Maes, Michael, Kubera, Marta, Obuchowiczwa, Ewa et al. · Neuro endocrinology letters · 2011
This review explains why depression often occurs alongside many other diseases, including ME/CFS, autoimmune conditions, heart disease, and neurodegenerative disorders. The common link appears to be activation of inflammatory and oxidative stress pathways in both the brain and body. These pathways may act like a 'warning system' that produces depression symptoms such as fatigue, anxiety, and physical discomfort when the body detects a threat.
For ME/CFS patients and researchers, this framework is significant because it positions ME/CFS within a broader inflammatory disease spectrum and explains why depression is so common in ME/CFS. Understanding shared inflammatory mechanisms may identify novel treatment targets and validate the biological basis of both conditions rather than attributing them solely to psychiatric causes.
This review does not prove causation—it identifies correlations and shared biological pathways. It does not establish that IO&NS activation causes depression in ME/CFS specifically, nor does it demonstrate that treating these pathways will resolve depression or fatigue. The narrative review format means conclusions depend on the authors' selection and interpretation of existing studies.
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
Maes, Michael, Kubera, Marta, Obuchowiczwa, Ewa, Goehler, Lisa, & Brzeszcz, Joanna (2011). Depression's multiple comorbidities explained by (neuro)inflammatory and oxidative & nitrosative stress pathways.. Neuro endocrinology letters. https://pubmed.ncbi.nlm.nih.gov/21407167/
BibTeX
@article{mecfsatlas-maes-2011-depression-multiple,
author = {Maes, Michael and Kubera, Marta and Obuchowiczwa, Ewa and Goehler, Lisa and Brzeszcz, Joanna},
title = {Depression's multiple comorbidities explained by (neuro)inflammatory and oxidative & nitrosative stress pathways.},
journal = {Neuro endocrinology letters},
year = {2011},
note = {PubMed: 21407167},
url = {https://www.mecfsatlas.com/evidence/maes-2011-depression-multiple},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/maes-2011-depression-multiple
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