title: Treatment for paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) and comorbid depression: a systematic review.
abstract: At least 30% of young people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) also have symptoms of depression. This systematic review aimed to establish which treatment approaches for depression are effective and whether comorbid depression mediates outcome.
  
  
  
  A systematic review was undertaken. The search terms were entered into MEDLINE, EMBASE, PsycInfo and the Cochrane library.
  
  
  
  Inclusion and exclusion criteria were applied to identify relevant papers. Inclusion criteria were children age <18, with CFS/ME, defined using CDC, NICE or Oxford criteria, and having completed a valid assessment for depression.
  
  
  
  9 studies were identified which met the inclusion criteria, but none specifically tested treatments for paediatric CFS/ME with depression and none stratified outcome for those who were depressed compared with those who were not depressed. There is no consistent treatment approach for children with CFS/ME and comorbid depression, although cognitive-behavioural therapy for CFS/ME and a multicomponent inpatient programme for CFS/ME have shown some promise in reducing depressive symptoms. An antiviral medication in a small scale, retrospective, uncontrolled study suggested possible benefit.
  
  
  
  It is not possible to determine what treatment approaches are effective for depression in paediatric CFS/ME, nor to determine the impact of depression on the outcome of CFS/ME treatment. Young people with significant depression tend to have been excluded from previous treatment studies.
authors.affiliation: Department of Psychology, University of Bath, Bath, UK.
authors.forename: Maria E
authors.identifier: 0000-0002-0839-3190
authors.initials: ME
authors.lastname: Loades
authors.affiliation: Department of Psychology, University of Bath, Bath, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sheils
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Esther
authors.initials: E
authors.lastname: Crawley
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015673:Fatigue Syndrome, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
keywords: CFS/ME; chronic fatigue syndrome; paediatric