Fibromyalgia and Chronic Fatigue Syndrome

[Guest guest]

Forwarded from Ilena's group:

> It's Not All In Your Head

>

> Dateline: 6/21/00

>

> As the FAME 2000 International Fibromyalgia Conference was nearing a close

> last month in Los Angeles, one of the presenters said: " Given the amount

of

> research that shows physical abnormalities in fibromyalgia, anyone who

still

> believes this illness is 'all in your head' should have their head

> examined! "

>

> Indeed, despite increasing research distinguishing Fibromyalgia Syndrome

> (FMS) and Chronic Fatigue Syndrome (CFS) from psychiatric disorders, the

> role of psychological factors is still being hotly debated. Dr. Muhammed

B.

> Yunus, M.D., one of the presenters at FAME 2000, has been researching the

> clinical characteristics of FMS for over a decade. Many of his published

> studies have challenged the notion that this syndrome is nothing more than

a

> problem of stress, anxiety, or depression. He argues that while

> psychological factors may aggravate symptoms, they also camouflage the

real

> cause of FMS, which he believes involves aberrant neurotransmitter

> mechanisms.

>

>

>

> --------------------------------------------------------------------------

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> ----

> " It is not the FMS patients who are disturbed, it is the physicians who

are

> psychologically disturbed because they ignore the data... "

>

> --------------------------------------------------------------------------

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> ----

> Yet some doctors still cling to the belief that FMS/CFS is psychological

in

> nature. Dr. Yunus calls this " Disturbed Physician Syndrome " (DPS). Says

> Yunus, " DPS people are trouble because of their preoccupation that FMS

> patients are psychologically disturbed. It is not the FMS patients who

are

> disturbed, it is the physicians who are psychologically disturbed because

> they ignore the data, and whatever data there is, they manipulate it to

say

> what they want it to say. "

>

> In fact, psychologist Phyllis Chesler, who suffers from CFS herself,

points

> out that the process of struggling for acknowledgment and understanding

is,

> in itself, highly stressful. She writes, " I believe people with poorly

> understood illnesses are subjected to a level of stress that's more than a

> healthy person can take. " She notes that rheumatoid arthritis and

multiple

> sclerosis were initially seen as manifestations of psychological stress,

but

> are now recognized as bona fide physical diseases.

> Research is increasingly showing that CFS and FMS are real, not

> psychosomatic. Findings such as abnormal levels of brain chemicals have

> been discovered in people with these illnesses. While many unanswered

> questions remain, this research may eventually lead to the discovery of an

> underlying cause (or causes), as well as promising treatments.

>

> FMS vs. Depression

>

> Recurrent or persistent pain, especially with an unrecognized or incurable

> cause, threatens our ability to function and our sense of well-being.

Many

> FMS patients have lost their careers, their role in the family, their

> capacity to think clearly, or the power to control their muscles. It is

> natural that such debilitation would lead to frustration and depression.

In

> fact, if you're experiencing these things on a daily basis, it would

> probably be abnormal not to be depressed.

>

> To illustrate the point that the lack of a known organic pathology does

not

> indicate a psychological cause, Dr. Yunus has compared FMS to other

diseases

> for which the etiology is known. He points out that cancer is known to be

> exacerbated by psychological factors such as depression, anxiety, and

> stress. Yet no one would say that cancer is a psychological disorder.

The

> fact that we don't yet know the cause of FMS does not mean that it doesn't

> exist, or that it is " all in your head. "

>

> Research has indicated that emotional disturbance in patients with chronic

> pain is more likely to be a consequence than a cause of pain. Dr.

> , a well-known FMS researcher and clinician, points out that

> depressed patients who are treated for depression generally respond very

> well to antidepressant medications. However, patients with fibromyalgia

> continue to have symptoms such as pain and disordered sleep.

>

> Examining the role of psychological factors in FMS is complicated by an

> inability to separate depression symptoms that may have existed before the

> onset of FMS from symptoms that are a result of chronic illness. But

> regardless of whether depression precedes or follows the onset of

> fibromyalgia, these symptoms are separate, and FMS symptoms will remain

> after the psychological symptoms are treated.

>

> Studies have shown that as a group, fibromyalgia patients are no more

> depressed than other patients with chronic rheumatic diseases such as

> rheumatoid arthritis. One study compared the responses on a depression

> rating scale of 45 FMS patients, 29 rheumatoid arthritis (RA) patients,

and

> 31 healthy controls with no pain (NC). No difference between the two

> illness groups was found. However, in each group a subgroup of patients

> appeared to be experiencing significant depressive symptoms.

>

> Another FMS expert, Don L. Goldenberg, agrees that although depressive and

> somatic symptoms are common in FMS patients, they are not more prominent

> than in other chronic conditions. He points out the vast majority of FMS

> patients do not meet the criteria for a psychiatric diagnosis.

> It's Not All In Your Head " > Page 1, 2

> CFS vs. Depression

>

> The controversy about whether Fibromyalgia and Chronic Fatigue Syndrome

are

> simply psychological disorders persists despite the fact that an abundance

> of research has shown otherwise. Last week's article focused on the

> distinction between Fibromyalgia Syndrome (FMS) and depression.

