Chronic Fatigue in Adolescents
1 From the Department of Pediatrics and Children's Hospital and Medical Center, Seattle, Washington
2 From the Department of Psychiatry, Children's Hospital and Medical Center, Seattle, Washington
3 From the Departments of Medicine, Laboratory Medicine, and Microbiology of the University of Washington School of Medicine
4 From the Department of Laboratory Medicine, Seattle, Washington
5 From the Departments of Laboratory Medicine, Microbiology of the University of Washington School of Medicine and Veteran's Affairs Medical Center, Seattle, Washington
Nine female and 6 male adolescents (mean age 14.5 ± 1.7 [SD] years) were evaluated for chronic fatigue associated with at least three additional symptoms present for 18.4 ± 8.4 months. Eleven subjects experienced the onset of symptoms with an acute illness (seven Monospot-positive). Medical history, physical examination, and laboratory testing yielded little helpful information. Serologic testing for Coxsackie B viruses 1 through 6, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, and Toxoplasma gondii in subjects and healthy controls provided little evidence for an infectious cause of persistent fatigue. Children's Depression Inventory scores and psychiatric interviews with the Schedule for Affective Disorders and Schizophrenia-Children's Version (K-SADS) identified five subjects with major depression. On the K-SADS, the 10 fatigued subjects without major depression endorsed many secondary symptoms of depression but were less likely than depressed psychiatric clinic patients to endorse primary symptoms such as depressed mood, guilt, and suicidality. At telephone follow-up 13 to 32 months after intake, 4 subjects were completely well, 4 markedly improved, and 7 unimproved or worse. Further research is necessary to determine whether chronic fatigue in adolescents is prodromal depression, a discrete psychosomatic condition, or an infectious or immunologic disorder that mimics depression.
Key Words: adolescents • depression • chronic fatigue
Submitted on August 24, 1990
Accepted on January 8, 1991
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