Biological abnormalities separate CFS from Depression

How biological abnormalities separate CFS from depression

JAAPA. 2008 Mar;21(3):19-23.

Erdman KM.

Baylor College of Medicine PA Program, Houston, Texas, USA.

PMID: 18432043 [PubMed - indexed for MEDLINE]

Full text is available for free at:

http://jaapa.com/issues/j20080301/articles/cfs0308.htm
PDF format:
http://jaapa.com/issues/j20080301/pdfs/cfs0308.pdf

Anyone who doubts my assertion that CFS is most definitively not depression should be encouraged to read this article! 

EXCERPTS:

"care must be taken as well to avoid the overdiagnosis of depression in patients who have unexplained physical symptoms. Although comorbid depression is a common emotional response to any chronic illness, some patients with CFS are not clinically depressed. These patients are poorly served when depression is the only diagnosis they are offered."

"Many clinicians, unaware of the volumes of evidence pointing to a physiologic etiology to CFS, may be overdiagnosing depression by default."

The CDC recently declared, “There is now abundant scientific evidence that CFS is a real physiological illness. It is not a form of depression or hypochondriasis. A number of biologic abnormalities have been identified in people with CFS.”6

CFS and depression share certain symptoms, but many others, such as sore throat, lymphadenopathy, arthralgias, myalgias, and postexertional fatigue, are not typical of psychiatric illness. In addition, patients with CFS generally do not have the usual depressive symptoms of anhedonia, guilt, and lack of motivation.12-14 The fatigue of depression seems to be motivation-related and milder than in CFS. When tested, depressed persons score highest on feelings of low self-esteem manifested as self-criticism and feelings of worthlessness and guilt, but CFS patients score highest on physical symptom-related points such as pain, sleep disruption, and lack of energy.15 People with depression tend to be withdrawn and without a sense of hope, whereas people with CFS are typically more proactive about seeking treatment, are hopeful for recovery, and often join support groups and lobby for research funding.16 Striving for improved quality of life is uncommon in depressed persons.

HPA axis abnormalities, including hypercortisolemia, elevated urinary free cortisol, and exaggerated cortical response to corticotrophin, appear in persons with depression.19 In patients with CFS, however, the opposite appears to be true. CFS patients have lower plasma cortisol than do controls and have a reduced response to corticotrophin. In a direct comparison study, depressed patients had the highest levels of circulating cortisol, normal controls had lower levels, and CFS patients had the lowest levels.20 Urinary free cortisol (UFC) excretion was significantly higher in patients with depression than in healthy comparison subjects, and UFC excretion was significantly lower in patients with CFS than in the comparison group in a 1998 study. The CFS patients who had comorbid depressive illness retained the profile of UFC excretion of those with CFS alone, which suggests a different pathophysiologic basis for depressive symptoms in CFS.21

A comprehensive review of neuroendocrine studies in 2001 also confirmed HPA abnormalities in CFS patients.22

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In fact, CFS shares more symptoms with MS than it does with depression, and some patients have been diagnosed with "atypical MS".  Unfortunately, too many doctors hear "tired" and tune out everything else because they've already leapt to the erroneous diagnosis of depression.  Anti-depressants have repeatedly been proven useless against CFS; the only thing that works is anti-virals.

I know there are people who will complain that I overdo this topic, but I'm going to keep beating this horse until every doctor, nurse, psychiatrist, etc. out there repeats after me "CFS is not depression.  The symptoms are different.  The treatment is different."  Only then can I stop lecturing on this crucial subject.  My health was permanently damaged by doctors who didn't know that -- I will not tolerate anyone else suffering the same way.