There is considerable evidence to support the idea that CFS is associated with depression.

• If psychiatric patients with a depressive disorder are asked about a wide range of somatic symptoms including fatigue (which they are usually not) those reported frequently include symptoms of CFS.(4)

• If operational criteria for depressive disorders are applied to patients with CFS a high proportion meet these, and an even higher proportion have a previous history of major depression/5)

• The prevalence of major depressive disorder in patients referred to hospital with CFS is substantially higher than that of patients with chronic disabling medical diseases/6,)

In practice, the diagnosis of depression can be difficult in such patients. Depressed mood is often not prominent and anhedonia can be hard to distinguish from the inability to pursue previously enjoyed activities. Furthermore, whilst there is a strong association between major depressive disorder and CFS, for as many as half of the patients seen in hospital clinics the symptoms cannot be readily subsumed under an operationally defined diagnosis of major depressive disorder.

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