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January 16, 1991

Chronic Fatigue Syndrome

Author Affiliations

University of California Davis

University of California Davis

JAMA. 1991;265(3):357. doi:10.1001/jama.1991.03460030063024

To the Editor.—  The recent article by Gold et al1 provides strong evidence that depression rather than infections by the Epstein-Barr virus (EBV) may be the major cause of chronic fatigue syndrome. Of the 26 subjects with chronic fatigue and the 18 healthy controls, 19 (73%) and four (22%), respectively, had lifetime episodes of major depression. There was no laboratory evidence that the frequency of EBV replication was significantly different between the two groups.We believe that it may be premature to dismiss altogether EBV infection as a possible cause of chronic fatigue. Our belief is based on the facts that (1) chronic fatigue syndrome may have multiple causes2; (2) university health physicians do encounter an occasional student with infectious mononucleosis who had protracted convalescence characterized by persistent fatigue; (3) there are a few case reports of chronic active EBV infections or chronic mononucleosis syndrome3; and (4)