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Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms - Source: Current Opinion in Psychiatry, Jan 2009

  [ 45 votes ]   [ 2 Comments ]
By Michael Maes • • January 9, 2009

[Note: oxidative and nitrosative stress pathways refer to complex series of biochemical reactions leading to harmful free radical and nitric oxide effects at the cellular level. LPS (lipopolysaccharide) is a component of certain bacteria normally confined to the intestine that may leak out due to infection.]

Purpose of Review The aim of this paper is to review recent findings on inflammatory and oxidative and nitrosative stress (IO&NS) pathways in chronic fatigue and somatization disorder.

Recent Findings
• Activation of oxidative and nitrosative stress (IO&NS) pathways is the key phenomenon underpinning chronic fatigue syndrome (CFS):

- Intracellular inflammation, with an increased production of nuclear factor kappa beta (NFkappabeta), cyclo-oxygenase-2 (COX-2) and inducible NO synthase (iNOS);

- And damage caused by O&NS to membrane fatty acids and functional proteins.

• These IO&NS pathways are induced by a number of trigger factors, for example: Psychological stress, strenuous exercise, viral infections, and an increased translocation of LPS from gram-bacteria (leaky gut).

• The 'psychosomatic' symptoms experienced by CFS patients are caused by:

- Intracellular inflammation (aches and pain, muscular tension, fatigue, irritability, sadness, and the subjective feeling of infection);

- Damage caused by O&NS (aches and pain, muscular tension and fatigue);

- And gut-derived inflammation (complaints of irritable bowel).

• Inflammatory pathways (monocytic activation) are also detected in somatizing disorder.


• 'Functional' symptoms, as occurring in CFS and somatization, have a genuine organic cause, that is activation of peripheral and central IO&NS pathways and gut-derived inflammation.

• The development of new drugs, aimed at treating those disorders, should target these IO&NS pathways.

Source: Current Opinion in Psychiatry, Jan 2009;22(1):75-83. PMID: 19127706, by Maes M. Clinical Research Centre of Mental Health (CRC-MH), Antwerp, Belgium. [E-mail:]

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Article Comments Post a Comment

significant step forward
Posted by: drewmanman
Jan 12, 2009
This review article is significant because it is published in a psychiatry journal, and the psychiatric community has often been skeptical that ME/CFS is an organic disorder. Hopefully this will help a lot of the skeptics to realize that there is something physically wrong with ME/CFS patients. Much of the groundbreaking research on the pathways described here has been done by Professor Martin Pall.
Reply Reply

Current Opinion in Psychiatry
Posted by: judimld
Jan 14, 2009
It is about time psychiatrists are becoming educated and learning more about CFS/FM/MCI. In the past many of them have created great hardships for patients suffering from those physiological illness and they caused many physically ill patients grief by testifying in the courtroom that these illness should be included as mental illnesses. I was one of those victims and lost everything due to psychiatrists' resistance to scientific research, out of their own lack of research and ignorance.
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