Psychomotor Functioning in Chronic Fatigue Syndrome and Major Depressive Disorder

Marianne Destoop, Didier Schrijvers, Filip Van Den Eede, Greta Moorkens, Bernard Sabbe
European Psychiatric Review, 2010;3(1):58-61
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Abstract

Several studies have identified clinical, biological and aetiological similarities and differences between chronic fatigue syndrome (CFS) and major depressive disorder (MDD). This article presents an overview of a common symptom cluster, i.e. psychomotor disturbances in both disorders. A PubMed search was performed to locate papers on psychomotor functioning in MDD and CFS. Numerous studies have demonstrated psychomotor slowing in major depression. Research on this topic in CFS is limited, although the majority of studies also demonstrate a reduced psychomotor performance. Only two published studies directly compared psychomotor functioning in MDD and CFS. The application of a standardised psychomotor test battery may be a helpful tool in the differential diagnosis between CFS and MDD, and might help to obtain a better insight into the underlying neurobiological processes of both conditions, although further research on this topic is required.
Keywords
Major depression, chronic fatigue syndrome, psychomotor, motor, cognition
Disclosure This article was supported by a grant from the Fund for Scientific Research in Flanders and by the Research Fund of the Faculty of Medicine at the University of Antwerp.
Received: December 14, 2009 Accepted February 22, 2010
Correspondence: Marianne Destoop, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp Faculty of Medicine, Universiteitsplein 1, 2610 Antwerp, Belgium. E: marianne.destoop@ua.ac.be

Major depressive disorder (MDD) and chronic fatigue syndrome (CFS) share several symptoms and aetiological factors. For instance, mood disturbances and somatic symptoms such as increased pain sensitivity and fatigue are common in both diseases,1–4 although it has been reported that mood and self-reproach symptoms are more prominent in depression and that CFS patients show a higher percentage of somatic symptoms than depressive patients.5 Complaints of cognitive dysfunction such as impaired attention and concentration, disturbed information processing, memory deficits, learning difficulties and slowed thinking have also been observed in both disorders.6

Furthermore, the two disorders share several predisposing factors, including female gender, early-life stress and childhood trauma and personality characteristics such as neuroticism and introversion. Moreover, physical and psychological stress have been shown to play a role as precipitating factors in both conditions.2,7–9 In accordance with this, the prevalence of current and lifetime history of major depressive episodes in CFS patients is high (25 and 50–75%, respectively).10 However, the co-morbidity of CFS and MDD does not address the temporal relationship between the two conditions in that depressive symptoms can both precede and occur in response to CFS.10

However, several clinical and biological differences between CFS and MDD have also been reported. First, many symptoms of CFS (i.e. sore throat, tender cervical or axillary lymph nodes, muscle pain, post-exertional malaise, unrefreshing sleep and headache) are not typical of MDD. Second, the chronic long-lasting course in CFS differs from the characteristic course in depression with remission, response, relapse and recurrence. Third, inverse dysregulations of the neuroendocrine (hypercortisolaemia in MDD, hypocortisolaemia in CFS) and serotonin system (reduced central 5-HT in MDD, increased 5-HT in CFS) have been described in the two conditions.11–13 Furthermore, the typical sleep abnormalities of MDD (reduced rapid eye movement [REM] latency and increased density) are usually not present in CFS.14,15 From a genetic point of view, the twin study by Roy-Byrne et al.16 showed that CFS and depression are associated but without evidence for co-variation, implying that the association is environmental or due to overlapping definitions.

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