Depression Around the Holidays for ME/CFS & Fibromyalgia Patients

I know a lot of people don’t understand why I don’t look forward to Christmas, but if you suffer like I do, I know you know where I’m coming from.  For me, the holidays just represent more work, more exhaustion, more flares.  I try my best to stay upbeat for my family but all I can think about is how all of the extras of the season are going to come back to bite me with a bedridden flare.

This year is even more of a worry for me because we have additional things going on that will make this holiday season very busy.  I always start to feel depressed and all I want is not to feel that way.  I guess I need to put that on my Christmas list for Santa…no depression for Christmas.  I know that it is common for us with chronic illness to become depressed around the holidays and article after article will give ideas and suggestions on how not to be depressed around the holidays, but who am I kidding?  I’m tired of writing those articles when I’m not feeling it myself. 

Getting gifts ready, whether they are wrapped or put in gift bags, shopping…all of the little extras that “normals” take for granted are just added stressors for me.  Trying to remember everything is another problem.  My mind is constantly going with what I can’t forget, who I still need to buy presents for, etc.  Lists aren’t even working for me this year because I’m then wondering who I forgot to put on the list.  It just goes on and on and I want the stress to be over! 

I think I need to up my Prozac over the next couple of weeks until the holidays die down.  Trying to talk to others about this doesn’t help because they don’t get it.  Most people suggest that you just don’t worry about it.  That’s easy to say when they are the ones who can wait until the last minute to do everything and still have lots of energy left over.  I don’t have that luxury.  None of us do who are sick.

Is Depression Part Of Your ME/CFS?

Many ME/CFS patients have been misdiagnosed with depression before they are finally given the proper diagnosis of ME/CFS.  I know I was told by doctors, even after my CFS diagnosis, that I was just “depressed” and needed to “lighten up” and not “stress so much”.  Over the past 20 years I have probably been on more than half a dozen different antidepressants.  While I don’t believe that people with ME/CFS are sick because they are depressed, I do believe that many do suffer from depression because they are sick. 

How can we not get depressed sometimes?  I know that I will go through bouts of depression each time I enter a flare.  Even when you have been sick as long as I have,  the return of major symptoms always brings with it some depression.  It’s never easy trying to carry on with life when you can’t fully enjoy it and after a while it gets old trying to pretend, put on a happy face and act as though it is no big deal. 

In my opinion, I would find it very hard to believe if someone with a chronic illness like ME/CFS would tell me that they have never suffered any depression since becoming sick.  I think that many times patients are afraid to ever mention the fact that they get depressed to their doctors because of the stigma that surrounds ME/CFS.  If a patient admits they are depressed, they fear the doctor will tie all of their symptoms to depression instead of to the real cause. 

While I am not big on taking tons of medications, I do believe that antidepressants are a staple for me and I need them. 

If you have ME/CFS or some other chronic illness, have you:

• been diagnosed with depression along with your illness?
• initially been diagnosed with just depression?
• fear telling the doctor that you have bouts of depression with your illness?
• take any antidepressants?

Alternative Treatments for Depression, Anxiety & Stress

I was reading an online article from Dr. Richard Podell, who is a clinical professor at the Robert Wood Johnson Medical School, on alterantive treatments for depression, anxiety and stress.� Dr. Podell is a specialist in stress disorders, ME/CFS and Fibromyalgia.

Dr. Podell believes that by adding alternative treatments to standard treatments the patient will receive better results and show an overall improvement.� This is what he has to say about combining natural and standard therapies:

Our approach adds to standard therapies the often over-looked elements of natural healing – including nutrition, herbal, and mind-body therapies. These add holistic support for the body�s natural healing systems, which help resist and overcome a broad range of both physical and mental health problems, including but not limited to depression, anxiety, and stress.

Dr. Podell also says that the mind and body function together, not separately, as many people think.

The unstated assumption of most conventional strategies is that mind and body function separately: Each organ of the body is largely on its own. However, current science shows that just the opposite is true.

The multiple systems of mind and body communicate and interact with each other in a complex holistic web of biochemical, hormonal, and metabolic relationships. Even such distant organs as the brain, thyroid gland, adrenal gland, immune system, gut, and liver interact, and in important ways function effectively as one.

Our functional medicine approach views all systems of the mind and body as part of one large, interactive web. This implies that any obstacle to healing that affects one part of the system feeds through and harms all others. Any improvement we can make in any part is also likely to feed through this web and improve your well-being as a whole.

