Psychiatry Advisor: Addressing depression in ME/CFS, 2018, Cindy Lampner

[Michelle]

I thought Lenny Jason had a good way to address this with the question, "if you felt better tomorrow, what would you do?" In a person with depression, he or she will likely answer, "er...I dunno." A person with ME is gonna give a laundry list of stuff we'd do if we woke up feeling better tomorrow.
(Apologies if somebody has already mentioned this upthread; my memory is shit.)

 

[spinoza577]

I think the question on the NHS website depression questionnaire is reasonably worded:

Have you found little pleasure or interest in doing things?

This may be the point: with depression you are not interested in things in any means, you don´t see any sense in doing things,

but with only anhedonia you rather would like to do things, you´re interested in things in their whole presentation, but in the details - which are necessary part of each thing to do - there is actually no pleasure.


This may implicate that the doing is nested up, the overall goal can be affected (depression), its mean parts can be affected (anhedonia), or the basal actings can be affected (I would say, eg typical ME/CFS).

Interestingly, it might be the same structure which would be affected in depression and me/cfs, only A) the roads leading to it might differ (e.g. different gentic predisposition), and B) it might be a difference in some considerable unusual property, maybe in frequence of nerve firing, or length of axons involved.

 

[Mithriel]

Anhedonia is in essence a lack of (or reduction of) pleasure or reward from normally enjoyable activities. That's it definition.

This is interesting. That definition exactly matches what happens with ME, no pleasure or reward just pain and illness, in fact it is a cost, the opposite of reward. I know that isn't what they mean, but their definition is not exact, is it, so you can see why some doctors insist we are depressed. Then when we argue we are told it is denial.

Looking at things like this is important because we need to find ways to distinguish what we feel because the other side do not think they have to.

I suppose we should say we do not feel pleasure or reward in things we used to fine good but emphasise that it is because of the PEM we experience when we attempt them.

 

[Trish]

I suppose we should say we do not feel pleasure or reward in things we used to fine good but emphasise that it is because of the PEM we experience when we attempt them.

I don't think I have lost my ability to feel pleasure or reward. What I have lost is the ability to do many of the things that used to provide pleasure and reward. And the few things left that do enable me to experience pleasure or reward have to be rationed into small pieces with long rests in between to avoid exhaustion and PEM.

 

[Mithriel]

What is in my mind is the things I have to do as a duty which would once have been a pleasure. Things like ordering presents for my family at Christmas which I did because I wanted to do it and because I know from experience that when I have had to stop doing something it is gone forever. It should have been fun but I was just relieved to get it done without collapse.

It is not that I don't experience pleasure in things. I get almost intoxicated with pleasure over things that other people take for granted like the day I had to go out but it was raining and I couldn't stop giggling at getting wet.

Though sometimes it is like the Rocky Horror Show "Even smiling makes my face hurt" enjoying things can be exhausting in itself, sigh ....

 

[Hip]

This is interesting. That definition exactly matches what happens with ME, no pleasure or reward just pain and illness, in fact it is a cost, the opposite of reward.

As Trish hints, you have be a bit careful with this definition of anhedonia, as although ME/CFS patients are unable to do certain things because of fatigue, PEM repercussions, or because brain fog prevents them, that does not mean there is no pleasure in other tasks which we still find doable.

I always enjoy posting on forums, for example. I enjoy discussing subjects and ideas, and interacting with other people online. Somehow I am able to muster up the mental energy for this.

And I know this sounds unlikely, but I also get some very mild reward in helping to do the clearing up after supper. It's just a mundane manual task, clearing the table, rinsing the dishes and loading up the dishwasher; but it a small way, I feel a mild sense of satisfaction when the task is done. Maybe it's because I achieve very little during the course of a day, so just the fact that I can complete a simple manual task gives mild satisfaction.

But tasks like ordering Christmas presents I would find a real chore, given the brain fog, because this sort of task puts cognitive strain on the brain

I would say that if you can still find satisfaction in some activities, then you don't have severe anhedonia at least.

But remember that many cases of depression do not exhibit any anhedonia. So you may still have depression even if you don't have anhedonia. Loss of self-esteem is another useful symptom to consider, when examining whether you have depression.



It's also important not to mix up anhedonia with blunted affect (blunted or weakened emotions). Blunted affect is actually a listed symptom in the CCC definition of ME/CFS. So you can expect blunted affect to be quite common in ME/CFS.

Blunted affect is another horrible symptom (I suffer from it too), as when severe, it results in all the emotional content (of flims on TV, or day to day human interactions) becoming meaningless, as your brain does not pick up on emotional themes. With blunted affect, you can watch a romantic or melodramatic film, and it will do nothing for you, as you don't tune into the emotions.