Sir,

Am I the only person who found MacHale et al’s discussion of their results confusing (2000)? According to the abstract and methods, they screened their patients with chronic fatigue syndrome (CFS) to exclude those with depression. Then they examined this group further using a standardised psychiatric interview (Schedule for Affective Disorders and Schizophrenia) in order to “exclude subjects with current psychiatric illness, with a particular emphasis on depression”. The data from the Hamilton Depression Rating scale are difficult to interpret given the number of illness-related items, but the scores did not indicate a significant degree of depression either. So, having excluded “subjects with depression or anxiety”, why did the authors claim in their discussion that “the main limitation of the present study is that our CFS subjects had high levels of depression”?

If this is correct, why was their depression not picked up by the three measures? Why were these patients not excluded from the research as stated by the authors, or funds permitting, used as a comparison group (cf. Costa et al 1995, Fischler et al 1998)? How depressed were the ten patients on antidepressants and if these were not effective, could their suboptimal treatment have contributed to their ongoing fatigue?

I was also baffled by the authors’ suggestion that the thalamic hyperperfusion may reflect “increased attention to motor and cognitive tasks”. What were the patients doing? The abstract states that the scans were conducted at rest. If the subjects had just completed a battery of cognitive tests, why did the authors not check to see if the data available supported their hypothesis (cf. Fischler et al)?

If this paper was subjected to peer review, why did no one challenge the obvious inconsistencies? Why did no one query the selective discussion of the findings and the misrepresentation of the literature on CFS and psychopathology? Does British Psychiatry no longer value scientific objectivity and attention to detail?

Yours faithfully,

Ellen Goudsmit (Dr.)

• Costa, DC., Tannock, C and Brostoff, J. (1995) Brainstem perfusion is impaired in chronic fatigue syndrome. Quarterly Journal of Medicine, 88, 767-773.

• Fischler B., Flamen, P., Everaert, H et al. (1998) Physiopathological significance of ^99mTcHMPAO SPECT scan anomalies in chronic fatigue syndrome: a replication study. Journal of Chronic Fatigue Syndrome, 4, 4, 15-30.

• MacHale, SM., Lawrie, SM., Cavanagh, JTO, et al. (2000) Cerebral perfusion in chronic fatigue syndrome and depression. British Journal of psychiatry, 176, 550-556.