While depression does not cause chronic fatigue syndrome (CFS), it can cause fatigue. Likewise, CFS may cause symptoms of depression. With proper treatment and support, you can learn to manage one or both of these conditions.

Depression may cause prolonged feelings of sadness, anxiety, or hopelessness.

Chronic fatigue syndrome (CFS) may cause continuous feelings of fatigue without any underlying cause.

It’s possible to have both conditions at the same time. It’s also easy to mistake feelings of fatigue for depression and vice versa.

The connection

People with CFS may become depressed. And while depression doesn’t cause CFS, it may cause increased fatigue, which can further fuel depression.

CFS may also worsen existing insomnia or sleep apnea. If you feel exhausted, you may not have the motivation or energy to do your daily activities. Even walking to the mailbox can feel like a marathon. The lack of desire to do anything can put you at risk for developing depression.

CFS is primarily a physical disorder, while depression is a mental health condition. But there can be some overlap between the two.

Symptoms of depression

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the nine symptoms of depression include:

  • continuous feelings of sadness, anxiety, or emptiness
  • feelings of hopelessness, helplessness, or worthlessness
  • disinterest in hobbies you once enjoyed (anhedonia)
  • changes in appetite
  • changes in sleeping patterns
  • trouble concentrating and making decisions
  • low energy for completing everyday activities
  • slower physical movements or reaction time
  • suicidal thoughts or ideation

You might also notice unexplained physical symptoms, including:

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

Symptoms of chronic fatigue syndrome

According to the DSM-5, CFS has three main symptoms:

  • decreased or limited ability to engage in regular activities that you normally enjoy
  • worsened symptoms and function after exercise or mental stress
  • waking up tired after getting enough sleep

You might also notice that it becomes more difficult to think clearly and stand or sit upright without needing to lie back down shortly thereafter.

While depression may cause you to lose interest in activities you once enjoyed, you may still be interested in those activities with CFS, but be physically unable to participate.

To provide a diagnosis of either condition, your doctor will try to rule out other mental and physical disorders that may cause similar symptoms.

If your doctor thinks you have depression, they may refer you to a mental health expert for evaluation.

To receive a diagnosis of depression or CFS, you’ll need to speak with your doctor or another health professional. You’ll also need to meet certain diagnostic criteria.

Depression diagnosis

When screening for depression, your doctor will ask you about your medical history and have you fill out a questionnaire that assesses your symptoms.

They may perform a physical exam and use other methods, such as blood tests or X-rays, to ensure that another disorder is not causing your symptoms.

Your doctor may also refer you to a mental health professional who’s trained in recognizing symptoms of and diagnosing depression.

You’ll need to experience at least 5 out of the 9 symptoms previously listed for a period of 2 weeks or more to receive a clinical depression diagnosis.

Chronic fatigue syndrome diagnosis

Before diagnosing CFS, your doctor will run several tests and perform a physical exam to rule out other conditions that can cause similar symptoms. These may include:

To receive a clinical diagnosis, you’ll need to experience the 3 main symptoms outlined above for at least 6 months and rate the intensity of your symptoms as moderate or severe for at least half of the time.

You’ll also need to experience problems with thought or executive function, or worsening of symptoms upon maintaining an upright posture.

Depending on your symptoms and diagnosis, you may benefit from therapy, medications, lifestyle changes, or a combination of these.

Depression treatment

A combination of medication and therapy is often the first-line treatment for depression.

You can work with your doctor or another mental health professional to find an antidepressant that works for you. Your options may include:

Therapies that are often used to successfully treat symptoms of depression may include:

  • cognitive behavioral therapy (CBT), which helps you recognize negative behaviors and replace them with more positive ones
  • dialectical behavior therapy, which combines aspects of CBT with mindfulness practices
  • mindfulness-based therapies, which incorporate mindfulness practices to help manage your symptoms
  • interpersonal therapy, which focuses on how you form and maintain relationships with others
  • psychodynamic therapy, which explores the unconscious process and unresolved conflicts that may underlie depression
Consider the risks and side effects

Antidepressants can have serious side effects, and some might not be effective for you. Your doctor may then recommend changing your dosage or switching to other mood stabilizers or antipsychotic medications.

Antidepressants may worsen symptoms of CFS. That’s why your doctor should screen for depression and CFS before prescribing any medication.

Remember: It may take some trial and error before landing on a treatment plan that works best for you.

Chronic fatigue syndrome treatment

According to a 2018 study, CBT and graded exercise therapy (GET) may be effective for treating symptoms of CFS when used together. GET involves slowly increasing the duration and intensity of physical activity.

Some medications may also help manage symptoms of CFS, including:

  • nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen
  • tricyclic antidepressants
  • SSRIs and SNRIs

More research is needed on the benefits of using antiviral therapy, immunoglobulins, corticosteroids, and alternative therapies for CFS. Current clinical trials are underway, and future treatments may become available.

Other at-home techniques may provide some symptom relief for both CFS and depression. These include:

The importance of sleep

People with depression or CFS, or both, should try to maintain good sleep hygiene. Trying some or all of the following tips may help you wake up feeling more well-rested:

  • Go to bed at the same time every night.
  • Create an environment that promotes sleep (such as a dark, silent, and cool room).
  • Avoid taking longer daytime naps (limit them to 20 minutes).
  • Avoid foods and drinks that may prevent you from sleeping well, such as caffeine, alcohol, and nicotine.
  • Avoid exercising at least 4 hours before bedtime.

Learn more about lifestyle changes for depression.

Talk with your doctor if you have prolonged fatigue that interferes with everyday activities. You should also reach out to them if you have symptoms of depression that do not start to improve after 2 weeks.

Both CFS and depression may negatively affect your daily life. However, by seeking support and creating a treatment plan, you may start to see your condition improve over time.

CFS and depression may have some overlapping symptoms, but they’re distinct medical conditions. CFS is a physical disorder, while depression is a mental health disorder.

With CFS, you may find that it’s harder to participate in everyday activities and things you typically enjoy because you become exhausted too quickly. With depression, you may have no interest in participating in such activities at all.

Both conditions, however, are manageable if you seek support. Your doctor will help you develop a treatment plan that works for you and your symptoms.