Almulla, Abbas F, Abdul Jaleel, Al-Karrar Kais, Abo Algon, Ali Abbas et al. · Brain sciences · 2023 · DOI
This study looked at 63 people with multiple sclerosis (MS) and 30 healthy controls to understand why MS patients experience chronic fatigue, depression, and anxiety. Researchers found that about half of the MS patients had signs of immune system overactivation and problems with red blood cell levels. These immune and blood abnormalities were linked to their fatigue and mood symptoms.
This research identifies immune activation and red blood cell abnormalities as potential biological mechanisms underlying fatigue and mood symptoms in MS, findings that may be relevant to ME/CFS patients who experience similar symptom profiles. Understanding these immune and hematological pathways could inform development of targeted treatments for chronic fatigue and mood disturbances in both conditions.
This study does not establish causation—immune activation and erythron abnormalities are correlated with fatigue and mood symptoms but may not cause them. The findings are from MS patients and may not directly apply to ME/CFS. The cross-sectional design cannot determine whether immune changes precede symptoms or result from them.
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
Almulla, Abbas F, Abdul Jaleel, Al-Karrar Kais, Abo Algon, Ali Abbas, Tunvirachaisakul, Chavit, Hassoun, Hayder K, Al-Hakeim, Hussein K, et al. (2023). Mood Symptoms and Chronic Fatigue Syndrome Due to Relapsing-Remitting Multiple Sclerosis Are Associated with Immune Activation and Aberrations in the Erythron.. Brain sciences. https://doi.org/10.3390/brainsci13071073
BibTeX
@article{mecfsatlas-almulla-2023-mood-symptoms,
author = {Almulla, Abbas F and Abdul Jaleel, Al-Karrar Kais and Abo Algon, Ali Abbas and Tunvirachaisakul, Chavit and Hassoun, Hayder K and Al-Hakeim, Hussein K and Maes, Michael},
title = {Mood Symptoms and Chronic Fatigue Syndrome Due to Relapsing-Remitting Multiple Sclerosis Are Associated with Immune Activation and Aberrations in the Erythron.},
journal = {Brain sciences},
year = {2023},
doi = {10.3390/brainsci13071073},
note = {PubMed: 37509005},
url = {https://www.mecfsatlas.com/evidence/almulla-2023-mood-symptoms},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/almulla-2023-mood-symptoms
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