A New York psychiatrist, Jeremy Coplan has been attempting to bridge the gap between mood and biological disorders for decades. Most studies to date have examined the overlap between mood disorders. A large 2013 study, for instance, found that alterations in calcium channel genes increase the risk of coming down with a wide variety of psychological disorders.
Coplan’s experience, however, suggests that that kind of analysis is too limiting. He believes that many psychological disorders transcend the boundaries that have been imposed by researchers and vice versa. They are better viewed on a spectrum that includes both psychological and physiological components.
Coplan suggests diseases may not be what they seem
His research bears this out. Panic, for instance, can be caused by physiological factors that are not often associated with it. In 2009 Coplan found that increased brain lactate – found in both chronic fatigue syndrome and fibromyalgia – is associated with panic-like symptoms in rats. (Coplan co-authored two of the ME/CFS brain lactate papers and the latest fibromyalgia study.) In 2005 he found that reduced blood flows to the frontal cortical regions of the brain induced anxiety in laboratory animals. In 2007 he noted that over or under activity of the prefrontal cortex could induce panic-like symptoms.
In his most recent paper Coplan proposed that a vast spectrum of illness exists that encompasses a wide variety of both physical and mental illnesses. To test his hypothesis he gathered together a set of people with an anxiety disorder who also had a physical condition, and assessed the incidence of a wide variety of pain, muscoskeletal, immune and psychiatric conditions present.
He hoped to expand the view we have of what a panic or anxiety disorder consists of. I would say he succeeded.
Results
The results were astonishing. Joint laxity (loose joints) were found in almost 60% of the anxiety patients compared to 10% of the population. Mitral valve prolapse, scoliosis and double-jointedness were approximately ten, three and seven times as common in the anxiety patients as in the general population.
Occurring in about 80% of the anxiety-plus patients, fibromyalgia was 30-40 times more commonly found in the anxiety plus group. Irritable bowel syndrome (IBS) and headache were five and three times as commonly found.
On the immune side allergic rhinitis (71%), hypothyroidism, chronic fatigue syndrome and asthma were three, eighteen, nine and four times more commonly found in the anxiety plus patients.
Major depression and bipolar depression were five and seventeen times more commonly found in the people with anxiety.
By the end of the paper it seemed crazy to refer to these as simply anxiety patients. They had a wide range of other conditions that most researchers rarely connect with mood disorders. Joint problems are common. Autoimmune processes may be present. Coplan proposed that these patients had a spectrum disorder in which five symptom/condition domains dominated.
- A = Anxiety disorder (mostly panic disorder);
- L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
- P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
- I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
- M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).
The title of the study indicated Coplan’s findings were preliminary. Because it included a select group of people with documented anxiety disorder and another physical disorder it probably reflected a special subset of anxiety patients. The study also did not contain a healthy control group and it was not very large.
Discussion
Work on Ehlers Danlos Syndrome (joint hypermobility) appears have driven much of Coplan’s thinking. EDS and other genetically determined connective tissue disorders such as Marfan’s disease have been associated with a high risk of psychiatric disorders (anxiety disorders, depression, schizophrenia, autism, attention deficit/hyperactivity disorder, eating disorders, personality disorders and substance use/misuse.) Clearly some common genetic underpinning is present.
Do similar pathophysiological problems underlie these disorders?
In fact many of the conditions listed have a spectrum-like appearance; i.e. they often appear together and transcend disease boundaries. A recent study, for instance, found that inflammatory disorders, “functional somatic syndromes” (i.e. ME/CFS, FM, IBS, etc.) and psychiatric disorders are also commonly found in migraine. The symptom spread in migraine, like ME/CFS and FM (and apparently anxiety, EDS, etc.) is enormous.
The authors concluded that migraine was a central sensitization disorder. A central sensitization disorder involving the immune system (the microglia) that impacts different parts of the sensory apparatus, could be present in many of these disorders.
Chronic Fatigue Syndrome and Fibromyalgia and FM
“Our argument is that delineations in medicine can be arbitrary and that some disorders that are viewed as multiple disparate and independent conditions may best be viewed as a single spectrum disorder with a common genetic etiology,” Dr. Coplan
My interest in this subject lies in the edginess, the inability to settle down, the increased sensitivities, the touchy nervous system etc. that have been a constant part of my chronic fatigue syndrome. These symptoms have never been enough for me to meet the criteria for anxiety or panic disorder but they are enough for me to wonder which connections might be present.
A similar study of ME/CFS and FM patients would likely have similar and different findings. Joint laxity, headache, migraine, irritable bowel syndrome, hypothyroidism and depression appear to be fairly common in ME/CFS and perhaps FM. Bipolar disorder, tachyphylaxis and anxiety disorder don’t appear to be nearly as common.
