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Psychiatry Advisor: Addressing Depression in ME/CFS

Discussion in 'PsychoSocial ME/CFS News' started by MsUnderstood, May 15, 2018.

  1. MsUnderstood

    MsUnderstood Senior Member (Voting Rights)

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    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."
     
  2. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    As you say @MsUnderstood some good, some not so good.

    It never seems to occur to them that while they busily push the BPS narrative that doesn't help and can cause real harm, they may be driving some patients, who experience depression because of their ME, away. I could understand an ME patient being reluctant to seek help for fear their entire situation might be put down to depression or false illess beliefs. It's a secondary harm caused by the BPS model and perpetuated by the influence of PACE.
     
  3. Webdog

    Webdog Senior Member (Voting Rights)

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    A 2015 CDC multisite clinical assessment concluded, "ME/CFS patients show significant impairment, particularly in vitality and physical functioning subscale scores, but with preservation of mental health and emotional role functioning."

    www.cdc.gov/mmwr/volumes/65/wr/mm655051a4.htm

    Screen Shot 2018-05-14 at 9.36.57 PM.png
     
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  4. Alvin

    Alvin Senior Member (Voting Rights)

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    My take on that article is the authors mean well but there are so many factual errors in it that i would rewrite it if i were designated to do so.
     
  5. strategist

    strategist Senior Member (Voting Rights)

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    I am often in good mood in the morning, despite also experiencing symptoms.
     
  6. Woolie

    Woolie Committee member

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    From my reading, this article is far from neutral, but is very cleverly written to appear so by paying lip service to some alternative perspectives. But the underlying message is:

    - CFS patients are different from your average depressed patient because instead of attributing their problems to their own inadequacies, they attribute them to "somatic" disturbances

    - for this reason, they will be resistant to CBT. It is counterproductive to try and challenge their strongly held beliefs in the physicality of their illness. They are not open to reassessing those beliefs. Best not to go head-on with them.
     
  7. chrisb

    chrisb Senior Member (Voting Rights)

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    There looks to be a problem with their suggested prevalence rate. It looks to me to be at least ten times too high. If that is what they believe the condition to be they will include all sorts of symptoms and belief states.

    And we know exactly why so many depressive and psychiatric symptoms are seen in ME. It is because Wessely, White, Sharpe and their mentors and collaborators defined the condition in such a way as to include them.
     
  8. Trish

    Trish Moderator Staff Member

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    When I see articles like this, one thing I look for is who it's written for and whether it's a personal blog, or, as in this case, a site that offers news and advice to medical professionals. That means this article matters more than many we see.
    https://www.psychiatryadvisor.com/about-us/section/4046/
     
  9. Trish

    Trish Moderator Staff Member

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    It does seem to be an awful muddle of bits cobbled together from different perspectives and randomly using different definitions and names.

    On the plus side, its reference list includes the Geraghty and Wilshire papers that critique PACE, and doesn't include any of the PACE papers! And it includes Naviaux metabolomics paper.
     
  10. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    It's definitely a mixed bag. But they use terms confusingly and interchangeably, which undermines it, in my eyes. MDD is clearly major depressive disorder, but what's the CE of 'CE/MDD'? They haven't been clear about what they're talking about. It's possible they meant ME/CFS (which they earlier label MD/CFS, mixing in CFIDS occasionally too).

    They're also wrong on their numbers. Depression is nowhere near as high as 80% in patients, and the ME prevalences are magnified many times.

    They're right that CBT isn't useful. The article also seems to posit that depression is secondary to CNS inflammation, which is probably actually right, but other parts seem muddled. A couple of places reveal the authors' biases, despite them trying to appear objective.

    Does someone have the spoons to kindly approach the editor pointing out the typos and providing more accurate links to prevalence of both the illness and secondary depression? Perhaps a brief mention can also be made of the evidence that shows harm from GET? Ideally, this would need to be framed objectively and in a scientific manner, which would make it more likely to get done.
     
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  11. Woolie

    Woolie Committee member

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    Its quite wily. Its says:
    This suggests some are more depressed than people with a chronic disease.
     
  12. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    Sure, but it's a typical weasel word. They're just trying to be vague because they don't want to outright make a definitive statement that may be wrong. So I wouldn't worry too much about the word 'many' there.
     
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  13. Barry

    Barry Senior Member (Voting Rights)

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    I find it quite positive to see any kind of psychiatric paper including quotes which discriminate ME/CFS from depression, and quotes that at least acknowledge doubts and concerns about the BPS approach and GET etc. Not so long back such things would have been completely obscured. To me it's as if the authors feel they have no choice but to accept, albeit reluctantly, that things are changing.
     
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