Dr Jackson and Dr Meth share a common concern—namely, that so few of the patients in our study were treated with antidepressants. First, our patients had screening psychometric scores "suggestive of depression," not clinically diagnosed major affective disorders. Second, our study was purposely designed not as a clinical trial, but rather as a prospective examination of the characteristics and natural history of fatigued individuals. The patients enrolled in our study continued to receive their medical care from their primary physicians rather than the investigators. In only four instances did the primary care physician elect to use antidepressant medication. This provided a unique opportunity to study the outcome of chronic fatigue after one year of follow-up. The fact that 28% of patients improved during the course of the year provides important baseline data for future therapeutic trials. Had selected patients been offered antidepressant medication simply on the basis of
Kroenke K. Chronic Fatigue-Reply. JAMA. 1989;261(5):697. doi:10.1001/jama.1989.03420050044021
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