Boundaries Falling
Smashing boundaries between diseases is getting to be pretty common. Inflammation is now judged to play a major role not just in diseases like heart disease and diabetes but in about a third of people with depression. Fibromyalgia is found in a significant subset of people with arthritis and other conditions. Antidepressants don’t just help with depression but reduce pain in people without depression, improve sleep in people without depression, and reduce inflammation. Now we see that elements of anxiety pervade many disorders and many disorders pervade anxiety.
Whether studies like this are helpful or hurtful to diseases like ME/CFS and FM that are struggling for legitimacy is another question.. Does involving ME/CFS in a spectrum of diseases that includes some mood disorders – as well as connective tissue, immune and endocrine disorders help or hurt a disease that has struggled to gain legitimacy?
Interesting!
I have EDS and MCAS – there appears to be a connection in those two. The med used for MCAS is a mild calcium channel blocker (GastroCrom). Are they thinking the calcium channels are the key here?
Having also Lyme coinfections and another protozoa (protomyzoa rehumatica), my doc feels that minerals are something that we have to be very careful in supplementing,it can reinforce biofilm (magnesium) make it harder for the immune system to detect things and the antibiotic or antimalarialal to get in to attack.
I’m certain it’s all connected, it’s just finding the key to turn the lock.
Issie
Interesting re: magnesium and thankfully there are transdermal preparations of magnesium available now.
Repeat after me: correlation is NOT causation.
Do a couple thousand more times.
I have had CFS for 26 years, and I have been depressed by that at times, and worked my way out of it, because BEING sick is depressing, and losing your ability to use a PhD in Nuclear Engineering is depressing. So? I wasn’t depressed before – I had my dream job at Princeton U., two little boys, and a daughter one the way – stress, yes; mood disorder, no.
Just another attempt to blame the victim.
Forget the blaming it on genes and connecting it to mental disorders: exactly like AIDS and Ebola, this is a physical illness, with something that caused it, and whatever reactions the body has to that.
NOBODY blames AIDS on genes; they just give you the drugs that take care of HIV.
Find out what causes it, and, if we’re lucky, how to fix it, by doing some SCIENCE. Sheesh.
Amen, Alexia!
I mean Alecia (spell checker error)
Genes do cause illness. I was diagnosed with FM 20 years ago, and only recently was found to have a genetic mutation that causes Fabry Disease….which accounted for all my symptoms.
A relief in one way – to know the cause…but very distressing to find that my son has inherited the Fabry mutation.
What is fabry disease
“NOBODY blames AIDS on genes”
Well, it does appear that some people are resistant and in some cases virtually immune to the AIDS virus. So, in fact, in some cases, we may very well be able to blame AIDS on genetic vulnerability.
Genetic HIV Resistance Deciphered
http://www.wired.com/2005/01/genetic-hiv-resistance-deciphered/
I agree that there are spectrum’s of illness, but can say equivocally that my illness was caused by medicine, actually an inoculation hepatitis B, I think im unusual as it has been accepted as cause by my medical colleagues. I have no mental health issues and even have it in writing so would humbly like the psych community to stop sprouting inflammatory lies about medical conditions such as Fibro and ME. Once Pandora box is opened I fear for those who sprouted this rubbish as both reputation and also finances will be gone as you will be sued for medical malpractice.
I believe that my autoimmune disorder, Mixed Connective Tissue Disease and Fibromyalgia, was somehow “triggered” by my Hep B vaccine series. I was going to report it to AVERS (who you report adverse effects from a vaccine to in the Government) back in 2000 but never did.
While correlation may not be causation, I don’t have trouble believing in physiological reasons for mental states and there being some sort of spectrum of sorts.
Like you, depression is not something I live with, though I do go through periods of grieving with ME/CFS and every time I suffer a substantial crash, it takes me days to adjust mentally. At times I don’t know if that is a physiological reaction or a “Here I go again” reaction that is essentially re-grieving having an illness that makes my body so very unreliable. So, it seems clear to me that for me depression is not generally a mental or physiological issue for me despite being ill with ME/CFS.
I don’t have trouble with seeing connections to psychological states because I don’t have to own those states as being the result of my thoughts. That is, my thoughts are typically not generating either depression or anxiety. One, I’m generally happy (and apparently I have genes that help in that regard though I’d like to give myself full credit), and two, I’m typically rather fearless about what I might encounter in life.
What’s written here rings true for me when it comes to physiologically induced anxiety. I have a number of things that sets off anxiety and it has nothing to do with my thinking and everything to do with physiological issues.