Dr. Podell provides a great list of alternative treatments for depression, anxiety and stress.� As always, never try any of these treatments without first consulting with your physician.

Alternative�treatments for depression – nutrients

• Inositol – Intracellular second mechanism [�messenger� within nerve cells]
• S-adenosyl methionine (SAMe) - Improves methylation pathways (see later section on Brain Biochemistry.)
• Fish Oil – Omega-3 essential fatty acid
• Tyrosine – Amino acid body uses to make norepinephrine and dopamine
• Eliminate wheat gluten – May apply if blood antibody test is abnormal
• Anti-hypoglycemia style diet – Mood stabilizing effect
• Folic Acid – Improves methylation pathways
• Vitamin B-12 – Improves methylation pathways
• Tryptophan – Amino acid. Body uses to make serotonin
• L-Carnitine – Improves mitochondrial energy metabolism
• Thiamine (Vitamin B1) - May help energy pathways
• �Allergy� elimination diet – May be helpful for some

Alternative treatments for depression – herbs & hormones

• St. John�s Wort – Serotonin and norepinephrine reuptake inhibitor
• Estrogen – Often helps in perimenopause; usually does not help during menopause
• Testosterone – Possibly helpful for both men and women
• Thyroid, especially T3 form – Double blind studies show improvement even if thyroid blood tests are normal
• �DHEA - Adrenal gland hormone

Alternative anxiety treatments – these have scientific studies supporting their use

• Magnesium�
• Inositol
• Valerian root
• Kava herb
• Rhodiola herb
• Appropriate exercise (not too much, not too little)�
• Hypoglycemia diet�
• “Food allergy” elimination diet
• Candida yeast overgrowth theory (speculative)

Stress management techniques and treatments

• Relaxation skills
• Cognitive behavior treatment (CBT)

Source

Factors Associated with Depression Among Individuals with ME/CFS

Objectives: Most previous research regarding chronic fatigue syndrome (CFS) and depression has relied on clinical samples. The current research determined the prevalence and correlates of depression among individuals with CFS in a community sample.

Methods: The nationally representative Canadian Community Health Survey, conducted in 2000/2001, included an unweighted sample size of 1,045 individuals who reported a diagnosis of CFS and had complete data on depression. Respondents with CFS who were depressed (n = 369) were compared to those who were not depressed (n = 676). Chi-square analyses, t-tests and a logistic regression were conducted.

Results:
� Thirty-six per cent of individuals with CFS were depressed.

� Among individuals with CFS, depression was associated with lower levels of mastery and self-esteem.

� In the logistic regression analyses, the odds of depression among individuals with CFS were higher for females, younger respondents, those with lower incomes and food insecurity, and those whose activities were limited by pain.

� Two in five depressed individuals had not consulted with any mental health professional in the preceding year.

� Twenty-two per cent of depressed respondents (7.9 per cent of all those with CFS) had seriously considered suicide in the past year.

� Individuals with CFS who were depressed were particularly heavy users of family physicians, with an average of 11.1 visits annually (95% confidence interval = 10.7, 11.6).

Conclusion: It is important for clinicians to assess depression and suicidal ideation among their patients with CFS, particularly among females, those reporting moderate to severe pain, low incomes and inadequate social support.

Source

How Biological Abnormalities Separate ME/CFS From Depression

“Chronic fatigue syndrome [ME/CFS] and depression share symptoms and may coexist - but thanks to new efforts spearheaded by the CDC, skilled clinicians can more easily tell them apart.”  Katherine M. Erdman, MPAS, PA-C

Assistant Director of the Physician Assistant Program at Baylor College of Medicine in Houston, Katherine Erdman, wrote a really great educational article titled How Biological Abnormalities Separate CFS from Depression.� You can read the entire article online at the Journal of the American Academy of Physician Assistants website.

Katherine Erdman points out in her article:

Investigators have been studying CFS from an evidence-based perspective for more than 2 decades. The CDC recently declared, “There is now abundant scientific evidence that CFS is a real physiological illness. It is not a form of depression or hypochondriasis. A number of biologic abnormalities have been identified in people with CFS.”

The lack of credibility given to CFS has been a key obstacle to understanding and acceptance of it as a formal disease state. The CDC, in collaboration with the CFIDS Association of America, initiated a public health campaign to educate the medical community and the public and to advocate for awareness and effective management of CFS. The campaign includes increased dissemination of scientific findings, a CFS Toolkit for clinicians, new continuing medical education opportunities, detailed information on the CDC Web site, public service announcements, advertisements, brochures, and a traveling photo exhibit.

