06 January 2010

Where ME/CFS stops and Depression starts

Historically, psychological interventions such as psychotherapy and cognitive behaviour therapy have been used as treatmeants for individuals who have demonstrated signs and symptoms of ME/CFS, where ME/CFS has been wrongly diagnosed as a major depressive disorder. In this entry I would like the opportunity to discuss the incidence of depression among individuals who meet the clinical criteria of ME/CFS (using the Canadian Consensus Document). It is essential that ME/CFS is aknowledged as a seperate disease to depression.

Individuals who have a diagnosis of ME/CFS may report experiences of one or more depressive episodes, as do many individuals with chronic illness. The risk of experiencing depression increasees . Depression is not a sign or a symptom of ME/CFS. A depressive episode may be triggered by the changes in lifestyle an individual experiences as a result of the ME/CFS, however it is a seperate illness, with seperate signs and symptoms.

Remember, A sign is the objective, observable or measurable evidence of disease, while a symptom is the subjective experience of the individual, things that are not measurable but that the patient reports, such as pain, dizziness or tiredness.

The signs and symptoms of ME/CFS were documented in the blog entry dated 03 January 2010; Signs and Symptoms of ME/CFS. Here I would like to list the signs and symptoms of Major Depressive Disorder, and to demonstrate the diffences between the two seperate ilnesses/diseases.

From the DSM-IV:

A depressive disorder is the name given to a discrete episode of persistant and pervasive emotional depression, which is not accompanied by hallucinations or delusions. At least five of the following symptoms must be present within the same two week period, including a depressed mood and/or a loss of interest and pleasure:

A depressed mood most of the day, nearly every day;
A markedly diminished interest or pleasure in all or most activities;
Weight and appettite changes;
Insomnia (inability to sleep) or Hypersomnia (increased sleeping);
Pyschomotor agitation or retardation (an increase or decrease in activity);
Fatigue, or loss of energy (However, not the same level of debilitating fatigue, with the experience of heavy limbs, and the urgent need to lie down, which is associated with ME/CFS);
Feelings of worthlessness or guilt;
Diminished ability to think or concentrate, or indecisiveness (However not associated with 'brain-fog', and not characterised by difficulty with word rretrieval etc, as in ME/CFS);
Recurrent thoughts of death, or suicide ideation;
The symptoms cause clinically significant impairment in social, occupational and self care functioning;
The symptoms are not due to the direct physiological effects of a substance or a general medical condition, or greif associated with bereavment.

For more information on the diagnostic criteria on depressive disorder, please visit http://behavenet.com/capsules/disorders/mjrdepep.htm

As you can see, there are some overlap's in the signs and symptomsm of depression and ME/CFS. One of the key things to keep in mind, however, is that depression is not a sign or a symptom of ME/CFS. It is understandable that if two years ago you had a very rewarding career, were a fulltime parent, or ran 5km every couple of days, and then suddenly you have had to adapt to a lifestyle of resting, pacing activity, the inability to maintain your original lifestyle (not to mention pain and fatigue), you may very well have an experience, or numerous experiences of depression. And lets be honest, ME/CFS has a myraid of ever changing symptoms, and there is always tradeoffs to any activity we participate in. ME/CFS is pretty rough going, and to get into a cycle of depression makes it so much harder to cope day in, day out. What is important is that if you suspect you are experiencing some signs or symptoms of depression, to go and have a talk with your doctor. Remember to take the Canadian Consensus Document with you when you go so that together you can establish what what is the ME/CFS, and what may be attributed to a depressive disorder. Discuss with your doctor treatment options, and what will work for you within your capabilities.

I have added a list of websites which may be of interest to follow up with:

The Cleaveland Clinic: This is an essay on chronic illness and depression, it has some useful information about different interventions and what you can do http://www.cchs.net/health/health-info/docs/2200/2282.asp?index=9288

Prohealth: An article on the ineffectiveness of treating ME/CFS with Cognitive Behaviour Therapy http://www.prohealth.com/ibs/library/showarticle.cfm?libid=14964
The Canadian Consensus Document: www.mefmaction.net/documents/me_overview.pdf
ME/CFS Australia: a great article which compares depression and ME/CFS using the Canadian Consensus Document http://www.mecfs.org.au/?q=node/12

In future entries, I would like to examine some of the following:

Maintaining identity, meaning and purpose while managing ME/CFS
Working in collaboration with your medical team
Differences between Fibromyalgia and ME/CFS
Some OT stuff - pacing activity and setting goals

I want to hear from people about areas they are interested to see discussed on here, so please leave comments, messages, or emails. Take good care of yourselves, ek.


  1. Here is a very informative PBS artical on TV for Depression Go to this link

    It is called This Emotional Life it is a 3 part series, I have fount it very informative, and you will understand there prosses in understanding the Hippocampis that causes Deep depression.

  2. I can't remember who said this, but it's always stuck with me:

    "Ask a clinically depressed person what she would do tomorrow if she got better, and the answer would be 'I don't know.' Ask a person with ME/CFS and the answer would be a list a mile long."

  3. Does that mean if you ask that question to someone who has both ME/CFS and depression their answer would only be half a mile long? Hehe

    I finally got the feed up and running on facebook if that works easier for anyone. Take care all, ek.