Can PEM cause depression?

Messages
12
Likes
68
How many people feel depressed in a low mood or generally feeling blah during PEM? I find I feel really down when PEM is really bad.

There are other possible explanations. My worst PEMs are usually triggered by emotional conflicts so I have plenty to feel down about.

You could feel down simply because you have crashed again after trying so hard to pace.
Or is low mood is some sort of headachy heaviness combined with a lack of energy that simply feels like being emotionally blah?

There are a number of different ideas trying to explain what is going on in clinical depression. One of explanations is that is cause by inflammation in the brain. But brain inflammation is an issue in MECFS too and inflammation is worse during PEM. Could that be why PEM can cause low mood?
 
Messages
4,616
Likes
11,387
Location
Alabama USA
I think all that you are saying is reasonable. One of the main reasons I get PEM is from emotional outbursts, from my mom (dementia) or my family (tired of me being sick) so I get it.

There are some studies I have seen explaining the inflammation in the brain causing depression.

It is also depressing to be sick for a long time, to have to be alone so much, to be unable to the room bright. I have blackout curtains on my windows. To have the pressure of noone knowing yet what really stole our healthy bodies and lives...

BCAAs have helped me with not having PEM so bad and I am able to do a little more around the house.
Building up my Vitamin D (under a Drs care) and magnesium is helpful as well.

My family is getting to the point now, where they know how to deal with me. I made it so that I have my own bedroom, with a door. I can control the light, sound and temperature. If someone is upsetting me I just tell them to get out, usually nicer than that. Boundaries and my autonomy are crucial for me to not have repeated crashes like I was having.

I know for myself ME/CFS has made me stronger emotionally, I can be in pain and not complain much. I can be alone a lot and be okay. I can be mindful and in the moment much better than when I had a dozen balls in the air, trying to multitask my life.

I don't look at Facebook or Instagram much at all anymore. It was getting too depressing to watch the polarized politics and all my friends all dressed up going to this or that fun looking thing. Their perfect Christmas trees... all that.

Best to you and yours! Hope you continue to find what works for you.
 

Hufsamor

Senior Member
Messages
873
Likes
3,089
Location
Norway
I will often get serve anxiety or depression as a part of the PEM.
I believe the theory about worsening inflammation is reasonable.

I can have a splendid time, and still get this almost crippling anxiety and /or depression afterwards, together with muscle cramps and all the other PEM stuff.
I have got this even from taking a walk, so to me, it doesn't necessarily have anything to do with circumstances like conflicts or other mental / psychological origins. ( this, I guess, it not good English, but you understand what I mean?:cool:)

(Of course , Im much more vulnerable to conflicts than I used to be as well, lacking the thicker skin you gets from more energy. I'm even careful with the news, and upsetting programs from conflict areas, and so on)
 

ljimbo423

Senior Member
Messages
1,492
Likes
3,099
Location
United States, New Hampshire
How many people feel depressed in a low mood or generally feeling blah during PEM? I find I feel really down when PEM is really bad.
I often feel down and my thinking goes south in a big way during PEM! Surprisingly, I am usually very happy and optimistic, even with ME/CFS but PEM can turn that around fast. I think I can best describe how I feel during PEM is morally defeated.

There are a number of different ideas trying to explain what is going on in clinical depression.

One of explanations is that is cause by inflammation in the brain. But brain inflammation is an issue in MECFS too and inflammation is worse during PEM. Could that be why PEM can cause low mood?
I think you nailed it right on the head with what I highlighted above! I think low grade brain inflammation causes a lot of ME/CFS symptoms, one of them being depression, low mood or as I like to put it, feeling morally defeated.

ME/CFS researcher Jarred Younger thinks it's low grade brain inflammation that's causing most or all of the symptoms in ME/CFS, including PEM. After much research, I tend to agree.
 
Last edited:

Wolfcub

Moderator
Messages
1,340
Likes
3,278
Location
SW UK
I would think PEM would be likely to cause many to feel depressed.
Sometimes before PEM there's a time you feel better. There might even have been a remission. Then something "too much" or too strenuous is done that's outside the pacing ideal.
This is okay for someone living a normal life. They get a couple of hours extra sleep and they recover in a day or two. But with ME/CFS you're back in the pits again. It can't be slept off. And you never know for how long. It's sometimes hard to see that this thing isn't going to just go away. It keeps coming back for you

It seems the renewed hope that a remission brings is dashed every time PEM comes.

Keep on dashing someone's hope, and the effect is going to be some level of depression. Even when someone is a positive thinker.
Imagine something horrible that keeps on coming back for you. If you think it's gone, it still comes back. That's depressing.

That's just the reactive natural depression anyone -sick with ME or not, would feel.

And then there's the indigenous kind. Such as the one you mentioned @Darach , if it is caused by inflammation.

