Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study 2023 Eggart

Background
Fatigue is a core symptom of major depressive disorder (MDD) and is frequently refractory to antidepressant treatment, leading to unfavorable clinical/psychosocial outcomes. Dysfunctional self-reported interoception (i.e., maladaptive focus on the body’s physiological condition) is prevalent in MDD and could contribute to residual symptom burden of fatigue. Therefore, we explored (a.) cross-sectional correlations between both dimensions and investigated (b.) prospective associations between interoceptive impairments at admission and symptom severity of fatigue at the end of hospitalization.

Methods
This observational, exploratory study included 87 patients suffering from MDD who completed self-rating scales, the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), and the Multidimensional Fatigue Inventory (MFI-20), at the beginning and end of hospitalization. Bivariate correlations (r) and hierarchical regression analyses were performed.

Results
The cross-sectional analysis showed moderate to large negative correlations between the MAIA-2 and MFI-20 dimensions except for the Not-Distracting scale. Symptoms of general, physical, and mental fatigue at the end of hospitalization were predicted by reduced body Trusting (β = -.31, p = .01; β = -.28, p = .02; β = -.31, p = .00, respectively). Increased Body Listening (β = .37, p = .00), Not-Worrying (β = .26, p = .02), and diminished Attention Regulation (β = -.32, p = .01) predicted higher mental fatigue.

Conclusions
Diminished body confidence at baseline identified patients at risk for post-treatment fatigue and could therefore serve as a target for improving antidepressant therapy. Body-centered, integrative approaches could address treatment-resistant fatigue in MDD. However, clinicians may also consider the potential adverse effect of increased Body Listening and Not-Worrying on mental fatigue in psychotherapeutic and counselling approaches. Due to the exploratory nature of this study, the results are preliminary and need to be replicated in pre-registered trials with larger sample sizes.

Open access, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05168-y

 

"You're not fatigued, you just think you are". Yeah, no one ever thought of that before. This is just high-level genius. For sure this is not already a very common belief, dating back beyond a century. Nope, this is brand-new novel insight right here. Preliminary stuff, needs decades of validation through the use of dozens, maybe even hundreds, of small scale trials of some kinds.

None of those questionnaires have any scientific validity. There is no amount of mathemagics they can throw at it that will change that.

Real professionals dig where there already are holes. How else are you going to know if it's worth digging there?

 

Yes they seem to have a very specific way of looking at and seeing certain things vs others might on 'the framing'. And it is about time the field was made to define at least the broad different component 'fatigues' that the ambiguous term umbrellas for and leaves apples and oranges and apples-combined-with-oranges compared in reviews.

It's like getting away with putting all 'bad hair' research under the one term when the stuff that looks into the objective hair diseases stuff has to comply with regulatory research standards, but the stuff that doesn't separate that out and just asks owners 'whether it makes you feel bad' doesn't and doesn't have to calibrate the feeling bit from the what the hair is actually like or any underlying conditions part from it and claiming they are both trying to cure/looking at the same things.

And I have that smell of the same safeguarding issues of people who with this condition being vulnerable to the exhaustion and it must feel like bullying having MDD and someone shapeshifting and barristering you with questions about 'maybe do you think you are thinking about your tiredness wrong with your body' when your brain is dog-exhausted. It feels so darned inappropriate and not a methodology at all to claim you've not probably led a horse to water with inconsiderate approaches to the disability in the itnerview design, pace of cognitive, style of questions, length of it etc. There really needs to be a step-change in how researchers are expeced to consider disability, vulnerability and limitations in their design so it isn't basically risking leading by the nose coercion. Even if the well interviewer thought it was a nice amiable chat.

I'm intrigued by how they get away with the term 'refractory to antidepressant treatment' rather than 'the drugs don't work [on]' (couldn't resist using the song lyrics) for depression. I guess that is/will be where this area would preferably take CFS, MUS, any illness they can get away with co-opting - can't possibly be that they need to have the humility of objectively even quoting the assessed effectiveness or 'don't work for everyone, and even in those they might they aren't 100% effective' facts.

Paricularly given that perhaps the drugs aren't tested to work on fatigue and sometimes they have this as a side effect whilst being taken for its impact on oher symptoms. So I'm not sure that just because antidepressants not designed for fatigue aren't curing fatigue isn't straw-manning the idea that the other stuff is the solution. Or that what they've suggested is the cause. Or that what they've designed tests either.

It's a crying shame because those suffering from this deserve to have whatever it actually is defined and then looked into properly so there is a chance of them having the best approach possible (individually re checking their meds, other possible conditions, deficinecies etc and situational, not just chucking them into a trial for a 'transdiagnostic' presumptive approach 'because its all fatigue' as a mixed bag)

I wonder why they have decided to go down this rewriting and starting using this term of 'stubborn refractory cases' etc. even in things like many autoimmune diseases you have 'atypical' or whatever as a termI thought

but then a google of the definition of refractory brings the following up, which has asthma as an example sentence so... but to be fair at least this relates I assume to what the std drugs were designed/tested to treat symptom-wise in this context