For example, poor glutamate to gaba conversion requiring me to watch my diet. Mild positional vertigo when turning my head to a certain position as I lay down to sleep–the sensation between spinning and nausea is panic and my body’s beleaguered HPA system sets off running. The same for when my ME/CFS leaves me feelings oxygen starved, which feels worse when I lie down (like someone with congestive heart failure); I end up feeling panicked.
This was perhaps most evident to me during the worst of my illness when I was nearly unable to sleep, was in an incredible amount of physical pain, and felt, every waking moment, like I was getting ready every to speak in front of a group of 5,000 for the first time. (That had only happened to me once in life and that’s when a doctor prescribed a med for my poor ME/CFS sleep, and I discovered that it was causing panic attacks and so I stopped it cold turkey not realising the impact of doing that.) It couldn’t be any clearer to me that that was physiological–just like the medicine induced panic. I wasn’t anxious over my lack of sleep or poor health… (I’ve always been one who said “Why not me?” instead of “Why me?” and so it’s not like I was even rejecting of the idea this nightmare of an illness was happening to me.) I was just riding whatever symptoms I was having until my body was done with that particular symptom.
For all of these reasons, I’m personally glad I know that almost all instances of anxiety are triggered by my body and perhaps my brain but not my mind. This means I can focus on calming my body while not searching my life for things to be anxious about and therefore not making matters worse.
Manganese and b6 are needed to convert glutamate to gaba. Fixable.
Just so , Claire. A very well presented and balanced argument.
Unfortunately so many of us have been told that our physical symptoms are all due to depression.
I’ve never taken anti-depressants for pain.
If they work – I might try them! Anything!!
I burned with anger while reading this foolishness! This sounds like more of the government sponsored propaganda to cover up the real causes of these disabling diseases! This researcher sounds like one of Wessley’s cousins, profiting off the suffering of others! Their goal is to distract and dismiss the severity of these diseases, while the government continues preventing real science from doing the proper research, on the proper patients, to get to the bottom of what is causing massive numbers of healthy to get the flu and never get well again! This has been going on since the first outbreak in the 1930’s at the LA hospital which was related to contaminated polio vaccines! The government’s cover up and dismissive attitude toward the suffering of these patients has been seen through the incredible lack of funding for research and the misappropriation of those funds, along with the despicable name change from benign myalgic encephalomyelitis to “chronic fatigue syndrome” or worse yet “yuppie flu”! Their message was loud and clear “Don’t pay any attention to them, they are just a bunch of stressed out over achievers”– that alone speaks volumes about the attitude of those responsible for finding the cause and cure!
As an RN, I worked full-time my entire life while raising my family and loved my job! I rode a bicycle 200 miles weekly and had always enjoyed an incredibly, athletic outdoor lifestyle right up to the very day I got the flu. I was perfectly healthy and much stronger than most at 51 years old! I was “vaccinated” yearly for the flu as well as routinely for DPT, pneumonia, hepatitis from A-to-Z and whatever else they thought might come down the pike! Then suddenly after getting the flu December 24, 2009 I descended into the Hell of myalgic encephalomyelitis- a disease I’d never even heard of! Yes, I got depressed! Who in their right mind would not be? The physical suffering, loss of job and b and loss of identity loss of friends and loss of hope or any kind of future? I wanted out of my body because the physical pain seeping from the marrow of my bones outward was so severe! I barely have the strength to make it to the bathroom and back to bed or the recliner. My short-term memory and ability to concentrate disappeared along with my strength, and a laundry list of other things, never to return again!
Let’s get real and talk about non-HIV AIDS, retroviruses, damaged immune system’s from endless numbers of vaccines or the effects of the adjuvants in vaccines or the viral contamination in vaccines, or let’s talk about Lyme disease and why people do not get cured from it or the testing of bio-weapons called “incapacitaters” on US citizens using us as guinea pigs “for our own good” which makes it legally OK!
I think you ought to feel ashamed for providing a news stand for these creeps to broadcast their dark propaganda from!
Actually in the piece as I think I mentioned the author argued that ME/CFS is a real physiological disorder that is different from depression and anxiety. In fact he worked on two studies involving lactate in the brain that proved that.
Plus he believes that immune dysfunction, hypothyroidism – which he thinks may reflect autoimmune problems – and connective tissue problems are common in this mix…
I think we’re all a little nervous when a psych angle is researched and discussed in conjunction with ME. I can appreciate the criticisms. But, I did understand the article to state what you’ve clarified, Cort. Also, I’m like Claire in some – but not all – regards. Especially when it comes to food sensitivities and MCS. These can set of mostly anxiety and CNS overstimulation – one can look like the other, & vice versa. Fish oil can actually exacerbate depression in me.
