Medical: Provider Information
Contrasting Chronic Fatigue Syndrome
(CFS) And Major Depressive
ONSET: CFS onset
in a significant number of people is acute, coming on suddenly with symptoms
described as flu-like. The onset of MDD generally presents with a more gradual
onset (Jason et al, 1997). Many CFS patients do not have a history of MDD
although some experience depression, a common co-morbidity in individuals with
chronic illness (Jason et al, 1997).
: Clusters or local outbreaks of CFS have been reported, but these are not
characteristic of MDD incidence (Farrar et al, 1995).
: MDD is frequently characterized by a sense of hopelessness, helplessness and
feelings of excessive guilt and self-criticism. These are not primary
symptoms expressed by people with CFS. MDD and CFS share common, distinct
features, such as fatigue, memory problems and sleep disturbances; however, MDD
patients do not generally experience most of the physical and neurological
deficits seen in people with CFS, which can include: sore throat; tender and/or
swollen lymph nodes; unusual headaches; muscle and joint pain; muscle twitching
and fatigue; nausea; irritable bowel syndrome; unusual sensitivities to
medications; post-exertional malaise; visual and auditory disturbances; speech
and language deficits; altered spatial perception; clumsiness and coordination
problems; disequilibrium; autonomic disturbances such as neurally mediated
hypotension; thermoregulation and others (Shepherd, 1999).
: Depressed persons often experience a loss of interest, loss of pleasure
(anhedonia) and feelings of worthlessness (Jason et al, 1997). As noted above,
MDD is characterized by a sense of hopelessness and helplessness, along with
feelings of excessive guilt and self-criticism. The person with CFS lacks these
core symptoms of depression (unless they have become clinically depressed after
the onset of CFS), particularly anhedonia (Shepherd, 1999).
debilitating fatigue is a prominent symptom of CFS, but is named by MDD patients
at a much lower incidence, 100% vs. 28%, respectively (Jason et al,
: Sleep problems are common to both CFS and MDD patients, and there may be
differing origins for each illness, but data is inconclusive. Other
studies related to neuroendocrine and immunological dysfunction may also lead to
the discovery of causes of sleep disruption in CFS (Demitrack, 1996; also see
Whiteside, 1998). Furthermore, Shepherd (1999) notes that the associated pain,
involuntary leg movements, muscle spasms, night sweats and other symptoms
experienced by many CFS patients can negatively impact sleep quantity/quality.
MALAISE : Post-exertional exacerbation of symptoms is a hallmark
feature of CFS.It can follow either physical or mental stress and generate a
relapse significant enough to require complete bedrest and totally
incapacitating the individual. Some studies have shown that this condition is
present at a rate of 79-87% in CFS and 19% in MDD (Jason et al,
INTOLERANCE : Exercise intolerance is characteristic of CFS, but
not MDD. CFS symptoms often worsen with exercise, while MDD symptoms generally
show improvement (Shepherd, 1999).
et al. (1997) state that CFS patients have slow decision-making speed, and have
more difficulty than controls sustaining attention to figural and verbal
stimuli. Depressed patients have more trouble with figures than verbal stimuli,
while CFS patients are equally impaired in both areas. Other studies, cited by
Jason et al. (1997), indicate that paired-associate learning was much worse in
CFS than in MDD and memory impairment differences appear to be associated with
attention deficits in the CFS patient rather than with memory storage
: Various psychiatric scoring instruments can beutilized to differentiate CFS and
MDD. Findings in several studies (Jason et al, 1997) suggest that “high or low
psychiatric rates in CFS samples may be a function of whether symptoms are
attributed to psychiatric or nonpsychiatric causation.”In Johnson et al. (1996),
when CFS case definition symptoms that overlap with psychiatric diagnoses were
coded as physical, the prevalence of psychiatric diagnoses decreased
: Frequently replicated research findings indicate abnormalities in the
hypothalamic-pituitary-adrenal (HPA) axis. In MDD, levels of plasma cortisol are
elevated and there is an exaggerated response to corticotropin (ACTH). In CFS,
plasma cortisol levels are low and there is a reduced response to ACTH.
Additional research has encompassed investigation into the role of serotonin
receptors, serum prolactin and melatonin secretion. In several studies,
differences in these factors have been noted between CFS and MDD, but findings
are inconclusive (Farrar et al, 1995).
: Most of the recent research has found that depression in CFS is a secondary
reaction to the chronic illness, and is similar to the depression seen in
other debilitating chronic illnesses such as multiple sclerosis or Parkinson's
disease. Studies have shown that depression in CFS usually follows onset and
most CFS patients do not experience depression prior to becoming ill (Jason et
ILLNESS : CFS can exist for many years, but it is not a progressive
disease. Symptoms can wax and wane for the duration of the illness. Many people
do recover, (Saunders, 1998); however, full recovery is rare. Data on CFS
prognosis is limited.
TREATMENT : Cognitive-behavioral therapy has been shown to be
helpful for both groups; however, it has not improved the fatigue of CFS (Jason
et al, 1997). Non-psychotropic drugs including antivirals, immune modifiers and
ion flow treatments (Jorge & Goodnick, 1997) have been used in CFS therapy
but responses to these are varied and could be termed investigational since few
double-blind and random studies have been done In addition, many CFS patients
with co-morbid depression do not tolerate standard doses of antidepressant
medications; symptom improvement may be noted at lower dosages than the [proven]
effective dosages prescribed for the MDD patient (Jorge & Goodnick, 1997;
- Demitrack, M. (1997). Neuroendocrine
correlates of chronic fatigue syndrome: A brief review. Journal of Psychiatric Research, 31
- Farrar, D., Locke, S., Kantrowitz, F.
(1995, Spring). Chronic fatigue syndrome 1: Etiology and pathogenesis.
Behavioral Medicine, 21, 5-24.
- Fukuda, K., & Gantz, N. (1995,
July). Management strategies for chronic fatigue syndrome. Federal
Practitioner. Belle Mead, NJ: Excerpta Medica: Reed Elsevier Medical
- Jason, L., Richman, J., Friedberg,
F., Wagner, L., Taylor, R., Jordan, K. (1997, September). Politics, science,
and the emergence of a new disease. American Psychologist, 52 (9),
- Jason, L., Richman, J., Rademaker, A.,
Jordan, K., Plioplys, A., Taylor, R.,
- McCready, W., Huang, C., Plioplys, S.
(1999, October 11). A community-based study of chronic fatigue syndrome.
Archives of Internal Medicine, 159, 2129-2137.
- Johnson, S.K., DeLuca, J., Natelson,
B.J. Assessing somatization disorder in the chronic fatigue syndrome.
Psychosomatic Medicine, 58, 50-57.
- Jorge, C., & Goodnick, P. (1997,
May). Chronic fatigue syndrome and depression: Biological differentiation and
treatment. Psychiatric Annals 27:5, 365-371.
- Saunders, C. (1998, September 15). New
directions in chronic fatigue syndrome. Patient Care, 32 (14),
- Shepherd, C. (1999). Living with
M.E.: The Chronic / Post-Viral Fatigue Syndrome (Rev. ed., pp.72-75,
154-56, 182, 231-32).
- Whiteside, T. & Friberg, D. (1998,
September 28). Natural killer cells and natural killer cell activity in
chronic fatigue syndrome. The American Journal of Medicine, 105 (3A),
17S-34S. Excerpta Medica.