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Next, I was asked by a member the difference between ME and depression.
This is an interesting one and sometimes difficult to pin down. Again, ask
the patient, they can help you!
This subject is covered extensively by another “expert patient colleague”. Dr. Eleanor
Stein, MD FRCP of Calgary, Alberta, Canada. Dr. Stein has ME and is the author of
“Assessment and Treatment of Patients with ME/CFS: Clinical Guidelines for Psychiatrists”.
This document and others are available to download at
<http://www.fm-cfs.ca/resources-p.html>.
Although not an exhaustive list, some pointers are listed below:
1. Depression and ME can co-exist or be independent of each other. Throughout a long
illness, low mood and true depression can come and go. If your GP asks about depression, you
should not get defensive, as it is part of their job to ask.
2. More variability of mood symptoms day-to-day in ME versus general trend of overall low
mood in depression proper. With ME, mood tends to coincide with other symptom flares e.g.
fatigue/ pain/ disabling dizziness.
3, Appetite loss/increase is more common in depression than ME unless there are overriding
gut symptoms or dysfunction.
4. Onset of ME is often post viral, depression almost never unless a life threatening illness
episode occurs.
5. Pain associated with or without a low mood is a feature of ME. Although chronic pain of
any origin can drive anyone to suicidal thoughts. All such individuals should seek immediate
advice if they feel this applies to them.
6. Agitation – a feature of a kind of depression that is not usually true of most ME
sufferers although they can co-exist too.
It is not uncommon for doctors to admit defeat in helping you manage ME and prescribe a
course of anti-depressants on a trial basis. They are not always implying that you are
depressed. Sometimes antidepressants such as amitryptyline in a low dose can help with pain
control and sleep problems. Like life itself there’s no guarantees and its trial and error.
However, whatever we do as doctors its HOW we do it that’s as important as WHAT we do!
I prefer a patient focused agenda and explain to patients the rationale and let them
decide.
7. There are many more symptoms in the ME menu and fewer in the depression one by
comparison.
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