And I agree with the distinction between depression and ME/CFS, having experienced both. Depressed-don’t want to do anything. ME/CFS=want to do everything I used to do and more, but can’t. Sometimes one can have both due to discouragement about treatment, cure, length of illness, etc. (high suicide rate relative to “normals” amongst ME/CFS) but each is distinctly different. And agree that physicians who know anything about either malady will know the difference, or should not be practicing.

Hi Jeanette,

When you are pregnant you have high doses of progesterone in your body, many think this accounts for the ‘wellness’ many women have when pregnant. The progesterone is stored in the placenta and again its thought that the loss of this store with the loss of placenta can throw some women into the baby blues.
I know you are not depressed but it might be worth checking your progesterone levels, and the implications for your ME.

I asked Dr Mikovits recently about my use of bio-identical progesterone cream and she said its all about balance, she had heard of anecdotal stories of women doing well on it as part of their treatment.

Also there is a good book by a Dr Lee (now deceased) who prescribed the bio-identical cream in his practice for over 30 years. Helen

Helen said: “When you are pregnant you have high doses of progesterone in your body, many think this accounts for the ‘wellness’ many women have when pregnant.”
********
Helen: That’s exactly right. It’s also well known that autoimmune diseases like rheumatoid arthritis and multiple sclerosis often go into remission during pregnancy, when our body produces high levels of progesterone. These autoimmune illnesses re-activate after child-birth and progesterone levels drop.

Low progesterone levels are also implicated in allergies, anxiety, brain fog, epilepsy, insomnia, migraine and pain. Also interesting is that progesterone increases dopamine neuron numbers. Dopamine can act like a brake, when it comes to suppressing the immune response. Estrogen dominance on the other hand stimulates immune response.

I think that the comment by Lehari is actually a perfect example of why this blog post is important. They clearly do not understand the disorders that we are dealing with. From an outsider’s standpoint, I am quite sure that it is very hard for them to understand, therefore we need to remember to stand strong, not angry, in the face of these comments.
I myself was quite offended by the comment, however in reading all of the rest I am again validated that I am not in fact crazy, that it makes real sense how great I feel emotionally when I have a rare moment not in pain, and how often I feel like I’m looking out the window at bad weather, desperate to play.

Lehari, I think you need to really step back and try to understand the issue here. It is very much not what it seems. You have to keep in mind the point that you are missing. It is not that it is being said that depression does not occur in patients with ME/CFS/FMS, it is that the real, biological causes and effects of these illnesses are not the focus of so many treatment plans. You would be surprised how much all of us with these illnesses have invested into the emotional side of things, only to find out that there is in fact major non-emotional mechanisms at work. Had it been only an emotionally based issue, I (and probably most here) would have been ‘fixed’ a long time ago, trust me.
Further, you may not know the length of time, the month, and the energy that each one of us spends in seeking treatments.
If you search this blog for ‘depression’, you will find so much wonderful insight as to clear published, peer-reviewed clinical findings and expert guidances that validate what Adrienne nicely lays out for us in this blog.

I have had two serious clinical depressions, one when my Father died and another when my marriage ended, so I know just what depression feels like — down, black, alone, helpless, suicidal.

I have had ME and Fibromyalgia since 1990 and I have never felt that way — I desperately wanted to fight back, to find a path through what was wrong with me, to get back to the business of living.

Twenty-two years later, at the age of 77, I seem to have hit a plateau where I can have a little bit of a life and I am very grateful for this. And I although I have been depressed since the onset of these syndromes it has never reached the level of a clinical depression.

But depression is such an easy way to blame the victim and this stops further further exploration of these syndromes which might ease and assist those who suffer so.

I have fibro, osteoarthritis, sleep apnea, restless legs syndrome/Willis-Ekbom Disease, periodic limb movements, and chronic major depression, along with a laundry list of other medical disorders. I know the difference between depression and all the other conditions. I also know that several of these conditions can cause depression and have caused it for me. Chronic illness of any kind can cause depression. My children have a very rare disorder, primary ciliary dyskinesia, and they both struggle with cycles of depression. It’s our responsibility to educate our doctors about the differences between the symptoms of fibro/ME/CFS and depression. I’ve fired three doctors (after all, I’m paying them) who said I was just depressed and if I would just try harder, the depression would go away as would many of my other symptoms. I wish each of them a long episode of chronic major depression.

Untreated depression is, in my opinion, a far worse disease to suffer with than untreated ME. But I, and many other patients, would gladly have our ME turn out to be depression because there are effective treatments for depression!

When I first got ill with ME, I had at the same time a recurrence of the major depression I’ve suffered from most of my life. I went to the GP, told him my depression was back, got my meds changed, did counselling, and after a few months the depression was back in remission.

My depression was gone, but the fatigue and other physical symptoms had only gotten worse. That’s when I was diagnosed with ME.

