Psychiatry Advisor: Addressing depression in ME/CFS, 2018, Cindy Lampner

Because having it F***ING SUCKS?? Anyway, is there any data showing this anywhere, or is this the authors opinion?

 

Would you believe anyone who thinks this?

Although the true prevalence of ME/CFS is difficult to ascertain because of the varied methods of assessment, a meta-analysis of 14 studies estimated it at 3.28% on the basis of patient self-reports.

 

"""Other researchers contend that CE/MDD is an atypical manifestation of anxiety or depressive states"""

I like these people the best because they are the most perfect illustration for when somebody has no idea what they even think they are trying to say, and apparently could not possibly be less bothered by it. 'I know they're depressed, even if they aren't depressed...' - and somehow it makes perfect sense in their mind.

It's like an Oliver Sacks vignette: "I first encountered 'Simon W.' at a psychiatric conference in Liverpool..."

 

Ditto!

 

The whole point of all of the article content is to come to the conclusion that CBT is a very reasonable therapy that should be pursued (be not afraid) by people with ME. She lays the groundwork for this reasonable conclusion by showing how 'balanced' her views are in including opinions from clinicians who take a biological view.

How to unpack this? She has no idea how frequent MD is in the ME population:

but the article opens with this nugget:

The 'major depressive disorder' link takes us to:
Clinical Outcomes Assessed for Major Depressive Disorder With Psychotic Features

I'm not clear on the relevance of this very short post to the topic at hand.

So we have no idea how many PwME have MDD as a co-morbid condition.

We are told from the author quoting a clinician with a biological view (it's all biological but meaning here leaving out the psychological bits that BPS see as fundamental) that depression in ME is most often situational from having with a life altering illness.

Yet I see this POV as being dismissed despite it's inclusion as she embeds this quote in the middle:

I'm not even sure what that means. But it seems to contradict the previous statements on depression made by Dr Gordon.

Then she offers up the real 'valid' point. The one where BPS researchers take more holistic approach by inclusion of psychological factors. This is seen as the reasonable approach. The PwME are unreasonable in that their underlying assumptions about the physical nature of the illness prevent them from seeing CBT as a reasonable source of help for the condition.

It's never made explicit but it's clear the CBT is not for coping with the situation--implied by a biological model. The reference to MDD and the link along with the very reasonable BPS view of a more holistic approach and is a result of the implied psychosocial factors. This shows us what the author thinks:

The 'balanced view' part is interesting. She includes the perspective:

The 'balanced view' part is interesting. She includes the perspective:

Then she undermines the argument by following this with:

This is the point. The whole article is to lead to this conclusion as the only reasonable way to think about the issues of major depression and ME.

So Snowdrop cranky pants here thinks the whole thing is garbage.

Again, even I'm getting tired of being cranky but this garbage needs to stop. It's nonsense with no basis in fact.

Depression is as biological as any other illness. CBT to alter beliefs is rather more limited than BPS proponents would have us believe. And it does nothing for the symptoms of ME. You know, the major thing affecting people with ME.

 

First thing, Psychiatry Advisor is a marketing tool. The company compiling it is Haymarket Media https://www.haymarket.com

The author of the article has a master's degree in library science, not science or psychology.

So, it is not a peer-reviewed medical journal and its content is not of high caliber.

And notwithstanding the good words of Dr. Eric Gordon, who lives in my town, he is an 'integrative' alternative medicine (cash business) doc, if that's your thing, fine.

Here's his basic who-I-am-as-a physician statement from his website https://www.gordonmedical.com/the-making-of-a-physician/

 

This.

How is it not obvious? Who are these people? It’s not rocket science is it.

 

Lack of specificity is a weakness of a model/hypothesis/theory, not a strength.

Lots of unjustified statements in this one, it's the usual 'experts' with no personal experience claiming they understand when they fail to listen or understand the experiences of patients.