What I always come back to when there is outrage in our community is to keep supporting and believing in the researchers (MD, PhDs, PhDs, and MDs) who are doing their utmost to help us. We all know who they are.
Cort,
One thing that I never have understood is if people cam have both fibromyalgia & CFS. Plus if they are two separate diseases or syndrome so or whatever they’re calling it these days then why are they grouped on some issues and separated on others. I was looking on the home page & noticed most of the listings said ME/CFS and did not include FMS but in the video section they’re separated there is a section for fibromyalgia and the ME/CFS! The other thing I’m confused about is I thoughtt the ME was supposed to replace CFS! Sorry if I have a lot of typos but my screen is so small & the font so light I can hardly read it,using time to upgrade my iPhone
Thank you
Marsha
I think it’s often difficult – maybe because this is a group of spectrum disorders – to know where one disease begins and the other ends. Thanks for reminding me that I need to get the FM section in there. Good luck on upgrading your phone.:)
CFS/ME/FIBRO/GWI deployed/non deployed including family members so called Lymies including MS highly likely Autism are all ‘undiagnosed’ waste basket ‘Labels’ of genetic
mutations pf protein collagen deficiencies it is 100% Ehlers Danlos Syndrome with MCAD Mast Cell Activation Disorder some even have ‘partial incomplete’ Marfan Syndrome…Marfan
score/Breighton score/Beighton score…WHO NIH CDC have made some serious mistakes not properly diagnosing EDS Types they are now Liable
Alicia, YOU ROCK! I’m “sick” of these kinds of self serving results myself…. Find what’s causing these illnesses and fix it!!
Interesting discussion, y’all.
If it’s all in my head, I have the tools to fix it: I’m very good at CBT and such, use them all the time.
Then why can’t I make myself well?
I just published my first book, with a CFS main character (of three), and it has taken forever. I would not do that to myself – so any attempt to put this off as ‘psychological’ gets me quite angry.
It’s the other way around: the situation – chronic illness and no energy and pain and… – are enough to make most people depressed, and I fight it every day and wrestle it to the ground, or I’d never get anything done, of the little I CAN do.
And I even understand people who are too tired and sick to make the effort I make – I’m lucky that I can. I pray for all of us.
Thank God someone gets it!Thank you Alicia, you just made my day ( my night actually, because its 4.24am ).
I don’t think you can disregard the impact of genes in the progression of ANY disease – including HIV/AIDS, by the way. Just using your HIV example: variance can and does drastically influence viral titers, mean time to AIDS, and risk of complications such as various cancers which HIV can trigger (infected patients have up to a 70x increased risk of a huge swathe of cancer types).
In the example of HIV, there is a single cause but a myriad of eventualities. Different genes play into each and every one of the disease stages – the likelihood of infection, the resistance to its spread within the body, and end-stage sequelae such as cancers. Why, even genes as diverse as those mediating inflammatory response, or apoptosis, or myelination, or calcium channel receptor function, will have a dramatic impact on who lives, who dies quickly, or who gets HIV-related dementia.
The same applies with CFS/FM/ME, except the waters are even MORE muddy here, because we are talking about a condition which is much more imprecise than a viral infection. There are many probable causes of CFS and FM, from viral to bacterial to allergic to genetic to epigenetic to psychological – and each of those things I just mentioned can (and do) feed back into each other.
The reason CFS/ME/FM is such a hard thing to treat is that it is a general symptom, a common end-game result of disturbing any one of a number of factors that prop up a quite delicate biological balancing act which our bodies must do. Genes of many kinds can (and do) make the balancing act unstable, in many different ways – by changing our pain perception; by changing how our body reacts to stressors or perceived invaders; by regulating our circadian rhythms; by giving us weaker or differently-structured tissues and vasculature; and on and on and on.
You simply cannot discount genes. As in almost all medical conditions, genetics and epigenetics is often what lets one person shake off an illness, while the other lies flat in the dust. There is no single “cure-all” – there are many fixes, and a cure has to be as individualized as the person themselves.
As medicine evolves we are realizing that there are very few things which just “come from nowhere”… a chronic disease state is almost always the result of many different factors coming together. Consequently, we will never find a universal single “cause” at which we can point an accusing finger… and so, a cure will almost always have multiple parts to it.
Thanks Tim….For what it’s worth I agree that ME/CFS is probably an end result that can be produced in lots of ways…
I tried to contact you via email but it didn’t go through. I wonder if you’d be interested in producing a blog on this subject?
Thanks – the email address used was a “spamcatcher”, sorry! I hadn’t anticipated much interest in what I had to say…. aww shucks! 🙂
I’ll email you shortly!
