Chronic fatigue and fibromyalgia - Psychoneuroimmunoendocrinology Review and Commentary

Townsend Letter for Doctors and Patients,  Feb-March, 2004  by Robert A. Anderson

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Immunity, compassion, anger

In 30 healthy volunteers, salivary IgA, heart rate and mood were measured before and after experiencing loving care or anger. Emotional states were induced in two ways: by self-induction and by viewing video tapes. Anger produced a significant increase in heart rate (p<.01) and total mood disturbance (p<.05) and an insignificant immediate increase in sIgA followed by significant decreases in sIgA at 1,2,3 and 6 hours (p<.01), and 4 and 5 hours (p<.05). Positive emotions (care and compassion), however, produced a significant immediate increase in salivary IgA of 41% (p<.05). Thus, in contrast to care and compassion, anger produced a significant inhibition of sIgA at one to five hours after the experience. The C/C group experienced dramatic decreases in tension/anxiety, anger/hostility, fatigue, confusion and an increase in vigor (p<.05). Self-induction techniques were more potent than external methods in induction of sIgA changes. [Self induction methods may be useful in minimizing the immunosuppression of negative emotions.]

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Rein G, Atkinson M, McCraty R. The physiological and psychological effects of compassion and anger. J Adv Med 1985 Sum; 8(2):87-105

COMMENT: The immune system appears to be integrally involved in the chronic fatigue syndrome; hence the full name, chronic fatigue immune deficiency syndrome. The inter-relationships of all the diverse factors in this multifactorial problem are not yet clear. As this study indicates, immune responses are markedly influenced by profound changes in emotional experience and expression. Significant anger markedly reduced salivary IgA (an immune globulin); sIgA in turn was markedly increased by attitudes/feeling states of compassion. The rise in sIgA with the feeling state of compassion was immediate. Unconditional love, highlighted as the leading principle of holistic medical practice by the American Board of Holistic Medicine, may indeed help not only the patient but also the practitioner who expresses it.

Psychiatric disorders, stress and fatigue

Two-hundred-fifty primary care patients presenting with upper respiratory infections or glandular fevers were followed for 6 months. 228 completed the Life Events and Difficulties Schedule and the Schedule for Affective Disorders and Schizophrenia. The experience of severe social adversity (provoking agents) had a significant association with psychiatric disorders at both 2 months (OR 5.3) and 6 months (OR 5.8) after onset of infection. The association was strongest for depression (OR 9.1 at 2 and 11.9 at 6 months). Social adversity had little relationship to development of post-infectious fatigue syndrome or delayed physical recovery. Social adversity is suggested to play a significant role in evoking psychiatric illness, especially depression, following acute infections.

Bruce-Jones WD et al. The effect of social adversity on the fatigue syndrome, psychiatric disorders and physical recovery, following glandular fever. Psychol Med 1994 Aug; 24(3): 651-59

COMMENT: It has been suggested that stress is significantly related to the self-perception of depression. Depression is among the most common presentations in patients consulting primary care physicians. It is almost universally present in those experiencing symptoms of the chronic fatigue syndrome. It may be present before onset of chronic fatigue symptoms, or be part and parcel of the syndrome itself. I have wondered how those afflicted with severe chronic fatigue symptoms could not feel depressed. This study indicates that the stress of socially adverse experience does not contribute to fatigue, but is related to subsequent experience of depression.

Chronic fatigue syndrome and depression

Forty-one chronic fatigue-fibromyalgia (CFS) patients who did not have depression prior to diagnosis were compared to 19 patients with multiple sclerosis, 17 with depression alone and 36 healthy controls. A battery of questionnaires assessed functional status, mood, fatigue and psychiatric status. Depressed patients had a significantly greater prevalence of psychiatric diagnoses compared to MS and CFS patients (p<.0001). Tension/anxiety and depression/dejection scores were worse in the depressed group compared to MS and CFIDS groups. Median score for depression was higher in the depression group (33) than the CFIDS group (19) or the MS group (10) and controls had the best scores. The CFS patients reported significantly less functionality (40) than the depressed (70) and MS (80) groups (more severe symptoms at rest that increased with activity or exercise, 50-70% reduction in overall activity level and inability to work full-time). On the Functional Status Questionnaire, CFS patients scored significantly worse than MS and/or depressed patients (lost workdays, low work performance, low perceived health) (p<0.008) except for sexual satisfaction (p=.022); number of friends was not significantly different (NS). Median fatigue scores were significantly higher in the CFS group. When questions related to CFS symptoms were removed, CFS patients were no more depressed than the MS patients.