 

I should add that Gordon has participated in a metabolomics research project and is focusing more on research these days, so not all bad (I hope).

 

Replying to myself here, but I looked up Eric Gordon's medical license in California (because I am so adverse to quack docs) and he has a 3 yr. license probation which makes for interesting reading https://www2.mbc.ca.gov/PDL/document.aspx?path=\DIDOCS\20180425\DMRAAAGL15\&did=AAAGL180425200017533.DID&licenseType=G&licenseNumber=82342 #page=1

 

Oooook. No need to read any further than this.

Spoiler: being sick sucks and not having any support or hope sucks even more. Also a "diagnosis" of depression has zero reliability and is easily thrown off, either way, by superficial features and, especially, physician bias.

Surprisingly, people who just lost their house to fire are not particularly responsive to jokes and people with nausea aren't as hungry as they should be, but no one's explained that.

 

It would be nice to have some clarity on what depression actually is.

 

Yeah that was my objection to the sentence where it mentions it is not fully explained. It literally never is, we don't even know what it is, how it works, how it starts, how it progresses, how it ends and even less about the role psychology plays, it could be minor or even largely irrelevant. We know freaking nothing about depression and somehow that it may not be fully explained in a particular context is a problem. OK, then, arbitrary impossible standards for some, zero standards for others.

Same with anxiety. "Do you have anxiety? Yes? Then I guess you have anxiety." There's nothing formal or reliable about it. Nevermind that sometimes it's a normal reaction anyway. It would be great if we knew more, but we don't, making stuff up is not the way to resolve that problem.

 

They should do research into the timing of depression. For me at least I've noticed a very strong and consistent pattern. It seems like whatever dysfunction is going on, it is also affecting brain chemicals or neuroinflammation. In other words, I believe my depression is a direct, rather than indirect result of the pathology that's going on. I bet other people would report similar patterns.

 

I've often observed simplistic doctor thinking like this:

profound loss of function + labs are normal = depression

Because depression can cause profound loss of functioning and normal labs indicate no underlying medical condition. They aren't interested in another explanation.

 

The article kind of distorted the point of that meta-analysis. That study found 0.76% prevalence on the basis of clinically defined cases rather than self-reports. So no one was endorsing that expansive prevalence estimate. Here is the results section from the abstract: "Results: Of 216 records found, 14 studies were considered suitable for inclusion. The pooled prevalence for self-reporting assessment was 3.28% (95% CI: 2.24–4.33) and 0.76% (95% CI: 0.23–1.29) for clinical assessment. High variability was observed among self-reported estimates, while clinically assessed estimates showed greater consistency."

 

Having an uncurable chronic condition which can be highly debilitating, no useful medical support, scorn from family and support systems, that could in no way be depressing? I do think reactive depression is possible, and hard to treat in us because of how many of us react to SSRIs. We do not seem to have much primary depression, but I will note our suicide and attempted suicide rate is higher than even primary depression. This is because, and you nailed it, it sucks. Bigly. (Technical word )

 

Those suggesting depression in ME/CFS is due to the limitations the illness places on your life:

You are in effect saying that your depression has a psychogenic cause. That is, you are saying the depression is caused by events and limitations in your life, rather than thinking the depression might have a biological cause in the brain.

So on the one hand, you reject the idea that ME/CFS is psychogenic. But when it comes to depression, you argue the reverse, promoting the idea the depression has a psychogenic basis.

I find that paradoxical, although such views are common in ME/CFS patients.



As someone who suffers from comorbid depression, to me it seems very clear that my own depression is biological in its basis, and not psychogenic. This is because my depression varies a lot from day to day and week to week, but this variation does not reflect or follow any events in my life.

One day I may have pretty bad depression which I will usually try to ameliorate with supplements and antidepressant drugs. The next I may be fine. But nothing has changed in my life. So clearly the depression comes from biological factors within, not from psychogenic factors in my life.