Hi Cort,
An interesting article. The one thing that Coplan might be missing is that there is a very high co-morbid occurrence of Ehlers Danlos Syndrome (EDS) Hypermobility with Postural Orthostatic Tachycardia Syndrome (POTS.) The symptoms of POTS are frequently miss interpreted by the medical community as anxiety. My bet is on a high rate of POTS not anxiety amount the ME/CFS patients. I have ME/CFS POTS and EDS Hypermobility.
I’m also HYPERPOTS. The connections with the “trilogy” of POTS, EDS, MCAS seems to suggest a pattern for our subset type. Would be interesting to figure out if some of these different channel dysfunctions are a compensatory thing or one possibility connected to the puzzle for cause. Treating MCAS has been a help with all three issues. Working on immune function seems to be where the help comes in. (GastroCrom works on the immune system at gut level. But,it is a mild calcium channel blocker.)
But, I do think if there is depression or anxiety it’s a result of – not a cause. And as stated above, anxiety disorders have been misdiagnoised, when in fact the proper DX is POTS and/or MCAS.
There can also be dysfunctions with methylation. Some very recent seminars that I’ve attended have found people with Vitamin B12 assimilation issues presenting with psychosomatic disorders. Either being low in or not properly metabolizing it.
Issie
You hit the nail on the head!
There is no doubt in my mind that the cause(s) of ME/CFS are biological. I also suspect that the biological/psychological duality of illness that has reigned for the last century is about to start crumbling down. Moreover, I believe that many “psychological” symptoms will be discovered to have a biological basis. We’re already getting hints of this from the human microbiome research that shows neurotransmitters are manufactured in the gut and that changing the gut microbiome can change behaviour. At some point, once science bears this out, perhaps society will finally lay to rest the current stigma that those with “psychological” illnesses (and illnesses not yet fully understood like ME/CFS) currently face.
Newtonian science’s perceived duality between physical and psychological imbalances have never existed in the Asian medical model in which everything counts equally in the unique care of each whole, non-compartmentalized person. Scot speaks well of this paradigm shift. Many with Neuroendocrine Immune Disease/s who have waited forty years for Western medicine to wake up and grow up into an expanded view of what real health is are moving over to the more comprehensive model and finding results, if only enhanced survival for the moment. Someone else can correct any inaccurate details in the following, but the news goes something like this: Recently the editor of the prestigious medical journal Lancet announced very publicly that about half of all peer-reviewed medical research papers (published in the official-story journals, I guess) are bought, biased, bogus or all three. If this report is anywhere near accurate, one might wonder if dollar-driven “Science” as currently practiced is as vaporous as the rainbow ether emitted from the rear of an airborne New Age unicorn.
Well, ultimately, it HAS to be biological, doesn’t it? Unless some of us are robots…
I’m not being facetious here. One of the big problems in medicine (actually, humanity in general) is the insitinctive belief that “we” are somehow separate from the bits that make up our body. There is a strong tendancy to view ourselves as sitting in a machine, as disconnected as a driver is from the car they’re driving.
It’s not so. We ARE the car, and the driver is very much an illusion. You cannot separate biology and psychology – they are fundamentally intertwined.
Don’t believe me? Well, do some basic psychological and physica tests… and then, go chug 4 espressos and a bottle of wine, and do the same tests again. Or: do the tests one time when you’re well, another time when you’re well but stressed and angry, and another when you’ve got the ‘flu.
It’s an unfortunate accident of medical history that psychology and biology were long treated as separate things. They’re not, of course, and thankfully over the last 20 years we’re seeing the start of a long-overdue reconciliation.
Yes, of course CFS is “biological”. But the search doesn’t end there, with that declaration! And neither does the treatment.
Placebo (and nocebo) shows us the huge power our mind has on perception of pain, fatigue, and so on. The “sickness behavior”, or “malaise”, is a striking example of how psychology and biology interact.
Someone with a cold, or even ‘flu, is physiologically EVERY BIT as capable of (say) lifting a heavy iron bar today as they were last week. But last week they were hard at work on a construction site, and today they can’t even get out of bed! Now, you tell me: what part is psychological, and what part is biological…?
I have to agree with Alecia. (Pardon me misspelling your name, it was spell checker error. :-/
When I became sick I had finished an advanced degree a few years earlier and had established myself in a new career that I loved. I had found the love of my life, was married less than 2 years and was never happier in my life.
Yes, once in a while I have a day when I am terribly depressed. I have to spend most of my life in bed, after living a very busy, challenging and fun life. If I wasn’t depressed by that I wouldn’t be a normal human being, would I?