In the beginning, my illness came on suddenly, out of the blue, like flu. I walked 10 miles 48 hours before. Felt fit, normal, healthy, like I'd always been before. I also was not depressed about anything and didn't have clinical depression or anxiety.
On a Tuesday afternoon at 2pm, I began to feel I was coming down with flu.
Along with the weird headache, sudden nausea, achiness, weakness, shakiness, I also felt horribly sad (couldn't work that one out!) I felt like I wanted to burst into tears.
It felt like I was terrifically moved by things, much moreso than normal. I couldn't listen to music without the waterworks. Tears to the bottom of my Soul. Not because of feeling sorry for myself at all.

It was one of my initial symptoms, and they all came as a package.

Weeks later I rationalised that "wanting to burst into tears" feeling as a typical flu side effect. It is common in someone recovering from flu.

Except that symptom came hand in hand with the others, and when I had remissions from the other symptoms, I also didn't feel like crying. And it lasted a long time (eight-nine months so far) And still recurs now if I relapse and the other symptoms recur.

So I recognised that whatever that was, probably had a physical cause. One that I couldn't figure out. But I also felt it was not "depression" as a separate affliction. But part of the whole package of whatever infection/inflammation/health disturbance/immune dysfunction etc was taking place.
 

Wishful

Senior Member
Messages
1,232
Likes
1,716
I don't have an internal readout for 'magnitude of depression', but I don't really consider myself depressed, even during PEM. I feel lethargic, lousy, often achey, but usually not 'sad'. In my journal, I usually just write 'bleh', which says it all for me.

At several points during ME, I felt suicidal, quite strongly at times. This was separate, driven by supplemental tryptophan or niacin, which I assume elevated quinolinic acid, which is known to induce suicidal moods. However, even while feeling suicidal, I didn't feel that the word 'depression' quite fit.

On fairly rare occasions, my symptoms subside a bit, and I feel a bit cheerful and energetic. I think that when that passes, I return to normal rather than depressed, but maybe I just have a different boundary I consider normal vs depressed.

One odd symptoms, that I've been experiencing again for the last few days: I sigh deeply a lot. It doesn't feel like lack of air. I think whatever neural network controls sighing is just triggering more frequently than normal.
 

Wolfcub

Moderator
Messages
1,340
Likes
3,278
Location
SW UK
Yes @Wishful I have had that sighing thing too. But unconnected with sadness of any kind. Almost as if there was something needed to be stretched inside....(best way I can describe it!) Lungs? Diaphragm? No idea. Whenever I got heart palpitations that happened more.
 

redrachel76

Senior Member
Messages
600
Likes
972
Location
Israel
My ME causes reversal of the sleep cycle. When I am forced to be awake during the day, or when I don't sleep enough for any reason, I get severe depression.

It passes if I rest and get a lot of sleep.
In a person with no ME, staying in bed and not exercising is supposed to make genuine depression worse. With me it makes it better.
 

ebethc

Senior Member
Messages
1,584
Likes
1,227
I often feel down and my thinking goes south in a big way during PEM! Surprisingly, I am usually very happy and optimistic, even with ME/CFS but PEM can turn that around fast. I think I can best describe how I feel during PEM is morally defeated.
same here.... it's like having the flu! I don't feel thrilled, or patient, but that's not the same as depressed.... I'm laying around thinking of all the things I want to do .... If anything, I think I've been been delusionally optimistic about recovery, although that's waning in a big way..

I think low grade brain inflammation causes a lot of ME/CFS symptoms, one of them being depression, low mood or as I like to put it, feeling morally defeated.
agreed! but what's causing the brain inflammation? I"ve been thinking that it may be my bad sinus microbiome... If my sinuses feel good, it's amazing how much better my brain feels..
 

taniaaust1

Senior Member
Messages
12,716
Likes
14,648
Location
Sth Australia
Yes. PEM certainly lowers my moods when I've got that. It's harder to be happy when one is feeling very exhausted to the point where one just wants to cry and literally feeling like one just cant go on.. and then feel sick and unwell on top of that.

I generally just attempt to shut myself away from the whole world to try to recover when I have bad PEM (doing anything or dealing with anything becomes painful), I hate even answering the phone when I'm in such a way. I'm sure I have some brain inflammation thing which flares too when I have PEM so that may at such times be affecting my emotions too.
 

ljimbo423

Senior Member
Messages
1,492
Likes
3,099
Location
United States, New Hampshire
agreed! but what's causing the brain inflammation? I"ve been thinking that it may be my bad sinus microbiome... If my sinuses feel good, it's amazing how much better my brain feels..
I have learned that it's lipopolysaccharides from increased intestinal permeability (leaky gut) that is causing my neuro-inflammation and all other symptoms.

However, that took 8-9 years of almost daily research, averaging about 30 hours a week, for me to learn that. Treating my gut has been and still is a slow process because when I take anywhere near a high enough dose of antibiotic herbs to treat my gut, I get reoccurring flu-like symptoms that feel just like the flu.

