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Chronic fatigue and depression

Iversen, Amy; Wessely, Simon

Current Opinion in Psychiatry: January 2003 - Volume 16 - Issue 1 - p 17-21
Mood disorders

Purpose of review Although chronic fatigue is reported by up to one third of patients contacting primary health care physicians, it remains a controversial symptom/syndrome which does not fall comfortably into either psychiatry or other branches of medicine.

Relevant findings Prospective studies suggest that the severity of fatigue reported at first consultation predicts severity at follow-up, including an increased risk of future major depressive disorder. There is a dual interaction between fatigue and depression, one increasing the risk of the other. However, there is not complete symmetry of the disorders; pre-morbid psychiatric history is a better predictor of depression than chronic fatigue syndrome, and conversely positive tests for infectious mononucleosis are a better predictor of chronic fatigue syndrome than depression. Chronic fatigue appears to show some genetic aetiology but links to immune dysfunction remain tentative and require further research. In terms of treatment, cognitive behavioural therapy and graded exercise therapy have proved effective and deliverable both in chronic fatigue syndrome and its related syndromes. The benefits are only for some; however, many remain disabled.

Summary Fatigue extends its influences and interactions widely. It is seen both in its own bespoke syndrome of chronic fatigue syndrome and also within the family of somatoform disorders. Depression, fatigue and physical illness appear to be intimately linked, each worsening the experience of the other having profound implications for patients' quality of life.

Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, UK

Correspondence to Dr Amy Iversen MA MRCP, Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK Tel: +44 20 7848 0448; fax: +44 20 7848 5129; e-mail:

© 2003 Lippincott Williams & Wilkins, Inc.