I have been disabled and unable to work for 32 years. I have been fortunate to have found several physicians who believed that this illness is real. I have tried many treatments modalities, some of which have made me permanently worse. Since there is no real research (psychobabble is not research) any treatment was always a shot in the dark.
I do have great hope that with the NIH FINALLY taking this disease seriously they will at least find the cause of this illness. Pardon me if after all this time I don’t hold my breath.
I do have to cop to occasionally becoming angry at all the denial and foot dragging by the medical community. Could that be what is making me sick? Just kidding.
I read with great interest the article and the comments. I want to add that I recently had a three hour consult with an expert on elher danlos syndrome. He asked me what my main objective for this consult. I said “to help my children and grandchildren not to ever go through the misery I have gone through by being labelled with a psychiatric disorder that has stuck for twenty years. He told me “unfortunately when a specialist makes a diagnosis, it is only he/she who can retract it.” How sad is that! Because of this psychiatric label, which was carelessly bestowed upon me, I lost everything. My credibility, My career, my ability to be gainfully employed, even if I had the stamina to do so. I asked him kindly not to add any more labels, so I can hopefully have symptoms only investigated and treated. I believe this will hopefully avoid my life being shortened because of medical error. Can you imagine here in New Brunswick, if you are labelled as a psychiatric patient, you may be treated “differently” when you enter the emergency department. Your physical symptoms may be attributed to your psychiatric label, and not taken seriously, which is wrong. How scary is that? My psychiatric story is written in Judging Judi, available at Lulu. Com.
So true Judith. My friend was sent home from casualty twice in a week. She died, cause of death, Dehydration.
She had been labeled bi polar. If that label wasnt on her records, she may well have still been alive today.
Wow….
I have POTS, asthma, migraines, mitral valve prolapse and histamine intolerance. I have found that my body is unable to clear/process anything that resembles an AMINE. A build up of these neurotransmitters from increased histAMINE in my diet (cheese/aged protein) or from pollen allergies or insect stings lead to pots asthma and migraines (reducing them leads to better functioning and no migraines). I also have trouble clearing norepinephRINE from my system – I am constantly ‘on edge’ from adrenaline which goes with pots and worsens on standing/dehydration or exertion. I think there is something connecting all this – one theory I have is that I lack the gut bacteria to produce DAO or other enzymes to correctly degrade Amines. It may also be a genetic cause.
There is fairly good evidence that much of what we regard as “mental illness” has a biological basis. Now that psychiatry is actually becoming more scientific expect to see a lot more evidence. The great thing about this is that once you have more understanding of the imbalances you can correct them.
While doing some research on depression to try and help a friend of my child I came across this study suggesting vitamin D levels are significant http://www.medscape.com/viewarticle/842008
It would not be surprising if people who are forced into being housebound sometimes become depressed by that but there may also be a biological basis for that depression. Supplementation with vitamin D has a poor record but this is a fat soluble vitamin and supplements are not usually given with fat, they might be more effective if they were. Vitamin D is present in fish oil and supplements of fish oil may help depressed people. http://consumer.healthday.com/encyclopedia/depression-12/depression-news-176/fish-oil-and-depression-644950.html
I would suggest to this researcher that they consider problems in utilising vitamin D when they look for a common genetic basis to the disorders they are studying.
My gp suggested I supplement with vitamin D (without testing first, of course, because I was ‘depressed.’ I took 5,000 IU for a few years, didn’t feel any better, so I upped my dose to 10,000 IU daily. Still didn’t feel any better, physically or mentally. After a recent blood test requested by my rheumatologist, his office called me to stop taking it–my ‘number’ was almost in the toxic range. I thought vitamin D was supposed to help wth pain, too?
Not seen any suggestions that vitamin D helps pain generally – however magnesium provides some benefit to most people who try it. As some magnesium salts can be laxative you need to choose carefully, not magnesium oxide, or use epsom salts in the bath.
Sorry it didnt help you.
“My interest this subject lies in the edginess, the inability to settle down, the increased sensitivities, the touchy nervous system etc. have been with me since the onset of chronic fatigue syndrome. These symptoms have never been enough for me to meet the criteria for anxiety or panic disorder but they are enough for me to wonder what connections might be present.”
Exactly. I will speak for myself and my family. I don’t get the problem here when researchers are capable dealing with nuanced reality.
I have had ME/CFS since 1989 and have always been resistant to the notion that this illness ‘necessarily’ has a component of depression (apart from reactive low mood which is a natural response to a life changing condition). However – despite this research being conducted by a psychiatrist and the sample being heavily loaded towards subjects with mental health problems I don’t think we should hastily dismiss the underlying premiss.The notion that there are core elements within specific diseases and unifying central aspects to a broad spectrum of illnesses is not mutually incompatible. Over the years I have seen many doctors and been diagnosed (or labelled?) with lots of illnesses. Recently I saw a doctor who is convinced all of this stems from – in his words – ‘an underlying central sensitisation disorder’. I am happy to write more about this if anyone is interested.
