Chronic fatigue

Most fibromyalgia patients are exhausted all the time and suffer from painful muscles and joints. But these aren't the only common symptoms of fibromyalgia, at least one-fourth of fibromyalgia patients also have some form of depression. In fact, adult fibromyalgia patients are much more likely than those without fibromyalgia to be depressed.

The link between fibromyalgia symptoms and depression makes sense. First, coping with the severe pain and fatigue of fibromyalgia can be frustrating and disruptive to your lifestyle. And fibromyalgia symptoms can also lead you through uncharted territory as you work through a maze of health care providers.

Like other people with depression, fibromyalgia patients often experience a loss of interest in their favorite activities and feel lonely, tired, and sad.

Depression makes the pain worse and causes lots of fatigue and functional disability in fibromyalgia patients,” says Roland Staud, MD, professor of medicine, division of rheumatology and clinical immunology at the University of Florida in Gainesville. There is a strong correlation, Dr. Staud says, between pain and depression: Alleviation of one leads to alleviation of the other.

Elizabeth W. Carson, Ph.D., a clinical psychologist on staff at St. Josephs Hospital in Atlanta, Ga., says she sees many fibromyalgia patients who are depressed as well as frustrated with their disease process. Depression makes the patient more aware of the pain of fibromyalgia.


Unfortunately, medications have become the main and the first step treatment for anxiety and depression treatments. We should not forget that in many cases the metabolism of the person, the gut interact with the brain (GUT-BRAIN AXIS) and the genetics (that can easily and very inexpensively be evaluated ) affect one’s symptoms. Therefore the following points MUST be considered before starting a patient on anti-depressants or anti-anxiety pharmaceutical medications:

  • Evaluating secondary pathways via using specific serum markers - Full Thyroid panel evaluation that at the minimum should contain TSH, Free T3, Free T4, and Reverse T3. The interpretation of these numbers is extremely important. Your values of any or all of these markers may be “within normal range” but the emphasis should be given on the correlation among these numbers rather than their individual absolute value. Please know that “Free T3 and Free T4 “ are different than “T3 and T4” and therefore the information obtained would be different as well.

  • A full evaluation of one’s vitamins, minerals, amino acids, and anti-oxidants levels where they actually are active and doing the work and not just circulating and wait to get recruited!! These measurements must be done in the immune system and not circulating blood. The most accurate way of doing this is through an intracellular evaluation of these elements inside your lymphocytes (immune cells) that still consists of a simple blood draw but the processing of the blood would be totally different.

  • Genetic evaluation that research has determined to be one of the elements important in the depression/anxiety pathway. Once we figure out the degree of deficiency, then we can correct it via natural supplementation.

  • Self-awareness and care.

  • Counseling.

  • Cognitive Behavioral Therapy (CBT).

  • Use of natural & botanical extracts if indicated by themselves or as an add-on to an appropriate pharmaceutical agent.

  • Using pharmaceutical anti-depressants with or without the use of anxiolytic medications for appropriate patients.

  • Ultimately a referral to a Psychiatrist may be warranted if all above fails.