Depression and chronic fatigue syndrome: How are they linked?

depression-chronic-fatigue-syndromeDepression and chronic fatigue syndrome, although different, may actually be linked. In both conditions, the patient will feel extremely fatigued, regardless of the sleep quality the night before. It is possible that a patient may have depression and chronic fatigue syndrome (CFS) simultaneously, or mistake one condition for the other. It’s important to recognize the key difference between depression and CFS in order to receive a proper diagnosis.

Depression is the feelings of sadness, anxiety, or hopelessness experienced for extended periods of time. Depressed individuals often have difficulty sleeping or may not sleep at all.


In CFS, the patient feels extremely fatigued even when well rested, and there is no explainable cause of this fatigue. CFS is often misdiagnosed and taken for depression, according to research findings.

Differences between depression and chronic fatigue syndrome

Although depression and chronic fatigue syndrome are often mistaken for each other, there are distinct differences that set each one apart. Symptoms of depression include experiencing continuous feelings of sadness, anxiety, or emptiness, feeling hopeless, helpless, or worthless, losing interest in once loved hobbies, eating too much or too little, having difficulty concentrating or making decisions, having headaches, cramps, stomach pains, and other types of pain.

Symptoms of CFS include headaches, joint pain, tender lymph nodes, muscle pain, and sore throat.

Depression and CFS can affect patients differently, depending on their daily activities. Depressed patients will feel tired and indifferent to activates. CFS patients want to engage in activities, but are too tired to carry them through.

In order to properly diagnose CFS, it’s important that your doctor rules out other conditions that have similar symptoms.

Depression or fatigue?

In order to distinguish between depression and CFS, doctors will often use guidelines from the Diagnostic and Statistical Manual of Mental Disorders commonly used for diagnosing mental disorders. The guidelines look for the following risk factors:

Depressed mood: Depressed patients cannot identify their source of depression, while CFS patients report depression due to being too tired to complete activities.

Diminished interest in activities: Depressed patients lose interest in activities, CFS patients want to complete activities but are too tired to do so.

Weight loss and decreased appetite: Depressed patients may lose interest in food, CFS patients want food but find meal preparation exhausting.

Insomnia: Depressed patients report insufficient or excessive sleep, CFS patients’ sleep is unrefreshing regardless of the number of hours of sleep they’ve had.

Fatigue or loss of energy: Depressed patients will report fatigue no matter what they do – all tasks are viewed as equally difficult. CFS patients experience overwhelming fatigue, and although they wish to do activities, they simply cannot.

Feelings of worthlessness or guilt: Guilt in depression is often delusional, CFS patients experience guilt due to being unable to do things.

Diminished ability to think or concentrate: In depressed patients, their problem concentrating improves with treatment, CFS patients do not benefit from antidepressants.

Thoughts of death and suicide: Depressed patients may think of death and have suicidal thoughts, CFS patients who develop depression may experience the same.

Medical complaints: Both depressed and CFS patients report medical conditions like pain.

Depression and CFS treatment

Some treatment methods for depression include talk therapy and medications. Talk therapy can include cognitive behavioral therapy, problem-solving therapy, and interpersonal therapy. Talk therapy helps you recognize any underlying issues and discuss them with a professional to come up with solutions and provide you with strategies to deal with upcoming and future situations that may arise. You can also work through your current feelings as a means of properly dealing with them in a healthy matter.


Medications for depression include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). If a medication is unsuccessful, your doctor may change the type you are on or prescribe a different dosage that may be more effective.

Here are some tips to manage your CFS flare-ups.

  • Pace yourself – know your limits and don’t try to push yourself over the limit, even if you’re having a good time.
  • Learn and understand what you can and cannot do, and use that information as your baseline. Staying within your baseline can help you feel better and make you more productive.
  • Listen to your body – it is the best indicator to your limits and abilities.
  • Make a routine that is manageable and within your baseline.
  • Control and manage stress.
  • Rest when necessary.
  • Avoid quick fixes as they often don’t work and can cause even greater stress.
  • Eat well-balanced meals.
  • Find ways to manage your symptoms instead of trying to cure them.
  • Stick to your treatment plan.

Tips for dealing with depression and fatigue

To better cope with depression and fatigue it’s important to:

  • Support your adrenals – Avoiding stimulants can help reduce CFS. You can speak to your doctor or naturopath about adrenal triggers and ways to improve your adrenal health.
  • Get tested for bacteria – Once the cause is established, your doctor can work with you to create a treatment plan to clear your system.
  • Revise your diet – Diet can play a large role in CFS. It’s best that you avoid processed, refined, high-sugary foods, foods that contain artificial sweeteners, and foods high in calories and fat. Instead, opt for a wholesome diet of whole grains, lean meats, and plenty of fruits and vegetables. Also, avoid foods you can’t tolerate.
  • Exercise – Exercise can naturally promote energy and help to lose weight. Those who are overweight or obese may feel more fatigued than those with a healthy weight. Keep in mind, however, that over-exercising can lead to fatigue as well – everything is good in moderation.
  • Limit sleep – Although you may be tired and choose to sleep throughout the day, you should limit your sleep to the overnight hours only. Try to push through your tiredness and carry on with your day.
  • Go out into nature – Many studies have pointed to the positive impact of fresh air and sunlight on fatigue levels. If you’re constantly cooped up inside, you can feel more tired. Therefore, head outdoors to relieve tiredness.
  • Try psychotherapy – If you really can’t understand the root of your fatigue, you may need to see a psychiatrist to have your mental health evaluated. You could very well be suffering from depression or another mental health disorder that requires treatment.
  • Aim for sleep quality – Proper sleep can improve fatigue. If you suspect you may be having a sleep disorder, go for a sleep test to determine the cause of your sleeping problems. It may also be tied to a mental health condition.
  • Get social – If you live in isolation or don’t go out to socialize, then you may feel fatigued. Reaching out to others and maintaining a healthy social life can help boost your energy levels.
  • Stay busy – If you’re bored or don’t have much to do, you may feel tired. Plan your days to keep yourself occupied, so you don’t have the time to stay idle and get tired.
  • Reduce stress – Stress can play a role in fatigue, so finding healthy ways to combat stress can improve CFS.

Author Bio

Mohan Garikiparithi got his degree in medicine from Osmania University (University of Health Sciences). He practiced clinical medicine for over a decade before he shifted his focus to the field of health communications. During his active practice he served as the head of the Dept. of Microbiology in a diagnostic centre in India. On a three-year communications program in Germany, Mohan developed a keen interest in German Medicine (Homoeopathy), and other alternative systems of medicine. He now advocates treating different medical conditions without the use of traditional drugs. An ardent squash player, Mohan believes in the importance of fitness and wellness.


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