Index
What is CFS?
Definition of CFS
Could CFS Be Depression?
Recent Evidence

Chronic Fatigue Syndrome (CFS) is an emerging illness characterized by debilitating fatigue (experienced as exhaustion and extremely poor stamina), neuological problems, and a variety of flue-like symptoms. The illness is also known as Chronic Fatigue Immune Dysfunction (CFIDS), and outside of the USA is usually known as Myalgic Encephalomyelitis (ME). In the past the syndrome has been known as Chronic Epstein-Barr Virus (CEBV).

The core symptoms include excessive fatigue, general pain, mental fogginess, and often gastro-intestinal problems. Many other symptoms will also be present, however they will typically be different among different patients. These include fatigue following stressful activities; headaches; sore throat; sleep disorder; abnormal temperatures; and others.

In March 1988 the CDC (U.S. Centers for Disease Control) published in Annals of Internal Medicine a group of signs and symptoms that collectively characterize CFS. (See accompanying box.)

The major criteria for diagnosing CFS are (1) the new onset of fatigue that lasts longer than six months and reduces one's level of activity by 50 percent and (2) the exclusion of other medical or psychiatric conditions that could cause the symptoms. However, to be diagnosed with CFS, the patient also must suffer either 8 of the 11 symptoms on the list of minor criteria or 6 of 11 of these symptoms as well as 2 of 3 from the list of physical criteria.

Clearly, those who meet the diagnosis for CFS are extremely sick for a long time. The CDC made the definition of CFS very restrictive to identify these persons clearly. Those who have less severe forms of the syndrome are presently excluded by this definition.

What about doctors who say that CFS patients suffer from depression and other psychological disorders?

Do these patients have the classic symptoms of depression?

CFS patients are commonly depressed, but as Dr. Kurt Kroenke, professor at a medical school in Bethesda, Maryland, U.S.A., asked: "Wouldn't anyone be depressed if he or she stayed tired for a year or more?" So it is fair to ask: Is depression the cause of CFS, or is it a consequence?

That question is often difficult to answer. A doctor may consider the second point of the major criteria, which says that 'psychiatric conditions that could cause the symptoms need to be excluded,' and conclude that the patient suffers from depression and not from an organic or physical illness. Yet, in many cases this is not a satisfactory diagnosis.

The medical journal The Cortlandt Consultant noted: "The most compelling piece of evidence that CFS is an 'organic' illness is its sudden onset in 85 percent of patients. The majority of patients state that their illness began on a particular day with a flu-like syndrome characterized by fever, [sore throat, swollen lymph nodes, muscle aches], and related symptoms." Physicians who have handled CFS patients are convinced that depression is often not the cause of symptoms.

"When we compared our cases," reported Dr. Anthony Komaroff, chief of General Medicine at Brigham and Women's Hospital in Boston, U.S.A., "we were struck by the fact that most patients said they had been perfectly healthy, energetic and successful in life until one day they developed a cold, flu or bronchitis and it never went away. The symptoms that could be considered psychological depression, malaise, sleep disturbances and so forth didn't exist before the onset of the illness."

One classic symptom of depression is loss of interest in everything. But Dr. Paul Cheney explained: "These patients are just the opposite. They re terribly concerned about what their symptoms mean. They can't function. They can't work. Many are petrified. But they do not lack interest in their surroundings."

Swollen glands, fever, unusual white-blood-cell counts, repeated respiratory infections, muscle and joint pains, and especially a peculiar malaise and muscle soreness that may occur after even moderate exercise--these symptoms just don't fit a depression-related syndrome.

In its November 6, 1991, issue, JAMA reported: "Preliminary data from an ongoing study of patients who meet the CDC's definition of chronic fatigue syndrome (CFS) show that most patients with the illness are not victims of depression or other psychiatric problems."

Dr. Walter Gunn, who closely monitored CFS research at the CDC, explained in this issue of JAMA: "Despite the fact that many physicians would have thought all of these patients [in the study] were depressed, we found that only 30% of the CFS patients had evidence of depression at the onset of fatigue."

There may even be physical differences between many CFS patients and sufferers of depression. "Patients with major depression disorder (MDD) often have abnormalities in rapid-eye-movement (REM) sleep, whereas patients with CFS have abnormalities in non-REM [sleep]," noted the medical journal The Female Patient.

The magazine Science of December 20, 1991, reported another significant finding. It said that research indicates that "CFS patients have altered levels of certain brain hormones" and observed: "Although the differences from normal controls were modest, CFS patients consistently showed decreased levels of the steroid hormone cortisol, and increased levels of the pituitary hormone ACTH (adrenocorticotropin hormone), exactly the opposite of the changes seen with depression."--Italics ours.

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