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Chronic Fatigue Syndrome (CFS) & seasonal affective disorder: comorbidity, diagnostic overlap, & implications for treatment

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By Terman M, Levine SM, Terman JS, Doherty S • • September 28, 1998

This study aimed to determine symptom patterns in patients
with chronic fatigue syndrome (CFS), in summer and winter.
Comparison data for patients with seasonal affective disorder
(SAD) were used to evaluate seasonal variation in mood and
behavior, atypical neurovegetative symptoms characteristic of
SAD, and somatic symptoms characteristic of CFS. Rating scale
questionnaires were mailed to patients previously diagnosed
with CFS. Instruments included the Personal Inventory for
Depression and SAD (PIDS) and the Systematic Assessment for
Treatment Emergent Effects (SAFTEE), which catalogs the
current severity of a wide range of somatic, behavioral, and
affective symptoms. Data sets from 110 CFS patients matched
across seasons were entered into the analysis. Symptoms that
conform with the Centers for Disease Control and Prevention
(CDC) case definition of CFS were rated as moderate to very
severe during the winter months by varying proportions of
patients (from 43% for lymph node pain or enlargement, to 79%
for muscle, joint, or bone pain). Fatigue was reported by 92%.
Prominent affective symptoms included irritability (55%),
depressed mood (52%), and anxiety (51%). Retrospective monthly
ratings of mood, social activity, energy, sleep duration,
amount eaten, and weight change showed a coherent pattern of
winter worsening. Of patients with consistent summer and
winter ratings (n = 73), 37% showed high global seasonality
scores (GSS) > or = 10. About half this group reported
symptoms indicative of major depressive disorder, which was
strongly associated with high seasonality. Hierarchical
cluster analysis of wintertime symptoms revealed 2 distinct
clinical profiles among CFS patients: (a) those with high
seasonality, for whom depressed mood clustered with atypical
neurovegetative symptoms of hypersomnia and hyperphagia, as is
seen in SAD; and (b) those with low seasonality, who showed a
primary clustering of classic CFS symptoms (fatigue, aches,
cognitive disturbance), with depressed mood most closely
associated with irritability, insomnia, and anxiety. It
appears that a subgroup of patients with CFS shows seasonal
variation in symptoms resembling those of SAD, with winter
exacerbation. Light therapy may provide patients with CFS an
effective treatment alternative or adjunct to antidepressant

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