The article also directs readers to resources and guidelines clinicians can use for the workup and diagnosis of a patient with ME/CFS symptoms. Overall, writes Erdman, the challenge to the clinician is to decide for each patient whether the fatigue and other symptoms are due to primary depression, physical illness such as CFS, or a combination.  Medical professionals may take a test on the information this article offers to earn educational credits.

Source

NIH Depression Drug Trial Now Recruiting

The National Institute of Mental Health (NIMH) is now recruiting male and female patients ages 18 to 75 with chronic and/or recurrent major depression, for a trial titled Combining Medications to Enhance Depression Outcomes (CO-MED). (ClinicalTrials.gov Identifier: NCT00590863)

The Phase IV interventional trial, which will be conducted at 15 clinics in 13 states across the U.S., will test whether two different medications when given in combination as the first treatment step � compared to one medication � will:

• Improve remission rates (currently only about one-third of patients achieve remission when treated initially with one medication)�
• Increase speed of remission,�
• Be tolerable,�
• And provide better sustained benefits in the longer term.

The time frame for the trial is 28 weeks, and target enrollment is more than 650 patients.

For more information about the trial and the 15 clinic locations � each with its own contact information/links � and to review the inclusion and exclusion criteria, go to the ClinicalTrials.gov description of the Combining Medications to Enhance Depression Outcomes (CO-MED) trial .

Source

Protein From HHV-6 Linked to ME/CFS & Depression

Kazuhiro Kondo, MD, PhD, of the Jikei University Medical School in Tokyo, has found through research that there is a HHV-6 (herpesvirus-6) protein present in ME/CFS patients that is not in normal healthy people. This may contribute to the psychological symptoms that are associated with ME/CFS and disorders like it.

Dr. Kondo says that chronic viral infection is believed to be one of the most suspected causes of chronic diseases that have yet to have a cause determined.

This latest news was announced at the International Symposium on Viral Infections in CFS. Jose Montoya from Standford University supported Dr. Kondo’s claim by stating at the same conference antiviral drug Valcyte resulted in an improvement in the cognitive functioning of CFS patients but did not alleviate the fatigue issue. Valcyte has been shown to be effective again HHV-6.

The problem with Valcyte is that it doesn’t prevent reactivation of the virus and that is an issue that needs to be solved in order for�a patient to be cured.�

Kondo identified a novel HHV-6 protein associated with latent (non-replicating) HHV-6-infected nervous system and immune cells. Transfecting this new protein, called SITH-1 (Small Intermediate Stage Transcript of HHV-6), into nervous system cells called glial cells resulted in greatly increased intracellular calcium levels. Increased intracellular calcium levels are believed to play an important role in psychological disorders and can contribute to cell death. Expressing the SITH protein though the use of an adenoviral vector in mouse resulted in manic-like behavior.

A serological study indicated that 71% of CFS patients with psychological symptoms – and none of the healthy controls – possessed the antibody against the SITH-1 protein (p < .0001).

Further tests indicated that 53% of depression and 76% of bipolar depression patients possessed the antibody.

Researchers have suspected that central nervous system infections could contribute to psychological and central nervous system disorders, and patients with CFS have a much higher than average rate of depression.

This virus spreads cell-to-cell instead of releasing viral particles into the bloodstream. This has hampered efforts to demonstrate that the virus plays a role in CNS disease. “This virus persists in the brain and other tissues, but not the blood, which is where investigators have looked,” says Kristin Loomis, Executive Director of the HHV-6 Foundation. “Indeed, standard serum PCR DNA for direct evidence of the virus are useless,” she added.

New ultra-sensitive assays are under development, she reports, “but currently the best way to identify patients with smoldering HHV-6 infection is to look for elevated IgG antibody titers.”

�

Dharam Ablashi, the co-discoverer of the HHV-6 virus, and the HHV-6 Foundation’s Scientific Director, warns that the test won’t be available in the near future. “It may take years to get the assay validated and into commercial production, but will be worth the wait,� says Ablashi. �This assay could identify large numbers of patients with CNS dysfunction who could benefit from antiviral treatment. The HHV-6 Foundation is working hard to help scientists like Dr. Kondo develop better assays.”��

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