With those flu-like symptoms (PEM) come the feelings of low mood and feeling defeated, no matter how much I have improved! Which I think is from neuro-inflammation. So treating my gut is a slow process but I continue to improve month to month.:thumbsup:

I can't tell you what's causing your ME/CFS, I can only share what I have learned.:)
 

Wishful

Senior Member
Messages
1,232
Likes
1,716
agreed! but what's causing the brain inflammation? I"ve been thinking that it may be my bad sinus microbiome... If my sinuses feel good, it's amazing how much better my brain feels..
The sinus symptoms might not be a cause, but a response. ME seems to involve some sort of immune system dysfunction, which would in turn affect everything else affected by the immune system. I know that my rosacea (bacterial infection of follicles) gets worse when my ME symptoms are worse. I have no reason to believe that the follicles are causing the infection that makes the ME worse. Timing and other triggers indicate otherwise.

If your ME inflammation reduces a bit, your immune system may stop overreacting in your sinuses, or fight more effectively with fewer symptoms. Maybe pay closer attention to which symptoms (ME or sinus) changes first to see which is the cause and which the effect?
 

ebethc

Senior Member
Messages
1,584
Likes
1,227
The sinus symptoms might not be a cause, but a response. ME seems to involve some sort of immune system dysfunction, which would in turn affect everything else affected by the immune system. I know that my rosacea (bacterial infection of follicles) gets worse when my ME symptoms are worse. I have no reason to believe that the follicles are causing the infection that makes the ME worse. Timing and other triggers indicate otherwise.

If your ME inflammation reduces a bit, your immune system may stop overreacting in your sinuses, or fight more effectively with fewer symptoms. Maybe pay closer attention to which symptoms (ME or sinus) changes first to see which is the cause and which the effect?
chicken vs egg :)
 

ebethc

Senior Member
Messages
1,584
Likes
1,227
I have learned that it's lipopolysaccharides from increased intestinal permeability (leaky gut) that is causing my neuro-inflammation and all other symptoms.

However, that took 8-9 years of almost daily research, averaging about 30 hours a week, for me to learn that. Treating my gut has been and still is a slow process because when I take anywhere near a high enough dose of antibiotic herbs to treat my gut, I get reoccurring flu-like symptoms that feel just like the flu.

With those flu-like symptoms (PEM) come the feelings of low mood and feeling defeated, no matter how much I have improved! Which I think is from neuro-inflammation. So treating my gut is a slow process but I continue to improve month to month.:thumbsup:

I can't tell you what's causing your ME/CFS, I can only share what I have learned.:)
leaky gut is really elusive for me... I feel like I do everything I can and can afford, but I don't see improvement
 
Messages
12
Likes
68
ME/CFS researcher Jarred Younger thinks it's low grade brain inflammation that's causing most or all of the symptoms in ME/CFS, including PEM. After much research, I tend to agree.
It is certainly a major part of it, but then there is the whole area of mitochondria damage and low energy production in cells throughout the body.
 

ljimbo423

Senior Member
Messages
1,492
Likes
3,099
Location
United States, New Hampshire
It is certainly a major part of it, but then there is the whole area of mitochondria damage and low energy production in cells throughout the body.
Good point. Until just recently, I thought the mitochondrial dysfunction in the body was most likely the biggest cause of symptoms. Once I saw Jarred Youngers' presentation at the September OMF symposium, that started changing.

I think it's clear that there is mito. dysfunction in the body and probably in the brain too. How much the mito. dysfunction in the body adds to the debilitating symptoms in ME/CFS, I don't know.

I now think it's probably much less than the low grade brain inflammation is causing.

I have and am, getting good symptom improvement from supplements that support mito. functioning, which I use to think was from improving mito. functioning in the body. Now I think it might be from improving mito. functioning in the brain.

So many symptoms can be explained by brain inflammation. PEM, fatigue, flu-like symptoms, POTS, light and sound sensitivities, etc, can all be do to an inflamed brain. As well as the varying amounts of anxiety and depression so many suffer from.
 

Wishful

Senior Member
Messages
1,232
Likes
1,716
The low energy production in cells throughout the body isn't a part of ME for all victims, so it's likely a secondary effect.

Has anyone reported on ME victims with body energy problems but no brain inflammation? Hmmm, I don't think I've seen any research papers mentioning the subgroup lacking the muscle problems, so a lack of papers doesn't mean much.

I still think researchers should make more effort to study the uncommon victims. Some people might have a variation that would reveal something important more easily than studying a few hundred more examples of 'standard ME'.
 

ljimbo423

Senior Member
Messages
1,492
Likes
3,099
Location
United States, New Hampshire
The low energy production in cells throughout the body isn't a part of ME for all victims, so it's likely a secondary effect.
I have seen posts that reflect that as well.

Has anyone reported on ME victims with body energy problems but no brain inflammation? Hmmm, I don't think I've seen any research papers mentioning the subgroup lacking the muscle problems, so a lack of papers doesn't mean much.
I agree. There's still far more to learn about ME/CFS than is known.

I still think researchers should make more effort to study the uncommon victims. Some people might have a variation that would reveal something important more easily than studying a few hundred more examples of 'standard ME'.
That could very possibly be true.