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Fatigue and Depression: Is It Chronic Fatigue Syndrome?

Fatigue and Depression

“I am absolutely exhausted, and it’s getting worse. And what’s up with the muscle and joint pain? Something’s terribly wrong here.”

Commenting on one of my L-methylfolate posts last night, a chipur reader was good enough to share information regarding his bout with depression, chronic fatigue syndrome, and exercise intolerance.

So that got me to thinkin’…

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is a mysterious load of misery. It’s characterized by extreme fatigue that’s often exacerbated by physical, emotional, and mental activity. And the problem is – it doesn’t resolve with rest.

Symptoms of CFS may peak and stabilize early in its presentation – then come and go over time. Complete recovery is a possibility; however, many sufferers get progressively worse.

Should you suspect you have CFS, get to a physician as soon as possible. If you, indeed, have it your chances of managing it well – or remission – are greater. If it isn’t CFS, early diagnosis and treatment are essential.

“What does CFS look like?”

The signs and symptoms of CFS are all over the board – and there’s no detectable pattern. Here are its primary symptoms…

  • Fatigue
  • Sore throat
  • Mildly enlarged and painful lymph nodes in the neck and armpits
  • Muscle pain with no explanation
  • Pain that moves from one joint to another with no swelling or redness
  • Headache – a new type, severity, or pattern
  • Unrefreshing sleep
  • Over-the-top exhaustion lasting for more than 24 hours after physical, emotional, or mental exercise

Other common signs and symptoms…

Chest pain, diarrhea, abdominal pain, dizziness and balance issues, chronic cough, allergies or sensitivities to foods and other stimuli, bloating, shortness of breath, weight loss/gain, visual disturbances, morning stiffness, chills/night sweats, irregular heartbeat, depression, irritability, anxiety, panic, and more.

“Who’s more likely to get it?”

Sorry, ladies. Although gender isn’t a proven risk factor, the record shows you’re at least four times more likely to get CFS than us guys. But that may actually be a good thing – it may be because you’re more apt to report symptoms and seek treatment.

Though CFS can present at any age, it’s more likely to strike those in their 40s and 50s.

“What causes CFS, anyway?”

No one really knows. But here are a few ideas…

  • Iron deficiency anemia
  • Impaired cellular metabolism
  • Depression
  • Viral infection
  • Immune system dysfunction
  • Hypoglycemia
  • An autoimmune process
  • History of allergies
  • Changes in levels of hormones generated by the activity of the HPA axis (I’m thinking especially cortisol)

“Is there a test?”

Unfortunately, there’s no test for CFS. And that means a diagnosis is grounded in signs, symptoms, and exclusion. So it’s all about rule-outs, and the biggies are…

Hypothyroidism, sleep apnea, depression, eating disorders, a relapse of a previously treated illness, substance abuse, and severe obesity (BMI: 40+).

“How is it treated?”

There’s no specific treatment for CFS. So that means physicians and counselors typically recommend a combination of strategies and techniques to manage symptoms. These may include…

  • Slow down! Learn to moderate physical, mental, and emotional stress.
  • Counseling – especially cognitive behavioral therapy (CBT) to address stress management, depression, anxiety, and thought management.
  • The gradual onset of an exercise program. If you already have one, adjustments may have to be made.
  • Make sure those lifestyle habits are healthy.
  • Treat the symptoms and associated disorders – depression, physical pain, sleep issues, allergy-like symptoms, hypotension, neurological issues (dizziness, balance issues, skin tenderness, etc.)
  • D-ribose supplements
  • Acupuncture
  • Massage, stretching, yoga, meditation, tai chi, breathing and relaxation exercises

The following experimental treatments for CFS are being studied…

  • Methylphenidate (Ritalin, Concerta, etc.): An amphetamine, which has shown promise in decreasing fatigue and improving concentration. It’s used to treat attention deficit/hyperactivity disorder (ADHD).
  • Corticosteroids (hydrocortisone)
  • Immune globulins and interferons: Used to improve the immune system’s ability to fight infection.
  • Cholinesterase inhibitors: These drugs improve the effectiveness of acetylcholine, a neurotransmitter that is believed to be important for memory, thought, and judgment.

The Wrap

So there you have it – a thumbnail on chronic fatigue syndrome (CFS). It should be just enough information to lend a hand in identifying a potential problem.

If you’ve been diagnosed with CFS, perhaps the article will provide a helpful refresher.

The sites of CFS support associations abound on the web. Here are a few…

National Chronic Fatigue Syndrome and Fibromyalgia Association The ME (myalgic encephalomyelitis) Association (UK) ME/CFS Australia

For much more on the biology of the mood and anxiety disorders, click here.

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  • Janeandpeter Johnson

    What if you truly believe that you have chronic fatigue, you have undergone a lot of tests, then moved, they want to do the tests again and again! One doctor says chronic fatigue then another says no! Where do you go for help as just being so damn tired makes it to exhausting to keep trying to find a reason why you are so tired! PLEASE HELP

    • Recovered CFS patient

      There is no test for CFS, it is purely a diagnosis of exclusion. So as long as you have been tested for iron deficiency, diabetes and the other usual suspects, then you DO have CFS (or at least chronic fatigue) if you have the symptoms.

      The solution is always the same: lifestyle change. CFS is generally caused by stress, so you need to remove the stresses. Don’t make the mistake of doing too little – that can be just as bad. The key to recovery is gradually increasing moderate mental and physical activity WITHIN YOUR LIMITS. Make sure you do enjoyable, motivating activities. Ensure you don’t have any significant periods of negative emotions (particularly anger), as that can be a major trigger for relapse.

      • Thank you so much for helping out Janeandpeter. Great input! It’s participation such as this that helps all of us learn, grow, and heal.

        Appreciate it, Recovered CFS patient…
        Bill