While depression may result from CFS in some cases, myself and anyone I know with CFS are always wanting to be able to do more, hoping to improve, wishing they could participate in more activities. While addressing emotional issues may help, getting hormonal balance as Rachel says above. Progesterone (not artificially taken) restored naturally will also help to combat high estrogen levels and have a positive affect on many other hormones that help with balancing and healing from the inside.

@happyMECFS, If you think untreated Depression is far worse of a disease to suffer than CFS. YOU MUST NOT HAVE CFS. True there is no real treatment for CFS which is a problem. Im 18, and have been disabled for 3 years due to CFS and Fibromyalgia. Unable to play the sports I love. Or graduate with my class. Depression is a completly different disease than CFS. In order to properally meet the requirements of CFS you cannot previously suffered from depression. Meaning you have the wrong diagnosis @HappyMECFS.

Maybe if these doctors took some time to research the actual possible causes of CFS, we would have TREATMENT. Instead they do nothing. Yet im stuck living my teenagers years disabled, sick, exaughsted, and in chronic pain. THANKS DOCTORS! -_-

When I became pregnant in 1990 I was in an experimental program for EBV and they had put me on the drug interferon which was a horrible medication. I was told that my pregnancy would help me to produce more of my own interferons and that there was a good chance I would go into remission. I was really fortunate because I did go into remission for a couple years. It seemed every time I did go thu an extremely tramatic event in my life is when my disease would come back, each time I would get sick it would be worse every time. I don’t know what they ever found out about the interferon and if it did help us because I had to go off while I was pregnant. I would love to know if the progesterone is something that would help with some of these symptoms. I am so tired of the symptoms of this disease and my family that did believe and support me have all passed away now. It is such a lonely place to be sick and then to realize that everyone around you is really kinda mean to you because they think that you aren’t doing anything to help yourself. I am depressed and lonely but what I wouldn’t do to be able to do just a little of what I used to do. I can’t believe anyone could have this disease and not go into a severe depression too.

I take some exception to the idea that people with ME, CFS or FMS may be depressed but not a clinical depression that leaves you apathetic.

That leaves out the likely possibility that for at least some people clinical depression may be co-morbid with the other disorders.

I have suffered from clinical depression off and on for most of my life. When in the depths of an exacerbation I am very apathetic and could care less about leaving the house.

At the same time, I really do wish that I could overcome both clinical depression and FMS and be able to have something resembling the more normal active life I once enjoyed most of the time. When I am in the depths of flares in both, I have to avoid cliffs.

When the physical symptoms/causes are treated with natural supplements/homeopathy, etc., the depression automatically lifts and goes away. Antidepressants just muff up the disease and complicate symptoms.l

I have had all three illnesses for most of my life. I was an abused child and until I was put on an anti-depressant at 30 yrs. old I had to idea what it meant to “want to do something”. I used the language because others did, but my idea of a great day would be one in bed with no one to bother me including my children. I am now 65 and have been Dx’d with sever unrelenting depression, Fibromyalgia, and CFS. I most definitely know the difference between the symptoms of these illnesses. My depression in under control with two different acting anti-depressants. When depressed I want to do nothing.
With both the Fibromyalgia and the CFS, I would give anything to regain my old life. I want so badly to go to church, but I simply cannot sit still on pews for more than an hour. Medicare just purchased a power chair for me. I do not know if you know how hard these are to attain from Medicare, but you need to be nearly if not an invalid.(Invalidism is a physical phenomenon not an emotional one. With all the tests available today we are long past faking not being able to walk.) It has given me some life back, in that I do not have to walk and within the restrictions of fatigue I can actually shop again. Unfortunately most friends and all of my family decided long ago, I was just an emotional wreck, not ill in any medical sense. Still I see my doctors and hope and pray.
Shari

Another way of looking at the difference between clinical depression and M.E. is that overexertion for people with M.E. causes swollen glands, fevers, sore throats (all physiological symptoms that can be SEEN for the many skeptics that still exist out there!) whereas one with clinical depression who finally manages to push him or herself to “exert/exercise” does not develop fevers, swollen glands, etc., but, rather, might actually feel more energized – increase in serotonin.

Just thought I’d throw that in there. Oh, and I confess that I can’t take credit for the above as it was one of my first doctors who not only has M.E., but who also happens to be a psychiatrist (only treats the disease physiologically – unless there’s “secondary” depression), that gave me that example. Going up a flight of stairs can land us in bed whereas someone who is clinically depressed doesn’t develop fevers, swollen glands, etc. after going up a flight of stairs.

And, for the record, not everyone (as others have said above) ends up with secondary depression or anxiety. I know I don’t have either…I can feel frustrated that my body won’t allow me to do what my brain/mind wants, but I also find some absurd humor about it all…laughter is good medicine.

