rollingout article "Why chronic fatigue is mistaken for depression: The consequences of misdiagnosis for an invisible illness"

Just logging this article (courtesy Dr Fluks' newsfeed) which rationally discusses the problem of misdiagnosing ME/CFS as depression.

Thought it deserved to be known about and discussed so others can analyse its strengths and weaknesses in finer detail.

I thought it gave a realistic overview and was reasonable about the way symptoms can overlap, why misdiagnosis can occur, why this is problematic and which symptoms distinguish ME/CFS from depression, including infectious onset and PEM.

Why chronic fatigue is mistaken for depression
The consequences of misdiagnosis for an invisible illness
https://rollingout.com/2025/04/20/why-chronic-fatigue-mistaken-depression/

 

It kept calling it Chronic Fatigue and claimed immune system modulators as a treatment. No mention of LTSE - Long Term Symptom Exacerbation from trivial exertion.

 

The title says CF, but the text says ME/CFS. Huge red flag that they have not clarified the differences.

PEM is not an «energy crash». PEM, when properly defined, does not occur in depression at all, unless the patient has a comorbidity with PEM.

It would have been better to show what the diagnostic criteria for ME/CFS require.

This is a non-argument. Depression doesn’t just appear - it is a result of something. And if a patient experienced all of those symptoms it would not be wrong to say that they have a comorbidity of depression.

While that is true for some, some might not have a definitive onset so it could appear like ME/CFS developed gradually. This could even happen for mild infections.

This section misses an important point - misinformation (as opposed to lack of information).

It also does not acknowledge how patients are being mistrusted and gaslighted.

This section misses the crucial points about encouraging activity for depressed patients and the harm done through not teaching them how to pace and not providing adequate help to be able to pace.

Overall, the article reads like a very superficial analysis of the issues pwME/CFS experience in relation to the diagnostic process.

 

I think depression is a result of many illnesses, both before and after diagnosis. Fix the underlying condition and the depression might disappear without further treatment. But the medical profession seems to treat depression as a disease in its own right and rarely treats it as anything else (in my experience). And the only treatment usually offered is anti-depressants.

In my own case I was prescribed four different anti-depressants in about 15 years or so (not all at the same time), during 1995 - 2010. I eventually fixed my own depression and anxiety when I got my levels of iron and ferritin up a lot higher than my doctor was happy with. I do keep my levels of anything iron-related in the "normal" range, but my GP was quite happy to leave me with a ferritin level of about 20. I feel much better with a level of roughly 100. I had to plead for a prescription for iron supplements and it was given extremely reluctantly. Later, I found that iron supplements of the kind that GPs prescribe in the UK can be bought in pharmacies without prescription. I've never needed to speak to a doctor about my iron ever since.

I have other health conditions that I know I can't fix because no cure is available, but at least I'm not drowning in depression and anxiety all the time now, which is a massive improvement in my quality of life.