Depression in Patients with Neuromyasthenia (Benign Myalgic Encephalomyelitis)

Abstract

Neuromyasthenia (benign myalgic encephalomyelitis) is a term used to describe a protracted and incomplete recovery phase following viral-like illnesses. There are few significant physical findings or abnormal laboratory determinations. Although depressive symptoms have been observed in individuals with neuromyasthenia, systematic psychological investigations based on a standardized interview technique have not been reported. This study was designed to investigate the prevalence of psychiatric disorders and psychiatric symptoms in a group of patients presenting with neuromyasthenia. The study consisted of three parts: a structured psychiatric interview (The National Institute of Mental Health Diagnostic Interview Schedule), a self-report measure (The Beck Depression Inventory) and Dexamethasone Suppression Test. Results indicated that relative to a matched comparison group of non-clinical volunteers, a significant percentage (67%) of neuromyasthenic patients met criteria for major depression. Even more striking was the observation that 50 percent of the sample had a major depressive episode prior to the development of neuromyasthenia. These findings suggest that sporadic neuromyasthenia may be the result of an organic illness in psychologically susceptible individuals.

Hypochondriasis Influences Quality-of-Life Outcomes in Patients with Chronic Fatigue

“…However, this associa tion was significant only for those patients seen in general medical settings, indicating that in a cross-section of the population or in an ill sample with a not too elevated inci dence of depressive disorders, the presence of depression covaries with quality-of-life measures. Similarly, in a large clinical study using the Illness Behavior Questionnaire (an instrument that includes the 14 items employed by us to determine the hypochondriasis score), depressed pa tients showed significantly higher levels of disease convic tion and general hypochondriasis than the nondepressed patients [37], Chronic fatigue patients, on the other hand, have been repeatedly shown to have a very high preva lence of depression [5,6,[38][39][40], They arc at the extreme end of the distribution of depressive symptoms in the population, and the usual relation between variability in depression (diagnosis or number of symptoms) and hypo chondriasis and quality of life throughout the rest of the distribution may not be observed.…”

Neurasthenia in a longitudinal cohort study of young adults

“…The proportions of neurasthenics who also exhibit a psychiatric disorder range from onehalf to three-quarters in psychiatric samples (Allan, 1944;Taerk et al 1987;Manu et al 1988;Strauss, 1988;Swartz, 1988;Kruesi et al 1989;Wessely & Powell, 1989;Hickie et al 1990), and from one-third to one-half in primary care settings (Katon & Walker, 1993). Katon & Walker (1993) reported that the association between fatigue and anxiety and depression increases as one moves from the community to primary care to tertiary care facilities.…”

Chronic fatigue syndrome and depression: conceptual and methodological ambiguities

“…Problems of causality will not necessarily be resolved by refinements in assessment procedures, though discriminating between symptom criteria will help to determine to what extent it is legitimate to talk of a depressive syndrome in the context of CFS. An indication that depression preceded the onset of a physical illness would, however, suggest that it plays some causal role and there is indeed some evidence of psychiatric disorder antedating the onset of chronic fatigue (Taerk et al 1987;Kruesi et al 1989;Wessely & Powell, 1989). Nevertheless, such evidence too needs to be carefully scrutinized.…”

“…(a) the syndrome may be a non-specific response, with multiple somatic and psychological causes (Straus, 1988;Swartz, 1988); (b) the relationship between these causes, somatic and psychological, may be interactive rather than additive (Archer, 1987;Taerk et al 1987;David et al 1988 b); the impact of any single factor would then depend upon the presence or absence of other coexisting conditions; (c) the variables involved may have a reciprocal influence, leading potentially to a vicious circle and a cumulative decline in functioning; (d) CFS may prove to be a heterogeneous condition, with different combinations of factors producing symptoms in individual cases.…”