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

Sly Saint

Sly Saint

Senior Member (Voting Rights)
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

Beyond those completed for routine referral into the service, no further blood tests or questionnaires are undertaken to complete this study. Participants agree for their pseudonymised data to be collected from the screening tests they underwent for referral into the specialist RUH CFS/ME service.

We are conducting this study because low mood is a common problem for young people with CFS/ME (between 20-30%) and it can make life more challenging for young people already experiencing difficulties. Ultimately, we would like to find better treatments for these children and young people.

We also suspect that those young people with CFS/ME and low mood may experience a different form of CFS/ME than those without low mood. We would like to understand this condition better. This study will take approximately 2 years.
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https://www.bristol.ac.uk/academic-child-health/research/research/cfsme/cadence-study/
 
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Arnie Pye said:
To the best of my knowledge, CRP is an inflammation marker, and it will be raised if the inflammation is 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?
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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.
 
Sid said:
Isn’t CRP typically normal in previous studies of ME/CFS?
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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
 
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Woolie said:
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
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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. :confused:
 
Sid said:
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. :confused:
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A means of retaining the current " treatment" model ?
 
Amw66 said:
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.
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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.
 
I can't find it on the clinical trials . gov website.
I guess the 2 years is how long it will take to get approval, collect the data from patients, and write it up. It's probably someone's PhD project.
 
Sly Saint said:
apart from seeking consent to use the existing data they will not be doing anything but an analysis; why will it take 2 years?
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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.
 
rvallee said:
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.
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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
 
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