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Valacyclovir treatment of chronic fatigue in adolescents

  [ 8 votes ]   [ 6 Comments ]
By T.A. Henderson • • January 31, 2014

By T. A. Henderson
Chronic fatigue syndrome (CFS) presents with fatigue, low motivation, diminished mood, and reduced activity, all symptoms having extensive diagnostic overlaps with depression. Studies have linked chronic viral infections with CFS, and antiviral therapy has effectively treated CFS in adult patients.

In a retrospective case series, 15 adolescents and preteens referred to the author for treatment-resistant depression or mood disorder were evaluated and found to have met the Fukuda diagnostic criteria for CFS. While a subset (4/15) had been diagnosed in the past with CFS, the majority had a current diagnosis of depression or a mood disorder.

The Diagnostic and Statistical Manual-IV Text Revision (DSM-IV TR) criteria for depression were not met in all patients, although 3 cases of mood disorder not otherwise specified (MD-NOS) and 1 case of Tourette syndrome (TS) plus MD-NOS were diagnosed. Baseline scores on the Children's Depression Inventory (CDI) were below the cutoff for depression in all but 1 patient. Baseline self-assessment scales for CFS or fatigue were obtained and sleep was evaluated with sleep logs.

All patients were treated subsequently with valacyclovir, with 93% having a positive response. At the end of treatment, scores on fatigue self-assessment scales improved significantly (P < .001). Vigor subscale scores also improved significantly (P < .001). Some patients experienced complete resolution of symptoms. Although not every patient was tested, available laboratory testing revealed increased counts of natural killer (NK) cells and decreased human herpesvirus 6 (HHV-6) antibody titers in all patients who responded to valacyclovir.

This article discusses the significance of infectious agents in the pathogenesis of psychiatric symptoms. The study's data support an intriguing hypothesis that a portion of treatment-resistant depression in fact may be undiagnosed CFS or other chronic viral infection.
Source: Henderson TA. Adv Mind Body Med. 2014 Winter;28(1):4-14.

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Article Comments Post a Comment

Very significant "cat among the pigeons"
Posted by: IanH
Jan 31, 2014
Thank God for this intervention!

How many people with "depression" diagnoses have "treatment resistant" (aka. refractive)depression. I can tell you it is many, well over one third of cases.

This urgently needs expanding to larger clinical studies and biochemical studies.

Depression has no biomarker. The hallmark indicator of depression is cognition. Albert Bandura once called depression "learned helplessnes". (Not a theory I took to in my undergraduate days). Of course it isn't easy to discriminate between cognitive indicators of "depression" and a disease which "gets you down" but it is easy (but not cheap) to identify the biochemical differences as these clinicans have done. Congratulations to them. May we have more.
Reply Reply

What criteria?
Posted by: AzizaJ
Feb 1, 2014
"Chronic fatigue syndrome (CFS) presents with fatigue, low motivation, diminished mood, and reduced activity, all symptoms having extensive diagnostic overlaps with depression." Really?

This makes you wonder what criteria they used. And it underlines the need for accurate criteria like the CCC or ICC.
Reply Reply

Posted by: IanH
Feb 2, 2014
On talking with colleagues we are agreed that in teenagers ME does appear like depression much more so than in adults.

There is a lack of motivation,irritability and diminished mood when compared to adults over 40. Pair that with parental lack of empathy and you can see why these teenagers are diagnosed with depression. However this is no excuse for the bias to diagnose them with depression.


Quite right AzizJ
Posted by: IanH
Feb 2, 2014
I just ignored that nonesense but focused on the endpoint.


my daughter
Posted by:
Feb 3, 2014
I would like parents to keep a daily diary of their childes symptoms, speak with their teachers. In my experience seeing a depression specialist was the key to diagnose ME and treatment started immediately with imipramine. I did take her out of school for a month of rest. She started sleeping, headaches decreased, joint and muscle pain decreased. Her low grade fever returned to normal and slowly she became more active. I wish the Valacyclovir treatment was available in 1995. Today she monitors her energy but has a full time carrier and is an active member of our society. Dr. Martin Lerner has a web site with a download file on how and why he uses Valacyclovir as does Dr. Jacob Teitelbaum.
Reply Reply

Posted by: IanH
Feb 5, 2014
Do you think the imipramine helped her recovery because in my experience it does not. How long long was your daughter on the imipramine? I wonder whether the rest and time and better management of living conditions is what helped.
Reply Reply

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