CADENCE study: to assess whether raised CRP is associated with probable depression in children and young people with CFS/ME, Loades, Crawley - ongoing

This study aims to assess whether raised CRP (a blood test used as a marker of inflammation) is associated with probable depression in children and young people with CFS/ME.
CACH team: Sandy Royston, Maria Loades, Esther Crawley

https://www.bristol.ac.uk/academic-child-health/research/research/cfsme/cadence-study/

 

Isn’t CRP typically normal in previous studies of ME/CFS?

 

To the best of my knowledge, CRP is an inflammation marker, and it will be raised if there is inflammation anywhere in the body. So it could be inflammation in the gut, the muscles, the lungs etc.

If someone wants to blame CRP for depression, why don't they find the inflammation and then try and cure it?

Edit : Grammar

 

It is early and my brain needs coffee after a long night, so apologies for the tangential order of thoughts.

Inflammation seems to be the new " thing" in mental health ( despite it bring a very old thing) .
As such it is probably likely to attract funding which keeps a working team together.
( I have clients in third sector who lurch from year to year chasing different funding pots with a lexicon of buzzwords and tackling some things in not very sensible orders because this is the only way to keep the balls in the air. From the outside, some areas of research appear uncannily similar - this may just be my weird perception )

Given the issues in recruiting for many recent studies, one that appears more biomedical may be more popular and thus generate enough " size" to be statistically meaningful.

Mood, anxiety and depression seem to be buzzwords for this team , and some kids do seem to benefit from this being looked at. However applying a blanket approach of assumption that this is part and parcel of presentation also does harm. When you keep finding things because of the way you phrase questions, you risk screening out other aspects, and this, from forums , seems to be a common feature . Listening is a skill that simply isn't there unless it ticks a particular box. Things which could be meaningful are thus actively screened out.

Some kids feel they are simply ignored when they describe symptoms ( anecdotal parent forum feedback)

CRP is an inflammation marker, but not the only one , and appears quite non specific.
If you were serious in looking for inflammation , would you not consider a panel of such markers , not necessarily those in standard bloods and would it not make sense to look at such markers over time ( do these change during growth spurts, during PEM ) and prevalence/ existence of comorbidities ( OI issues, EDS, gut issues etc)
With a control group(s) this might be interesting.


So this again is a focus on low mood , seeking reinforcement of a pet theory poorly measured . A data trawl seeking correlation.

The aspect I find more difficult is the complete inability to look at why there may be low mood. Gaslighting, having an illness where there are no proper treatment options, where virtually every aspect is trivialised and where accessing appropriate provision is made difficult usually does affect mood

There are few illnesses where life is made so difficult at key stages in personal development.

The real question is why low mood actually affects so few.

 

I'm guessing they're looking for subclinical differences, which seems to have become quite a thing of late. Lots of studies suggesting those with major depressive disorder have higher CRP levels, on average, than controls without depression - even though generally below the threshold for clinical concern.

Even though there's good evidence from interferon studies that raised inflammatory markers (including CRP) can induce some of the symptoms of depression (most commonly the fatigue) and even full-blown depression in vulnerable people (particularly those with a history of depression), there seems to be no shortage of people making the reverse causal claim - that thinking negative thoughts causes your CRP to go up. My guess is that this is the direction these authors will be going in, given their interests. Whatever the question, the answer is bound to be reeducation of some sort.

There seem to be lots of traps in this kind of study, because so many factors can influence (subclinical) CRP levels, including your weight and physical fitness. So CRP measurements may just pick out those cases that are moire severe anyway, and won't tell us anything specific.

edited for typos

 

That would be my worry also. Mild elevations of CRP are common in some types of depression. It tends to be within normal range in ME patients. Hopefully this won’t be used as a pretext to say patients should exercise more to bring down inflammation.

 

A means of retaining the current " treatment" model ?

 

CRP in ME-patients is normal, but I didnt expect these guys to do a literature check before wasting research funds anyway

 

ETA
A significant source of anxiety ( from forums )is when kids approach the 2 year mark with little/ no improvement as 2 years is intimated at the start by medics as the optimal period for " recovery ".
There is an expectation that recovery is normal and within this period.

 

apart from seeking consent to use the existing data they will not be doing anything but an analysis; why will it take 2 years?

 

Maybe requires separate staff funding? Or allowance for slow consent process

 

It's a jobs program. The point is to employ people long-term. Not much point doing any of this quickly. No one is expecting anything useful out of this anyway, nobody outside of the team will actually read the paper, nobody cares what they do all this time as long as they promote the BPS model of illness.

 

There may be a long term view here. NICE guidelines touched on paediatrics but there needs to be updated specific guidance.
This could be a fishing expedition