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Table 6 Clinical features that help to distinguish depression and CFS/ME

From: Investigating unexplained fatigue in general practice with a particular focus on CFS/ME

Variable Depression CFS/ME
Physical Exertion Exercise can improve mood and energy levels overall Nearly always causes delayed worsening of the fatigue and other symptoms
Mood Low Usually normal
Motivation Reduced Normal in the majority and in the absence of complicating depression
Sleep Early morning wakening common but difficult initiating sleep also seen Difficulty initiating sleep and getting up in the morning
Memory Often rumination about the past and feelings of guilt Word finding difficulty and precise recollection of recent events.
Concentration If engaged can be normal Impaired especially with extraneous noise and movement
Energy Persistently low but with only minor day to day variability and no delayed post-exertion worsening Variable from day to day and accompanied by delayed worsening with physical, mental and emotional exertion
Appetite Low. Weight can go down. Normal. Weight either maintained or sometimes increased.
Affect One of sadness. Reduced spontaneity of action and of facial expression Normal. Frustration and sometimes anger seen.
Interest in outside life Reduced. No desire to complete previous hobbies or see family and friends Maintained. Impaired energy reduces ability to continue with hobbies, social life and leisure activities.
Response to anti-depressants Fatigue may be improved Little or no response if no complicating depression and many are hypersensitive to normal starting doses.