I wish the “psychiatric community” in the U.K. (We all know which doctor keeps spouting falsehoods about M.E. as “psychological” despite ALL the evidence to the contrary!) would cease with the CBT and graded exercise “treatments.” And, yet, they still get more and more funding…wrong group to get any money for research in my opinion.

Christmas eve, i am in bed…my body is chopped.
i live in a slum house…had money..live in a high end place..
sister i asked her to take fragial items,,,i was a teacher..’
birth sister screaming at a high pitch voice, she sings..
birthmother did the same..my mind snapprd..
my life….at rge age of 13,,,here i am…..

cop wanrs proof…i was loced up for 6 months..
ex husband always beat me.good hr is dead..a doctor..
i shoukd warch nass on tv,,,nyc
c u

I know that my depression and ME occurred at the same time. I have Sheehan’s Syndrome.- my pituitary doesn’t function. I know the lack of hormones being released into my body contributes to my depression. Thankfully, medication has helped balance my mental state but I always battle with ME n depression.

Can Adrienne or anyone comment on why, with progesterone creating a state of remission for many, is it then not used to treat our ailments? Please understand I don’t condone use of hormones however, most of us have tried just about every med with little or no improvement noted. In reading these stories about the benefits of progesterone I must ask this question.

Please comment.

georgia

After suffering from CFS for four and a half years I stopped taking antidepressants. Guess what? Physically I feel much, much better without them. That horrible fatigue is gone.

Psychological illness my ass.

I get extremely angry when someone calls me, a CFS sufferer, depressed. I am not depressed, more like bummed out I can’t do anything. Depression has nothing to do with CFS. I have done much research on the cause of CFS and believe it has to do with environmental toxins. Check out my blog for more info on toxins. Nice post. NWA

Yes, I agree with the doctor. The other thing that depression causes is a lack of hope. I have hope as one professional, who did an exam for an insurance company, pointed out. He also stated this is odd for depression. Never-the -less, he still misdiagnosed most inappropriately. We really need to deal with professionals who know what they are doing otherwise we end up in worse shape. I sure hope education and policy change because it is so very difficult to find good professionals who understand these illnesses where I’m from. This in itself is discouraging. …they wonder why we seem to be depressed… sheesh!!!

Wonderful article. I have C.F.S combined with an appallingly painful bowel disorder – the regular gut attacks lasting for 96hours+. i yearn for life but long to die during them just to escape the pain. Yet my zest for life remain as avid as it was pre illness.

My best attempt to explain I’m not clinically depressed has been to insert comments to Ruby Wax’s description of depression. My contrasting feelings aim to prove, that my thoughts & feelings are light-years from clinical depression….

Ruby Wax’s on depression & my comments interspersed in caps….
“Your personality leaves town & you’re replaced by something very dark.I’M STILL MEE – I’M ENTHRALLED, CAPTIVATED, AMUSED & ENGAGED BY LIFE – I FEEL NO DARKNESS OTHER THAN THE DREAD OF NEVER BEING OUT OF PAIN & ILLNESS TO ACTIVELY INTERACT, CONNECT, SOCIALISE, TALK WITHOUT FEELING AWFUL. You’re no longer you, which is really scary. When you’re out, you’re out. I used to hope a car would hit me. I’VE HOPED A GUN COULD BE PULLED ON ME, JUST TO ESCAPE THE PAIN & THIS ILLNESS BUT NOT TO END ME WHICH HORRIFIES ME AS MUCH TODAY AS IT WOULD HAVE DONE PRE-ILLNESS. I LOVE LIFE – I HATE ILLNESS & PHYSICAL AGONY THATS TAKEN OVER AND IS GOING ON AND ON WITH NO PROMISE OF LET UP ‘I didn’t plan anything, but anything would have been better than that pain. It isn’t even pain, it’s indescribable hopelessness – bigger than that.THE ONLY HOPELESSNESS I FEEL IS, “WILL I EVER BE FREE OF THIS PAIN, WILL I EVER HAVE ENERGY TO BE ME, THE ME WHO IS STILL VERY MUCH ALIVE AND ITCHING TO SING, DANCE, DRIVE, MOVE, LOVE AND LAUGH WITHOUT AGONY OR WITHOUT EXHAUSTION SO SHATTERING THE NEED TO LIE DOWN IS BEYOND THE EXHAUSTION OF THE VERY WORSE INSOMNIA, SLEEP DEPRIVATION, JET-LAGGED, FLOOREDNESS I’VE EVER KOWN IN HEALTH, ALONG WITH GLANDS THAT THROB & A SORE THROAT And, it goes on for months and months.”

Since 2002, I have been given way too many antidepressants! I told the doctors a good many, many times that I have FM and I am in pain physically but I am NOT depressed as I suffered with depression in my 20’s so I know what that feels like with feeling like you are in a deep black hole and there’s no way out. It is very refreshing to see that actual doctor feels the same way. Thanks again, Adrienne for this article.