>

> There is an even greater body of research that compares patients diagnosed

> with primary depression to those who fit the criteria for Chronic Fatigue

> Syndrome. According to CFS expert Dr. Komaroff of Harvard Medical

> School, studies of CFS patients around the world show evidence of

> abnormalities in the brain and immune system. Although we still do not

> understand the cause of these problems in CFS patients, Komaroff points

out

> that it is not " all in their heads. " Says Komaroff, " There is no evidence

> of any psychiatric disorder in a sizable number of patients with this

> illness. "

>

> In fact, research has distinguished between depression and CFS on both a

> biological and psychiatric basis. Studies of brain pathology have

revealed

> abnormalities in patients with CFS that are not characteristic of

> depression. For example, a 1992 study showed that CFS patients exhibit

more

> alpha electroencephalographic (EEG) activity during non-REM sleep. This

> irregularity is not found in patients with major depressive disorders. In

> addition, a greater number of CFS patients (53%) report difficulty falling

> asleep, while this number is only 26% for depressed patients.

>

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>

> " There is no evidence of any psychiatric disorder in a sizable number of

> patients with this illness... "

>

> --------------------------------------------------------------------------

--

> ----

>

>

> Immunological and neurological findings also differ between CFS and

> depression. A 1995 study indicated that CFS patients with more severe

> cognitive problems exhibited more abnormalities in their immune systems.

> Since the study statistically controlled for depression, this finding

> indicates that the presence of cognitive dysfunction in CFS sufferers

cannot

> be explained merely by depressive symptoms.

>

> In addition, a study in the British Medical Journal revealed upregulation

of

> hypothalamic 5-hydroxytryptamine receptors in patients with postviral

> fatigue syndrome but not in those with primary depression. Other research

> comparing CFS and depression found baseline cortisol levels were highest

in

> the depressed patients, lowest in the CFS group, and intermediate between

> the two in the control group. These findings and many others suggest a

> biological distinction between the two disorders.

>

> A number of comparative studies have been done that look at similarities

and

> differences between CFS, Multiple Sclerosis, and clinical depression.

> Results have shown that patients with CFS more closely resemble the MS

group

> than the depression group on measures of anger, severity of depression,

> anxiety, and frequency of current psychiatric diagnoses. Another 1996

study

> using the Beck Depression Inventory (BDI) found that the depressed group

> exhibited a significantly higher percentage of self-reproach symptoms than

> the CFS and MS groups. CFS and MS patients also report higher levels of

> fatigue and reduced activity levels than depressed patients.

>

> One very telling research finding is that generalized loss of enjoyment

and

> interest (a common symptom of depression) is unusual in CFS. A study by

> Fred Friedberg presented at the American Psychological Association

> convention in 1996 found that only 10% of a sample of 36 CFS patients

> reported that they have " lost the desire to do things. " This compares to

> 60% of the 44 patients in the depressed group. Indeed, CFS patients

> commonly report that their depression stems from not being able to do the

> things they value, and they tend to engage in overactivity when their

> symptoms decrease, which often results in an exacerbation. This

push-crash

> cycle is very familiar to CFS sufferers and is not characteristic of

> clinical depression.

>

> Although some symptoms overlap between CFS and depression, the flu-like

> symptoms common to CFS occur much less frequently in depression. A study

by

> Komaroff et al. measured various symptoms in CFS patients and found

> recurrent sore throat, painful lymph nodes, mild fevers, and headaches at

a

> frequency rate of 43-65% in CFS, but these symptoms occurred much less

> frequently (10-22%) in primary depression.

>

> Finally, while fatigue is common to both depression and CFS, the severity

> and effect of the fatigue appears to be much greater in CFS. According to

> research cited by Fred Friedberg and Leonard in their book,

> Understanding Chronic Fatigue Syndrome, fully 100% of CFS patients report

> severe and debilitating fatigue, compared to only 28% of depressed

patients.

> The effect of the fatigue on functioning has also been found to be

> significantly greater in patients with CFS than in those with clinical

> depression.

>

> These and a multitude of other findings provide evidence against an

> explanation of CFS as a form of depressive illness. It is also important

to

> note that a substantial proportion of CFS patients have no psychiatric

> disorder, yet still manifest symptoms. This suggests that CFS cannot be

> attributed completely to psychological factors.

>

> Addressing the Depression

>

> While depression is clearly not the cause of Chronic Fatigue Syndrome or

> Fibromyalgia, you should not ignore feelings of stress or depression.

They

> may be acting as contributing factors, as is the case in most illnesses.

> The good news is that depression is highly treatable, with a variety of

> medications that can be tailored to individual needs. Having a network of

> emotional support is also essential in coping with any illness,

particularly

> one that is so complex and poorly understood.

>

> There is so much about CFS/FMS that we cannot control. However,

depression

> is one thing that we can do something about. Most people with chronic

> illness have increased feelings of sadness or hopelessness at some point;

> this is to be expected. Don't suffer in silence. Reach out to others who

> can understand and offer help, and consider talking with your doctor about

> how you can address symptoms of depression together.

>

>

>

http://chronicfatigue.about.com/health/chronicfatigue/library/weekly/aa06210

> 0a.htm

>

>