Juruena, Mario Francisco, Cleare, Anthony James · Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) · 2007 · DOI
This review article examines whether ME/CFS, atypical depression, and seasonal affective disorder share common biological roots. The researchers found that all three conditions may involve underactivity in the body's stress-response system (particularly a part of the brain called the hypothalamic-pituitary-adrenal axis), rather than overactivity as seen in other types of depression. This suggests these conditions might be more closely related than previously thought, which could help explain why patients sometimes experience overlapping symptoms.
This work is significant because it provides a biological framework for understanding why ME/CFS patients often present with depressive and seasonal mood symptoms, and vice versa. Recognizing these shared mechanisms could improve clinical recognition, reduce diagnostic delays, and support development of targeted treatments addressing the underlying HPA axis dysfunction rather than treating symptoms in isolation.
This review does not establish causation or prove that HPA axis hypofunction directly causes ME/CFS. It also does not demonstrate that all patients with these conditions have identical HPA axis abnormalities, and it cannot establish whether HPA changes are primary pathogenic mechanisms or secondary consequences of chronic illness. The article is a literature synthesis rather than new empirical data.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Spotted an error in this entry? Report it →