What treatments work for anxiety and depression in children and adolescents with [CFS]? An updated systematic review, 2021, Clery et al

rvallee

rvallee

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Oxford criteria, so tagged as "chronic fatigue", not applicable to ME/CFS.


Philippa Clery*, Alexander Royston , Katie Driver, Jasmine Bailey, Esther M Crawley, Maria Loades
https://research-information.bris.a...-for-anxiety-and-depression-in-children-and-a


Objectives
Children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared to age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings.

Design
A systematic review. We searched Cochrane library, Medline, Embase and PsychINFO databases from 2015-2020. We combined the updated results with our previous reviews in a narrative synthesis.

Participants
Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centre for Disease Control, National Institute for Health and Care Excellence, or Oxford criteria); validated measures of depression and/or anxiety.

Interventions
Observational studies or randomised controlled trials.

Comparison
Any or none.

Outcomes
Studies with outcome measures of anxiety, depression, or fatigue.

Results
The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared to specialist care alone. Previous studies evaluated cognitive behavioural therapy (CBT); pharmacological interventions; and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated.

Conclusion
Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME.
 
A rare admission from the authors of most of the studies applicable here that they are of poor quality and insufficient to conclude anything. Which makes their past, and likely future, assertions of this positively bizarre, but no less than usual.
 
Nice that they got to shoehorn in Crawley's LP study, however. I doubt this paper mentions that study's 3,000-word correction.

Edited: Out of an excess of discretion, I removed a very derisive adjective before "LP study." It was true but I decided to remove the word anyway.
 
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But as we know there is no treatment. I assume you mean provide symptomatic treatment where possible and provide good ongoing support to the child and their family.
There can also be comorbid anxiety and/or depression exacerbated by having a seriously debilitating physical illness. But I suspect a lot of the anxiety and depression diagnosed in pwME is either misdiagnosis based on questionnaires, or natural sadness and anxiety about the drastic changes ME makes to our lives.
 
Regarding anxiety and depression in children... A personal anecdote.

I had major surgery in the first half of the 1970s. I'd been extremely severely ill for a month before the doctors decided there really was something wrong with me and operated on me. After I recovered sufficiently I was kicked out of hospital then after some more time spent in recovery I was sent back to school. I was exhausted, and I stayed exhausted for the next two or three years. I put on vast amounts of weight, plodded through life with zero energy, was extremely depressed and very, very anxious, and had no mental or physical energy. I wasn't diagnosed with CFS in that era. I was diagnosed with laziness.

My GP diagnosed me with anaemia about 2 or 3 years after my major surgery and I got treated for it. Slowly I lost weight and my depression and anxiety diminished. Unfortunately for me, I didn't connect me feeling better and losing weight and being less depressed and anxious with the iron pills. I connected it with starting smoking which happened at about the same time, which made it much harder for me to give up smoking in later life. I didn't ever want to go back to being the person I was in my early teens again.

Over forty years later I bought my medical records and discovered that following the surgery I had in the first half of the 70s I was discharged with known iron-deficiency anaemia, and a little note was left on one page of the surgery notes saying to my GP "Please treat this girl's anaemia". I doubt my GP ever read it. He certainly never acted on it at the time.

Decades later I discovered that anxiety and depression are a common sign for me of low iron and they are almost always cured, at least for a while, with iron treatment.
 
Arnie Pye said:
Regarding anxiety and depression in children... A personal anecdote.

I had major surgery in the first half of the 1970s. I'd been extremely severely ill for a month before the doctors decided there really was something wrong with me and operated on me. After I recovered sufficiently I was kicked out of hospital then after some more time spent in recovery I was sent back to school. I was exhausted, and I stayed exhausted for the next two or three years. I put on vast amounts of weight, plodded through life with zero energy, was extremely depressed and very, very anxious, and had no mental or physical energy. I wasn't diagnosed with CFS in that era. I was diagnosed with laziness.

My GP diagnosed me with anaemia about 2 or 3 years after my major surgery and I got treated for it. Slowly I lost weight and my depression and anxiety diminished. Unfortunately for me, I didn't connect me feeling better and losing weight and being less depressed and anxious with the iron pills. I connected it with starting smoking which happened at about the same time, which made it much harder for me to give up smoking in later life. I didn't ever want to go back to being the person I was in my early teens again.

Over forty years later I bought my medical records and discovered that following the surgery I had in the first half of the 70s I was discharged with known iron-deficiency anaemia, and a little note was left on one page of the surgery notes saying to my GP "Please treat this girl's anaemia". I doubt my GP ever read it. He certainly never acted on it at the time.

Decades later I discovered that anxiety and depression are a common sign for me of low iron and they are almost always cured, at least for a while, with iron treatment.
Click to expand...
 
Though not everyone with ME has a vitamin B12 deficiency, there is the suggestion that a B12 deficiency is more common in people with ME compared to the general population.

However there are a number of possible explanations for this hypothetical association
  • It is an indirect result of ME, eg in that people with ME tend to have poorer diets
  • It is somehow a result of having ME for some people
  • Vitamin B12 issues somehow makes people more susceptible to getting ME
  • Both vitamin B12 deficiency and ME are influenced by a third distinct factor down stream
My subjective experience of having vitamin B12 deficiency is that its symptoms are hard to distinguish from ME symptoms, but that supplementation appears to only have any positive effect when I am in deficit. So when I am in deficit supplement may improve my symptoms but only up to the point of correcting the deficiency. Subsequent supplement does not result in further improvement in ME symptoms, though it may prevent returning to a deficiency with its associated worsening of ME symptoms.

It may be that testing levels of vitamins and minerals is appropriate for everyone with ME to ensure that deficiencies are not contributory factors.
 
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Peter Trewhitt said:
Though not everyone with ME has a vitamin B12 deficiency, there is the suggestion that a B12 deficiency is more common in people with ME compared to the general population.

However there are a number of possible explanations for this hypothetical association
  • It is an indirect result of ME, eg in that people with ME tend to have poorer diets
  • It is somehow a result of having ME for some people
  • Vitamin B12 issues somehow makes people more susceptible to getting ME
  • Both vitamin B12 deficiency and ME are influenced by a third distinct factor down stream
My subjective experience of having vitamin B12 deficiency is that its symptoms are hard to distinguish from ME symptoms, but that supplementation appears to only have any positive effect when I am in deficit. So when I am in deficit supplement may improve my symptoms but only up to the point of correcting the deficiency. Subsequent supplement does not result in further improvement in ME symptoms, though it may prevent returning to a deficiency with its associated worsening of ME symptoms.

It may be that testing levels of vitamins and minerals is appropriate for everyone with ME to ensure that deficiencies are not contributory factors.
Click to expand...
Iodine deficiency can also influence energy levels, and is not easily tested for. A diet interview is the easiest way to screen for it (the other is collecring all urine output for 24h). With an illness that can influence dietary habit for whatever reason, a dietary interview, together with bloodwork, should be administered to pick up on (potential) deficiencies.
 
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