A Systematic Review of Chronic Fatigue Syndrome: Don't Assume It's Depression
Prim Care Companion J Clin Psychiatry 2008;10:120-128
© Copyright 2014 Physicians Postgraduate Press, Inc.
Objective: Chronic fatigue syndrome (CFS) is
characterized by profound, debilitating fatigue and a combination of
several other symptoms resulting in substantial reduction in occupational,
personal, social, and educational status. CFS is often misdiagnosed as
depression. The objective of this study was to evaluate and discuss
different etiologies, approaches, and management strategies of CFS and to
present ways to differentiate it from the fatigue symptom of depression.
Data Sources: A MEDLINE search was
conducted to identify existing information about CFS and depression using
the headings chronic fatigue syndrome AND depression. The
alternative terms major depressive disorder and mood disorder
were also searched in conjunction with the term chronic fatigue
syndrome. Additionally, MEDLINE was searched using the term chronic
fatigue. All searches were limited to articles published within the
last 10 years, in English. A total of 302 articles were identified by
these searches. Also, the term chronic fatigue syndrome was
searched by itself. This search was limited to articles published within
the last 5 years, in English, and resulted in an additional 460 articles.
Additional publications were identified by manually searching the
reference lists of the articles from both searches.
Study Selection and Data Extraction: CFS definitions,
etiologies, differential diagnoses (especially depression) and management
strategies were extracted, reviewed, and summarized to meet the objectives
of this article.
Data Synthesis: CFS is underdiagnosed in more than 80% of
the people who have it; at the same time, it is often misdiagnosed as
depression. Genetic, immunologic, infectious, metabolic, and neurologic
etiologies were suggested to explain CFS. A biopsychosocial model was
suggested for evaluating, managing, and differentiating CFS from
Conclusions: Evaluating and managing chronic fatigue is a
challenging situation for physicians, as it is a challenging and difficult
condition for patients. A biopsychosocial approach in the evaluation and
management is recommended. More studies about CFS manifestations,
evaluation, and management are needed.