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Does hypocortisolism predict a poor response to cognitive behavioural therapy in chronic fatigue syndrome?

Published online by Cambridge University Press:  17 July 2009

A. D. L. Roberts ,
M.-L. Charler ,
A. Papadopoulos ,
S. Wessely ,
T. Chalder  and
A. J. Cleare
A. D. L. Roberts
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK Chronic Fatigue Syndrome Research and Treatment Unit, Maudsley Hospital, London, UK
M.-L. Charler
Affiliation:
Chronic Fatigue Syndrome Research and Treatment Unit, Maudsley Hospital, London, UK
A. Papadopoulos
Affiliation:
National Affective Disorders Unit, Maudsley and Bethlem Royal Hospitals, London, UK
S. Wessely
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK Chronic Fatigue Syndrome Research and Treatment Unit, Maudsley Hospital, London, UK National Affective Disorders Unit, Maudsley and Bethlem Royal Hospitals, London, UK
T. Chalder
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK Chronic Fatigue Syndrome Research and Treatment Unit, Maudsley Hospital, London, UK
A. J. Cleare*
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK Chronic Fatigue Syndrome Research and Treatment Unit, Maudsley Hospital, London, UK National Affective Disorders Unit, Maudsley and Bethlem Royal Hospitals, London, UK
*
*Address for correspondence: Dr A. J. Cleare, Department of Psychological Medicine, Section of Neurobiology of Mood Disorders, Institute of Psychiatry, 103 Denmark Hill, LondonSE5 8AF, UK. (Email: a.cleare@iop.kcl.ac.uk)
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Abstract

Background

There is evidence that patients with chronic fatigue syndrome (CFS) have mild hypocortisolism. The clinical significance of this is unclear. We aimed to determine whether hypocortisolism exerted any effect on the response of CFS to cognitive behavioural therapy (CBT).

Method

We measured 24-h urinary free cortisol (UFC) in 84 patients with Centers for Disease Control and Prevention (CDC)-defined CFS (of whom 64 were free from psychotropic medication) who then received CBT in a specialist, tertiary out-patient clinic as part of their usual clinical care. We also measured salivary cortisol output from 0800 to 2000 h in a subsample of 56 psychotropic medication-free patients.

Results

Overall, 39% of patients responded to CBT after 6 months of treatment. Lower 24-h UFC output was associated with a poorer response to CBT but only in psychotropic medication-free patients. A flattened diurnal profile of salivary cortisol was also associated with a poor response to CBT.

Conclusions

Low cortisol is of clinical relevance in CFS, as it is associated with a poorer response to CBT. Hypocortisolism could be one of several maintaining factors that interact in the persistence of CFS.

Keywords

Chronic fatigue syndromecognitive behavioural therapycortisolHPA axismyalgic encephalomyelitis
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 3 , March 2010 , pp. 515 - 522
Copyright
Copyright © Cambridge University Press 2009

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