Chronic fatigue

Following my GP’s comment about chronic fatigue syndrome a few weeks ago, I logged onto Amazon and bought a few books on the subject. I’m not at all certain that I have CFS (or ME as it’s also known), and my GP thinks depression is the correct diagnosis. However, I’ve now had a couple of episodes of ‘depression’ where fatigue was a more prominent symptom than low mood, so I wanted to find out more – both to see whether the CFS label might fit and to learn some pacing techniques.

I’ve just finished the first book which is Beating Chronic Fatigue by Kristina Downing-Orr. I’ve written a general review of the book on Goodreads, including my reservations about the treatment plan the author offers, but here I’d like to relate the book more to my personal experience.

Of particular interest to me was the chapter on the differences between depression and CFS. According to the author, many people with chronic fatigue are misdiagnosed with depression. Here are some of the differences she highlights:

With depression, people often feel apathetic and lose all interest in or gain little pleasure from activities they previously enjoyed (anhedonia). Most CFS people can’t wait to recover, so they can again actively participate in their life’s previous joys. As a result, they often feel frustrated by and impatient with their lack of recovery.

I have certainly experienced apathy and anhedonia when depressed, but with my most recent episode, and the one in 2009, I don’t remember this being the case. I still enjoyed the things I normally would, when I had the energy for them. I wanted to be able to get on with my life and felt frustrated that I couldn’t – though it’s hard to be certain whether this is because I was enthusiastic but exhausted, or whether I just wanted to become more ‘acceptable’ and feel like less of a failure.

Depressed people often don’t want to get out of bed in the morning because they believe the day will lead to nothing other than hopelessness and despair. In contrast, people with CFS can’t get out of bed because they simply don’t have the energy or strength to do so.

Again, I’m no stranger to loss of motivation, hopelessness and despair, but this year and in 2009 my experience was overwhelmingly one of lack of energy and strength. I feel more sure about this than the previous point. I really wanted to get things done but I just didn’t have the energy.

When people with CFS go out or exert themselves a little too much, they can feel both mentally and physically worse, often leading to a lengthy setback. However, when individuals with depression push themselves and go, say, to a party, they often feel better for having made the effort. Mental exertion in CFS can lead to a worsening of physical and psychological symptoms. In depression, there is no detrimental effect.

My experience is absolutely that I can push myself too hard and there is a detrimental effect (in the case of the party, I might well enjoy it but still pay the price with exhaustion the next day). However, I know a lot of people with depression who’d say the same; surely they can’t all have CFS. Some mental health experts, such as Tim Cantopher, have said very similar things about depression i.e. that pushing yourself too hard can lead to a setback and delay recovery. For me, whether my main symptom is low mood or fatigue, it’s crucial to find a balance between doing too much and too little.

Other hallmarks of CFS that the book points to are flu-like symptoms and post-exertional malaise (feeling worse after exercise). I definitely tend to feel worse after a busy day but I’m not certain whether exercise itself is the trigger. As for flu-like symptoms, the only one I have is aching muscles which isn’t enough for a diagnosis using the criteria the book provides. Incidentally, other descriptions of CFS I’ve read online seem to fit me better.

My verdict? I’m not about to diagnose myself with chronic fatigue syndrome or go out and buy the 16 nutritional supplements the book recommends. However, it’s clear that fatigue is a real problem for me and that I no longer quite fit the ‘standard’ picture of depression. I will continue to look for information on pacing (this book was a bit vague on it) and I’ve also decided to make diet a priority, as I’ve been relying on processed convenience foods when exhausted. There are so many areas of my life I’d like to sort out and don’t have the energy to, but I’m hopeful that eating more fruit, vegetables and lean proteins will actually give me some of that energy. My aim is not to restrict the amount I eat or ban certain foods, but just stock up on all my favourite healthier ingredients (and not keep a lot of junk food in the house) so it’s easier for me to eat better. Unfortunately, this will require a trip to Evil Tesco. I’ll keep you posted…