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Is it Fatigue or Is It Depression?

  [ 752 votes ]   [ Discuss This Article ]
By Michael McNett, MD, Medical Director of the Fibromyalgia Treatment Centers of America; reproduced with permission from Canary Times, the quarterly publication of the CFS/FM/CS Coalition of Chicago.* • • September 13, 2006

For anyone suffering from Chronic Fatigue Syndrome (CFIDS) or Fibromyalgia (FMS), it’s normal to feel down in the dumps. These conditions can dramatically limit your life, leaving you in a situation that may bear no resemblance to how you had always imagined yourself living. Being forced into a quality of life far below your desires naturally causes a great deal of anger and sadness. If it’s bad enough and lasts long enough, you may develop full-blown depression. While depression and sadness look very similar, they are very different processes in the brain. Sadness is about a particular situation, but depression is about life itself. Also, while sadness is temporary and causes no long-term problems, depression involves a change in how the brain works. If left untreated, these changes may result in a permanent “rewiring” of the brain which can make it very hard for the brain not to be depressed. As a result, the longer and more severe a person’s depression, the greater the likelihood of recurring depressions over the course of the lifetime. In addition, depression can become so severe that it causes suicidal thoughts. If untreated, these thoughts can become urges and, ultimately, actions. Depression, being potentially fatal, is the most serious complication of either CFIDS or FMS. This makes it doubly important to recognize and treat as soon as possible. For those suffering from CFIDS and Fibromyalgia, however, this isn’t easy. Many of the symptoms of CFIDS and FMS imitate depression. You may think, “If I could just get my health back, I’d be ok.” Actually, this isn’t true. Once depression has developed, simply taking away the cause doesn’t cure the depression – it becomes self-sustaining. As an example, a healthy person wins the lottery and dances in the streets. A depressed person wins it and stays awake at night worrying about all the taxes they have to pay. In a very real way, depression takes over your mind and guides how you think – always toward negativity and victimization. So how does one tell if one is depressed, particularly if illness causes poor sleep, unhappiness with quality of life, and makes one tired all the time? Here are some guidelines. The Criteria Psychiatrists Use to Diagnose Depression
Over a two-week period, a person must have five or more of the following symptoms (representing a change from normal for them):
n Depressed mood (as apparent to themselves or others)
n Loss of pleasure, loss of interest in hobbies (Note – at least one of these first two symptoms must be present.)
n Weight gain or loss (unintentional)
n Sleep increase or decrease
n Listlessness (decreased motor activity)
n Fatigue
n Worthlessness or guilt (inappropriate to life situation)
n Cognitive dysfunction (inability to think or concentrate)
n Preoccupation with death (possibly suicidal thoughts or urges)
n The symptoms must impair work, personal, or social functioning.
n The patient can’t have bipolar illness (“manic-depressive disorder”)
n The symptoms can’t be caused by a medical illness or medications.
n The episode can’t have started within two weeks of the death of a loved one.
How CFIDS and FMS Complicate Diagnosis Since CFIDS and FMS both cause people to have sad moods, listlessness, fatigue, sleep problems, difficulty concentrating, and an inability to participate in hobbies, the exception “can’t be caused by a medical illness or medications” makes the diagnosis very difficult. One primary way to tell the difference is the idea of hopelessness and helplessness. If there are things a patient can do to help themselves (for example, taking medication) and they say, “What’s the use? It won’t help anyway,” that’s depression talking. Unwillingness to do physical therapy, prioritize how energy is spent on activities, keep doctor appointments, exercise, or do biofeedback may be signs that depression is developing. Also, a fairly rapid worsening in mood can be another sign of depression. Uncontrollable crying, anger outbursts, or constant simmering irritability, particularly if continued for longer than two weeks (and not associated with a major loss) are pretty good signs that a major change has taken place. Clearly, any comments about death or “I feel like I’m nothing but a burden” should be taken seriously. Typically, the patient is the last person to recognize these problems. It’s most commonly family and friends who see these changes and suggest that something needs to be done. If you are a person suffering from CFIDS or FMS, be sure your loved ones read this article. Then, if they tell you that they’re concerned about depression, it’s important that you get checked out by a doctor, preferably a psychiatrist. Simple questionnaires can be employed [such as the Beck Depression Inventory or the Zung Self Rating Depression Scale] that can indicate whether depression is likely to be present. These, combined with a good history and physical examination, can usually reliably tell whether depression is present. There are several types of treatment for depression. Exercise is very helpful (though it can be hard for CFIDS/FMS sufferers). Psychological counseling is important, as well. Grieving is a key factor in healing – it’s very important to let out the feelings you have about your situation. In addition, cognitive therapy can be important in helping you learn how to cope with your medical condition. Occasionally, deeper psychotherapy may also be indicated to deal with life-long patterns that may predispose you to depression. Antidepressant Medications

There are several kinds of antidepressant medications. The decision on which to use should be individualized – discuss the pros and cons of the various options with your doctor and work together to decide which would be the best for you. If one type doesn’t work, it can be replaced with another type, or they may even be used together. Learn the side effects of your medications and notify your doctor if any develop. In summary, depression is a common complication of both CFIDS and FMS. Because it worsens your suffering and can lead to permanent changes in the brain or even death, it is very important to recognize it and see your doctor if you or your loved ones suspect you may have it. There are a variety of very effective treatments available. With rapid diagnosis and prompt treatment, almost everyone can be helped significantly. The only place for “the blues” is on your stereo! NOTE: Patients should be aware that certain medical conditions and medications can cause symptoms of depression. For example, thyroid hormone and nutritional imbalances, beta blockers, certain sleep medications and other drugs and conditions can cause you to feel depressed. If you experience the symptoms discussed in this article, schedule an in-depth discussion with your physician to determine the cause.

* Michael McNett, MD, is Medical Director of the Fibromyalgia Treatment Centers of America, based in Arlington Heights, Illinois ( He is actively involved in FM therapy research, drawing on a background in family medicine, pharmaceutical research, psychology, addiction medicine, and integrative medicine. Dr. McNett’s FM protocols are featured in the book Taking Charge of Fibromyalgia, now in its 8th edition, by Julie Kelly, MS, RN, and Rosalie Denvonshire, MSW, LCSW, another member of the FTCA staff. For information about the CFS/FM/CS Coalition of Chicago and its activities and newsletter, go to or call 312/409-5363. Note: The information provided here is not intended to diagnose, treat, cure, mitigate, or prevent any disease. Consult your physician for medical advice.

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