I'm not sure how readers will interpret this article. I started out feeling outraged, but on "second read" realized I initially misinterpreted some of the statements made. The article may offer "confirmation bias" for those already convinced that ME is a psychological illness. Yet, for those who take the time to carefully read it, the message provides something to agree with for those on both sides of the bio/psycho argument. https://www.psychiatryadvisor.com/d...s-in-chronic-fatigue-syndrome/article/765601/ A few of the better parts: In an email interview, Susan K. Johnson, PhD, professor of psychological science, University of North Carolina, Charlotte, told Psychiatry Advisor that prevalence estimates of depression in patients with ME/CFS span a wide range, from a low of 5% to as high as 80%. "This wide range is likely due to the coding assumptions applied to psychiatric interviews. It is possible to overestimate the prevalence of psychiatric disorders in CFS when there are so many overlapping symptoms that, depending on coding assumptions, can be attributed to somatic or psychiatric causes." Some researchers believe that depression, fatigue, and other manifestations of ME/CFS are part of the symptom cluster of an underlying biological disease state, possibly involving the presence of a hypometabolic syndrome, disturbances in the hypothalamic-pituitary-adrenal axis, activation of the shared oxidative and nitrosative pathway, or aberrations in the 2-5A synthetase/RNase L pathways. Eric Gordon, MD, a physician whose California-based practice focuses on complex chronic illnesses, told Psychiatry Advisor that depression should not be regarded as an integral feature of CFS. "There are CFS patients who also have depression. Depression is often an example of the inflammatory response in certain people's central nervous system, and since inflammation may be part of CFS, we see this type of depression in some patients with CFIDS. Patients with CFS may have an element of situational depression because their lives are interrupted and their friends and family may treat them as malingerers; however, this is not in any way a defining characteristic of CFIDS patients. Many are not any more depressed than anyone else with a chronic disease." And a few of the questionable parts (some good, some bad): Dr Johnson noted that there are distinguishing factors that differentiate the depression seen in CFS from clinical depression. "Whereas depressed patients' cognitions are dominated by a negative view of the self, CFS patients are primarily preoccupied with symptoms for which they make somatic attributions. People with CFS [are] generally more disabled than depressed patients. While exercise exacerbates fatigue in CFS, individuals with depression generally report more positive mood following exercise. Additionally, CFS can be separated from depression in terms of neuroimaging and neuroendocrine responses." Other researchers contend that CE/MDD (sic) is an atypical manifestation of anxiety or depressive states, and that it is best understood as a psychological disorder. Still others believe that the depression common in patients with ME/CFS is a natural response to the severe fatigue and disability imposed by the disease process. Dr Johnson told Psychiatry Advisor that people with CFS are unlikely to seek help from mental health professionals. "Community studies of CFS find that while many people endorse depression symptoms, they tend to seek help from physicians for these symptoms. Patients who are seeking treatment from a mental health provider will likely be more open to CBT approaches which have been shown to be helpful. CBT requires that the patient be willing to examine and change their beliefs about the illness and its disability. Antidepressants are not very helpful in CFS, although they offer symptomatic relief in some cases. For many patients with CFS, challenging their illness beliefs (via CBT) will be counterproductive, and ACT (acceptance and commitment therapy) and stress management approaches may be more helpful. Approaches to treatment need to be individualized and respectful of the patients' lived experience."