Depression may be associated with the onset and persistence of fibromyalgia symptoms. Seen from one perspective, fibromyalgia is sometimes seen as the somatic expression of
psychological distress – somatization. Although this is as much a restatement of the problem as a convincing solution to it. Furthermore, deriving as it does from Freud’s formulation of conversion syndromes, it carries the pejorative implication that such symptoms are hysterical (see ref 38 for an extreme statement of that view). An alternative view accepts that somatic symptoms are simply part of the depressive syndrome, perhaps magnified as an individual difference in some subgroups. This would predict Inhibitors,research,lifescience,medical a necessary overlap with depression, and a potentially shared etiology. The evidence for this might proceed from heritability, biology, and treatment similarities. The pattern within families indeed suggests Inhibitors,research,lifescience,medical that fibromyalgia is a depressive spectrum disorder.39 Other similarities with the depressive phenotype include
cognitive impairments40 and disorders of the hypothalamo-pituitary axis.41 Finally, the symptoms of fibromyalgia are responsive to antidepressants.42 Chronic fatigue Chronic fatigue syndrome (CFS) has proved to be an even more controversial diagnosis. Inhibitors,research,lifescience,medical The complaint of fatigue is common in community surveys, as indeed is that of low spirits or mild depression. The number of somatization symptoms and history of a dysphoric episode are the two strongest Inhibitors,research,lifescience,medical predictors of new onset of
fatigue as well as recurrent/chronic fatigue over a 13-year follow-up interval in the Epidemiological Catchment Area (ECA) study. A history of unexplained fatigue at baseline was also a very high risk for new-onset major depression compared with those who never reported such fatigue, (RR = 28.4; 95% CI, 11.7, 68.0).43 The etiology of chronic fatigue is complex and heterogeneous. Data for “interfering fatigue” Inhibitors,research,lifescience,medical (IF) has been obtained on 7740 individual twins giving a prevalence of 9.9% in the previous year. IF was significantly associated with 42 of 52 potential correlates! There were two broad clusters: Major depression, generalized anxiety disorder, and neuroticism; >Beliefs of ill health coexisting with alcoholism and stressful not life events. Genetic effects may be particularly important in women, and shared environmental effects in men.44 Clinic samples show a similarly heterogeneous picture. In women, chronic fatigue syndrome, fibromyalgia (FM), and multiple chemical sensitivity (MCS) show mutual comorbidity: of 163 women with CFS, 37% also met criteria for FM, and 33% met criteria for MCS. Patients with additional illness were more learn more likely to have major depression and a higher risk of psychiatric morbidity compared with patients in the CFS only group.45 This offers support for the notion of a single syndrome, perhaps with weakly distinct dimensions.