Question

Like many other people with ME/CFS, I often feel fed up and frustrated by all the restrictions this illness imposes on my life. But I don’t feel depressed. I now have a new bright GP who thinks I am depressed and he wants me to try a course of antidepressants – to see if they make me feel happier! I know I would feel happier if I just felt well again. But I’m not convinced that I need antidepressants to do so!

Answer

GPs often make a diagnosis of depression based on guidance produced by The National Insitute for Health and Care Excellence (NICE). Patients need to have at least five symptoms from the guideline to be diagnosed with mild depression. Making a diagnosis should involve what is called a functional assessment. This involves assessing how depression impacts the patient’s day-to-day life and their ability to carry out normal daily activities.

The information below contains the NICE diagnostic criteria for depression. As you can see, there could be a problem here in relation to ME/CFS because four of the highlighted symptoms also occur in ME/CFS. However, if someone with ME/CFS has symptoms of depression that do not overlap with ME/CFS, then a diagnosis of depression, along with appropriate treatment, must be considered.

Alternatively, if you don't feel you have the necessay symptoms of depression, then you should return to your GP and take a copy of the NICE Guideline for ME/CFS to demonstrate the differences. I would also add that antidepressants can be prescribed to people with ME/CFS to help relieve the symptoms of pain and/or to try and improve sleep and sleep quality – see ‘more information' below.

See also:

• Mental Health: Anxiety and Panic Attacks
• Mental Health: Low Mood
• Treatment: Selective Serotonin Reuptake Inhibitors

NICE Clinical Guideline: Depression in adults: recognition and management | October 2009

Depression is a common mental health problem – it affects nearly 1 in 6 people in the UK. The main symptoms of depression are losing pleasure in things that were once enjoyable and losing interest in other people and usual activities. A person with depression may also commonly experience some of the following: feeling tearful, irritable or tired most of the time, changes in appetite, and problems with sleep, concentration and memory.

People with depression typically have lots of negative thoughts and feelings of guilt and worthlessness; they often criticise themselves and lack confidence. Sometimes people with depression harm themselves, have thoughts about suicide, or may even attempt suicide. Occasionally a person with severe depression may have hallucinations and delusions. People with depression may have feelings of anxiety as well.

Depression may have no obvious cause, or it can be set off for a variety of reasons (such as physical illness, or difficult things that happened in the past or may be happening now, like bereavement, family problems or unemployment). Some people have what is called ‘seasonal depression', which is linked to the change in seasons (usually occurring in winter when the days are shorter). People may have just one episode of depression. However, about half of people who have had an episode of depression will go on to have further episodes. Most people will feel better within 4 to 6 months of an episode of depression, while others experience symptoms for much longer.

Symptoms

1. 1. Depressed Mood.
   2. Markedly diminished interest or pleasure in most or all activities [anhedonia].
   3. Significant weight loss (or poor appetite) or weight gain [e.g., more then 5% of body weight].
   4. Insomnia or hypersomnia [increased sleep requirement].
   5. Psychomotor retardation [slowing down or hampering of mental or physical activities].
   6. Fatigue or loss of energy.
   7. Feelings of worthlessness or excessive or inappropriate guilt.
   8. Diminished ability to think or concentrate, or indecisiveness.
   9. Recurrent thoughts of death (not just fear of dying), or suicidal ideation, plan, or attempt.

Definitions

• • Subthreshold depressive symptoms: Fewer than 5 symptoms of depression.
  • Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
  • Moderate depression: Symptoms of functional impairment are between ‘mild' and ‘severe'.
  • Severe depression: Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.

Note: A comprehensive assessment of depression should not rely simply on a symptom count, but should take into account the degree of functional impairment and/or disability

• • NICE recognises the symptoms of depression used in The Diagnostic and Statistical Manual of Mental Disorders (DSM IV).

More information

• The ME Association ME/CFS/PVFS Clinical & Research Guide (The ‘Purple Book') examines depression in ME/CFS in more detail. We can send a free copy of the booklet to any nominationed healthcare professional together with ME Medical magazine.
• We have produced a free summary of the 2021 NICE Clinical Guideline for ME/CFS, and suggest that you familiarise yourself with its recommendations and discuss them with your GP, ME/CFS Specialist Service, or Social Care provider (as appropriate).
• Deatiled information relating to Mental Health and commonly prescribed antidepressants can be downloaded from the website shop. For example:
  • Depression – Antidepressants & other treatment options: We explain depression and how it is completely understandable when living with ME/CFS. We also review treatment options including antidepressants, self-help, good CBT, and, counselling.
  • Drugs – Amitriptyline: Depression, Pain & Sleep Relief: We explain how Amitriptyline was developed as an antidepressant, but is now used more commonly to help with pain and sleep problems that occur in ME/CFS.
  • Managing Your Emotions: Dr Lisa Dvorjetz (Psychology Adviser to the ME Association) explains the role that emotions can play on health despite ME/CFS being a neurological condition, and considers how you can best manage them.