Herane-Vives, Andres, Papadopoulos, Andrew, de Angel, Valeria et al. · Journal of affective disorders · 2020 · DOI
This study compared stress hormone (cortisol) levels in people with ME/CFS and people with a specific type of depression called atypical depression, both with and without fatigue. Researchers measured cortisol in two ways: through hair samples (showing levels over 3 months) and saliva samples (showing daily patterns). Both ME/CFS and atypical depression groups had lower daily cortisol output than healthy people, but normal cortisol levels when measured over longer periods, suggesting the low levels might be temporary or related to how the body's rhythm changes.
Understanding cortisol patterns in ME/CFS helps clarify whether the condition shares biological mechanisms with depression and whether HPA axis dysfunction is a core or secondary feature. This research addresses the significant diagnostic confusion between ME/CFS and depression, potentially improving clinical recognition and tailoring treatment approaches specific to each condition's underlying biology.
This study does not prove that low cortisol causes ME/CFS or atypical depression, nor does it establish that the conditions are identical. The cross-sectional design cannot determine causality or temporal relationships, and the normal hair cortisol levels suggest that acute low cortisol may be transient rather than a fundamental defining feature of either condition.
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
Herane-Vives, Andres, Papadopoulos, Andrew, de Angel, Valeria, Chua, Kia-Chong, Soto, Lilian, Chalder, Trudie, et al. (2020). Cortisol levels in chronic fatigue syndrome and atypical depression measured using hair and saliva specimens.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2020.01.146
BibTeX
@article{mecfsatlas-herane-vives-2020-cortisol-levels,
author = {Herane-Vives, Andres and Papadopoulos, Andrew and de Angel, Valeria and Chua, Kia-Chong and Soto, Lilian and Chalder, Trudie and Young, Allan H and Cleare, Anthony J},
title = {Cortisol levels in chronic fatigue syndrome and atypical depression measured using hair and saliva specimens.},
journal = {Journal of affective disorders},
year = {2020},
doi = {10.1016/j.jad.2020.01.146},
note = {PubMed: 32217231},
url = {https://www.mecfsatlas.com/evidence/herane-vives-2020-cortisol-levels},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/herane-vives-2020-cortisol-levels
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