CFS vs major depression diagnosis

Discussion in 'Fibromyalgia Main Forum' started by cindy_cfids, Jul 9, 2003.

  1. cindy_cfids

    cindy_cfids New Member

    p.s. - stress causes higher cortisol levels, so higher cortisol levels are not (in themselves) indicative of major depression, BUT lower cortisol levels firmly dispute the diagnosis of major depression.
    A simple hormone profile should dispute anyone labeling a person with CFS as suffering from major depression (versus reactive depression). It's fairly accepted that patients with major depression have higher cortisol levels and patients with CFS have lower cortisol levels.
    The following are examples from government websites - National Institutes of Health, Surgeon General's Office & Center for Disease Control - better examples are available but this at least backs up this statement:

    "Although its causes are unclear, major depression is associated with hormonal abnormalities .... Research suggests that higher cortisol levels, often found in depressed patients, ..."

    Biological Factors
    "Some of the core symptoms of depression, such as changes in appetite and sleep patterns, are related to the functions of the hypothalamus. The hypothalamus is, in turn, closely tied to the function of the pituitary gland. Abnormalities of pituitary function, such as increased rates of circulating cortisol and hypo- or hyperthyroidism, are well established
    features of depression in adults (Goodwin & Jamison, 1990)"

    C. Hypothalamic-Pituitary Adrenal (HPA) Axis 
    "Multiple laboratory studies have suggested that the central nervous system may have an important role in CFS. Physical or emotional stress, which is commonly reported as a pre-onset condition in CFS patients,
    activates the hypothalamic-pituitary-adrenal axis, or HPA axis, leading to increased release of cortisol and other hormones. Cortisol and
    corticotrophin-releasing hormone (CRH), which are also produced during the activation of the HPA axis, influence the immune system and many
    other body systems. They may also affect several aspects of behavior.
    Recent studies revealed that CFS patients often produce lower levels of cortisol than do healthy controls. Similar hormonal abnormalities have been observed by others in CFS patients and in persons with related
    disorders like fibromyalgia. Cortisol suppresses inflammation and cellular immune activation, and reduced levels might relax constraints on inflammatory processes and immune cell activation. As with the immunologic data, the altered cortisol levels noted in CFS cases fall within the accepted range of normal, and only the average between cases and controls allows the distinction to be made. Therefore, cortisol levels cannot be used as a diagnostic marker for an individual with CFS.
    A placebo-controlled trial, in which 70 CFS patients were randomized to receive either just enough hydrocortisone each day to restore their
    cortisol levels to normal or placebo pills for 12 weeks, concluded that low levels of cortisol itself are not directly responsible for symptoms of CFS, and that hormonal replacement is not an effective treatment."