Maes, Michael, Ringel, Karl, Kubera, Marta et al. · Journal of affective disorders · 2013 · DOI
This study found that people with ME/CFS often develop antibodies (immune proteins) against serotonin, a chemical messenger in the brain. These antibodies were linked to higher levels of inflammation, signs of bacteria leaking from the gut, and worse symptoms including pain, fatigue, brain fog, and mood changes. The findings suggest ME/CFS involves immune system problems that may contribute to the condition's core symptoms.
This study provides evidence that ME/CFS involves specific immune dysregulation against serotonin, linking three known disease mechanisms (autoimmunity, inflammation, and gut barrier dysfunction). Understanding these interconnected pathways may eventually lead to targeted treatments and biomarker-based diagnostics for ME/CFS patients who currently lack objective diagnostic tests.
This study does not prove that anti-5-HT antibodies cause ME/CFS—it only shows association. The cross-sectional design cannot establish causality or determine whether antibodies precede symptom onset. It also does not explain whether serotonin antibodies are primary drivers or secondary consequences of the underlying disease process.
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, Ringel, Karl, Kubera, Marta, Anderson, George, Morris, Gerwyn, Galecki, Piotr, et al. (2013). In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocation.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2013.03.029
BibTeX
@article{mecfsatlas-maes-2013-myalgic-encephalomyelitis,
author = {Maes, Michael and Ringel, Karl and Kubera, Marta and Anderson, George and Morris, Gerwyn and Galecki, Piotr and Geffard, Michel},
title = {In myalgic encephalomyelitis/chronic fatigue syndrome, increased autoimmune activity against 5-HT is associated with immuno-inflammatory pathways and bacterial translocation.},
journal = {Journal of affective disorders},
year = {2013},
doi = {10.1016/j.jad.2013.03.029},
note = {PubMed: 23664637},
url = {https://www.mecfsatlas.com/evidence/maes-2013-myalgic-encephalomyelitis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/maes-2013-myalgic-encephalomyelitis
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