Abbey, S E, Garfinkel, P E · Reviews of infectious diseases · 1991 · DOI
Many people with ME/CFS experience depression, but it's unclear why. This review examines four possible explanations: depression might be the main illness with fatigue as a symptom, depression might develop because of having ME/CFS, both conditions might occur together separately, or depression might be incorrectly diagnosed. The authors discuss how depression can affect medical tests used to study ME/CFS, which is important to understand when interpreting research results.
Understanding whether depression causes ME/CFS, results from it, or exists separately is crucial for accurate diagnosis and appropriate treatment. This analysis helps patients and clinicians recognize that depression in ME/CFS may have different origins, and helps researchers design better studies by accounting for depression's potential effects on test results.
This review does not prove which model is correct—it examines the evidence for each without definitive resolution. It does not establish causality between depression and ME/CFS, only describes possible relationships. The paper cannot determine whether depression screening practices are accurate or whether current diagnostic criteria adequately distinguish these conditions.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Abbey, S E & Garfinkel, P E (1991). Chronic fatigue syndrome and depression: cause, effect, or covariate.. Reviews of infectious diseases. https://doi.org/10.1093/clinids/13.supplement_1.s73
BibTeX
@article{mecfsatlas-abbey-1991-chronic-fatigue,
author = {Abbey, S E and Garfinkel, P E},
title = {Chronic fatigue syndrome and depression: cause, effect, or covariate.},
journal = {Reviews of infectious diseases},
year = {1991},
doi = {10.1093/clinids/13.supplement_1.s73},
note = {PubMed: 2020805},
url = {https://www.mecfsatlas.com/evidence/abbey-1991-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/abbey-1991-chronic-fatigue
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