Tag: Goudsmit

Chronic fatigue syndrome and depression

Comment on: Cerebral perfusion in chronic fatigue syndrome and depression. [Br J Psychiatry. 2000]

 

I found MacHale et al’s (2000) discussion of their results confusing. According to the abstract and methods, they screened their patients with chronic fatigue syndrome (CFS) to exclude those with depression. Then they examined this group further using a standardised psychiatric interview (Schedule for Affective Disorders and Schizophrenia), in order to “ exclude subjects with current psychiatric illness, with a particular emphasis on depression”. The data from the Hamilton Rating Scale for Depression are difficult to interpret given the number of illnessrated items, but the scores did not indicate a significant degree of depression either. So, having excluded “subjects with depression or anxiety”, why did the authors claim in their discussion that “the main limitation of the present study is that our CFS subjects had high levels of depression”?

You can read the rest of this comment here: http://bjp.rcpsych.org/content/177/5/470.long

 

Source: Goudsmit E. Chronic fatigue syndrome and depression. Br J Psychiatry. 2000 Nov;177:470. http://bjp.rcpsych.org/content/177/5/470.long

 

Chronic fatigue syndrome

Comment in: Chronic fatigue syndrome. [Br J Gen Pract. 1992]

Comment on: Antidepressant therapy in the chronic fatigue syndrome. [Br J Gen Pract. 1991]

 

Sir, The adoption of the term chronic fatigue syndrome for conditions like myalgic encephalomyelitis and effort syndrome in the paper by Lynch and colleagues (August Journal, p.339) is difficult to understand. The differences between these disorders are so marked, that an umbrella term is destined to be both confusing and misleading.

The emphasis on the term fatigue is unfortunate for many reasons. First; research has shown that only a tiny proportion of people with unexplained fatigue fulfil the standard diagnostic criteria for myalgic encephalomyelitis. (1) Secondly, Lynch and colleagues’ definition of chronic fatigue syndrome is too broad to distinguish people with myalgic encephalomyelitis from those who are feeling run down or depressed or suffering from the more common and less severe post-viral syndrome. Thirdly, the term trivializes the illness. Everyone gets tired now and then and most people find it hard to understand how some may be disabled by it. In our view, the name suggests something which is tolerable and volitional, requiring little more than adequate rest and a positive attitude. What the term fails to communicate is that the fatigue reported by people with myalgic encephalomyelitis is severe and debilitating; that it is unlike anything most of them have experienced before and that it is often associated with an intense influenza-like malaise. (2’3) We therefore agree with English that as far as myalgic encephalomyelitis is concerned, ‘fatigue is the most pathetically inadequate term’. (2)

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371802/pdf/brjgenprac00062-0041.pdf

 

Source: Goudsmit EM, Macintyre A, Sullivan M. Chronic fatigue syndrome. Br J Gen Pract. 1991 Nov;41(352):479-80. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1371802/