Depression: moody tiredness

Four years ago Paddy came down with the flu. He described himself as 'unwell ever since'. He complained of fatigue, sore muscles and bones, and a disturbed sleep pattern. So far, his symptoms could have been considered 'a possible case of CFS1 and this was the reason for his referral. However, as we delved a little further into his symptoms, Paddy gave a very clear picture of depression, and it became obvious that he was not suffering from a Postviral Fatigue Syndrome. His tiredness was described as 'a moody tiredness, a weariness — like a heavy weight holding me down'. He had lost interest in his job, he didn't feel like socialising, and he avoided situations that he had relished heretofore. He was socially withdrawn, and he had lost all sense of pleasure in life. Finally, his sleep disruption was classical of depression: he woke every morning at 4 a.m., and try as he might, he could not get back to sleep again.

We spoke at length about his depression, but we could not find an obvious cause for it. He was happily married with a few healthy kids, his business ventures were going well, he had no financial difficulties and there were no recent stresses. In spite of all that, Paddy was depressed, and quite considerably so. His fatigue was simply part and parcel of that. We should now look again at Paddy's original flu. He clearly thought it was responsible for his plight. However, we have just said that he was not suffering from a Postviral Fatigue Syndrome. What role, then, did the virus play in all of this? The answer is quite simple: viral infections not only induce fatigue states, they can give rise to depression.

Anxiety: restless tiredness
Jenny was convinced that she had multiple food allergies. She was sure that these were the cause of her chronic fatigue. She thought, for example, that onions gave her a bloated tummy, that yeast and bread gave her a rapid heartbeat, and that beef gave her diarrhoea and a jittery feeling in the pit of her stomach. However, she would still experience these symptoms when she avoided (what she thought were) her troublesome foods. That's why she thought that she had other food allergies not yet discovered.

But her symptoms were of interest in their own right. Look at them for a moment apart from the foods which were said to cause them. She was tired all the time, she had bouts of diarrhoea and a bloated abdomen, her heart was beating too fast, and she felt jittery in the pit of her stomach. These are physical symptoms of anxiety, and they call for further exploration. 'Well, yes,’ she confessed, 'I am a bit of a worrier.' Jenny frequently stayed awake for hours at night thinking about the events of the day, worrying about her children, and planning her chores for the morning. She also described having to live through many days with 'a strange feeling of something bad about to happen'. Nothing particularly bad ever did happen, but Jenny was unable to calm her mind with such reassuring thoughts. She had an anxiety disorder, and her fatigue was just a manifestation of that.

Jenny was encouraged to eat all foods, even those she thought were making her ill. Meanwhile she was given some medical treatment for her anxiety. She improved greatly over the following few months.



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