I totaly agree with Alicia
Beware psychiatrist with their somatic syndromes and attemps to conflate psychology and physical disease. Used with such devastating effect in the UK to corrupt science and research into ME
Good to hear from you Eilidh. I agree with your and Alicia’s comments and wonder if the Ebola cases, such as the British Nurse whose Ebola virus lay dormant (Latency) and reactivated shows, what Doctors have always said regarding ME? Do other viruses follow this pattern causing inflammation in different parts of the body to cause the different ME symptoms?
A US Dr who had Ebola, thought recovered was left with CFS!
Simmaron Research are now studying cluster outbreaks across the US involving viruses and insect bites, which leave CFS type symptoms!
Can I throw in the mix, the UTI infections causing Sepsis and delirium, mistaken for psychosis. It is not psychosis, it is organic, from infection and Psychiatrists and doctors often don’t recognise the difference!!
Ann
I have had CFS for 30 years and I thought we had moved beyond believing the random pet theories of psychologists and psychiatrists. CFS is a physical illness. Many of us are so disabled by it that it’s a wonder we can keep our heads together at all. Anxiety and depression are a normal response to chronic illness.
Studies have found that antidepressants have no effect on CFS, although they reduce depression in those who have depression as well. No surprises there.
85% of people diagnosed with CFS will never regain their pre-illness level of health. This is in the Canadian Consensus paper on CFS. That is a massive burden of illness for families and communities. If about 1/100 people gets CFS, this is a crisis situation.
Remember when peptic ulcers were caused by “stress”? And then researchers found it was bacteria all along? Whoops.
So much more research is needed into CFS. Let’s take people with CFS seriously and campaign for scientific research, lots of scientific research, until we get it figured out.
Seriously. Seemed interesting at first, but the credibility of this material in terms of whether or not it should have been posted here vanished for me with the words “functional somatic syndromes.”
I have bad connotations about that term as well although the term itself is not bad – it refers to diseases that impair functioning but for which the biological basis has not been determined. I agree that’s it’s often been used by researchers who want to portray ME/CFS and FM in psychological sense – but it’s not always used that way. It’s often used by researchers doing biological research to as an easy way to group these disorders together
Mitochondrion. 2015 Jul;23:1-6. doi: 10.1016/j.mito.2015.04.005. Epub 2015 Apr 29.
Increased prevalence of two mitochondrial DNA polymorphisms in functional disease: Are we describing different parts of an energy-depleted elephant?
About 20% of the population suffers from “functional syndromes“. Since these syndromes overlap greatly in terms of co-morbidity, pathophysiology (including aberrant autonomic activity) and treatment responses, common predisposing genetic factors have been postulated. We had previously showed that two common mitochondrial DNA (mtDNA) polymorphisms at positions 16519 and 3010 are statistically associated with the functional syndromes of migraine, cyclic vomiting syndrome and non-specific abdominal pain.
Thus, we conclude that these two mtDNA polymorphisms likely modify risk for the development of multiple functional syndromes, likely constituting a proportion of the postulated common genetic factor, at least among individuals with HgH. Pathophysiology likely involves broad effects on the autonomic nervous system.
Comorbidity in Migraine with Functional Somatic Syndromes, Psychiatric Disorders and Inflammatory Diseases: A Matter of Central Sensitization?
Functional limitations in functional somatic syndromes and well-defined medical diseases. Results from the general population cohort LifeLines.
CONCLUSION:
Functional limitations in FSS patients are common, and as severe as those in patients with MD when looking at QoL and work participation, emphasizing that FSS are serious health conditions.
There’s also a subset called “functional gastrointestinal disorders”. This study found increased rates of Ehlers Danlos Syndrome in IBS!
Neurogastroenterol Motil. 2015 Apr;27(4):569-79. doi: 10.1111/nmo.12535.
Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study.
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CONCLUSIONS & INFERENCES:
Joint hypermobility syndrome is significantly associated with FGID, and this subgroup of patients have increased comorbidity and decreased QOL. Further research is required to understand the pathophysiological basis of this association.
I know these posts are controversial and maybe it’s not helpful at this point in these diseases history to post any information that associates them with mood disorders – even if that same information also associates with non mood disorders.
