Novakovic, Mina, Løhde, Linda, Brandt-Christensen, Anne Mette et al. · Ugeskrift for laeger · 2024 · DOI
Quick Summary
This case report describes an older woman who was diagnosed with ME/CFS 30 years ago but was later found to actually have depression with severe fatigue as a main symptom. She received electroconvulsive therapy (ECT) for depression and regained the ability to walk after six years of immobility. The case highlights how depression and ME/CFS can look similar and sometimes get confused with one another.
Why It Matters
This case is clinically relevant because it demonstrates that severe fatigue and immobility attributed to ME/CFS may occasionally have a psychiatric etiology responsive to ECT. It underscores the importance of thorough diagnostic evaluation in patients with ME/CFS-like presentations and the need for clinicians to consider overlapping depression, particularly atypical depression with prominent fatigue symptoms, in differential diagnosis.
Observed Findings
A 71-year-old woman with a 30-year history of CFS/ME diagnosis was unable to walk for six years.
Upon reassessment, depression with atypical symptoms (particularly extreme fatigue) was identified as the primary diagnosis.
The patient was treated with electroconvulsive therapy.
Following ECT treatment, the patient regained the ability to walk.
Inferred Conclusions
Depression with atypical presentations dominated by fatigue can be misdiagnosed as CFS/ME, representing the reverse of the more commonly reported misdiagnosis pattern.
ECT may be an effective treatment option for patients in whom depression (rather than ME/CFS) is the underlying diagnosis.
Thorough diagnostic reassessment is warranted in ME/CFS patients with treatment resistance or atypical features.
Remaining Questions
How common is the misdiagnosis of depression as ME/CFS, and what clinical features best distinguish between these conditions?
What are the specific characteristics of 'atypical depression' that led to the initial CFS/ME diagnosis, and how can clinicians better identify such cases earlier?
Would other patients with similar presentations respond comparably to ECT, and what patient factors predict treatment response?
What This Study Does Not Prove
This single case report does not prove that ECT is effective for ME/CFS or that patients with ME/CFS should be treated with ECT. It does not establish the frequency with which depression is misdiagnosed as ME/CFS. The case cannot determine whether other ME/CFS patients with depression might respond similarly, and causality between ECT and functional recovery cannot be definitively established from one case.
Tags
Symptom:Fatigue
Method Flag:PEM Not DefinedWeak Case DefinitionNo ControlsSmall Sample