I am just personally so intrigued by the changes that occurred in me in this area; the anxiousness, the ability to settle down, etc. When I saw anxiety being opened up to new interpretations which included immune, connective tissue and neuroendocrine indications I thought that was really interesting – and could ultimately be helpful in producing a biological interpretation of ME/CFS. It’s part of my personal search to understand the pathophysiological basis of my ME/CFS. I cannot believe that the “arousal” I associate with ME/CFS doesn’t have a physiological basis.
I understand how off-putting discussions like this can be, though, particularly in the UK and Europe – where people with ME/CFS are struggling to get out of a psychological paradigm.
It is very difficult in the UK but I still appreciate you’re posting the link.
I’m wondering now if the consultant I saw recently had read about this research – but as he is ENT (I have persistent dizziness, plus ENT problems alongside ME) it feels unlikely. I’m going to ask him the next time I have an appointment.
I have to say I didn’t feel like I was being psychologised at all (I’ll leave that to the neurologist’s I’ve seen who haven’t had a clue about ME/CFS).
My perception and curiosity is the same as yours Cort – I’d really like to know more about the underlying triggers for the general amplification of nervous system response to normal stimulation.
Boy is this nicely said
“for the general amplification of nervous system response to normal stimulation.” – yes, indeed. It makes me wonder if central sensitization is present in many of these disorders – and are the microglia (immune part of the brain) involved?
I thought the finding of hypothyroidism was fascinating. Who would have thought that? Check out this on hypothyroidism
http://thyroidpharmacist.com/articles/are-you-going-crazy-or-is-it-just-your-thyroid
Or that connective tissue problems are frequent? I don’t have EDS but I would be surprised given the amount of myofascial pain I believe I experience if connective tissue problems weren’t present.
MERUK, by the way, thought elastase in the blood vessel walls was effected in ME/CFS.
Sadly, it seems many here still think of any psychological problems as a separate part of the body. Thereby promoting the “old” way of thinking about these things. The new understandings related to emotion, depression and anxiety is more tied to a physiological reason. Be it a calcium channel malfunctuon, too high glutamate, imbalance in neurotransmitters, vitamin deficiency or dysfunction in proper metabolism of such. The brain is connected to the body and is NOT separate. Should not be thought of as separate and for sure affects bodily functions. Why the uproar of a suggestion of a psych dysfunction? That too is a body function and has a scientific explanation. Just finding the cause is what is key. We have to change the way people think about and connotations associated with “mood disorders”. It is a part of the body and the brain can get sick and cause body dysfunctions too with a scientific explanation. It’s not a thought process problem, it’s a physiological problem affecting cognitive (and thought) dys-function. (Sadly, some docs need to learn this way of thinking too. It will be good when the old way of looking at “mood disorders” is changed worldwide.)
Issie
Well said, Issie!
It seems that I read this differently than most of the people here. I read it to say that the researcher thinks there might be physiological abnormalities responsible for anxiety, that are also responsible for EDS, pain disorders, autoimmune disorders and mood disorders. I.e., they’re not saying that pain/autoimmune disorders are psychological, but rather that anxiety/mood disorders are physiological and may share a basis with pain/autoimmune disorders.
You read it how I thought I wrote it 🙂
That’s the way I read it too, Ian. Thanks Cort.
Here is my in depth interview on just this topic with Dr Theoharides http://thecoffeeklatch.com/dr-theoharides-what-do-mast-cells-mast-cell-activation-disorder-have-to-do-with-pain-fatigue-allergies-and-autism/
I’ve seen this before. Excellent blog and interview. Having MCAS myself and treatment helping so much with my other issues (POTS, EDS etc) it’s for sure a piece of my puzzle. Thanks for helping spread awareness!
Issie
Thanks again Cort for providing interesting material – which provokes discussion. I am out of ‘discussion’ ideas. But am certain that understanding what is happening at the craniocervical junction and neck – what is different there- is critical to any next step of understanding. In my family we have cases of CFS started from a neck injury, from a virus , and from aging. Complete understanding of scoliosis and its implications seems essential.
Please take time to read about mitochondrial disease on Umdf.org or Mitoaction.org. I sense that this disease has already been discovered and named, it’s mitochondrial disease. Conville to seats can affect any cell in your body except red blood cells. It can affect your brain, can cause pain, create large amounts of fatigue, muscle weakness, the list goes on and on. It is found in 1:4000 people and can be tested through a mitochondrial dr or a geneticist. Please look into this disease too
Reminds me of this: http://ohtwist.com/2016/02/17/the-chronic-constellation/
Oh my goodness….how it does fit with my family. Sadly, most all of it is there.
Issie
Forgot to thank you Tania for the post. May explain alot. I have all the pieces, just never seen or compiled it so completely.
Issie
I wonder if others also have neuropathy issues (not due to diabetes – docs say it’s genetic) in their family?
Issie