What treatments work for anxiety and depression in children and adolescents with Chronic Fatigue Syndrome? An updated systematic review

Philippa Clery, Alexander Royston , Katie Driver, Jasmine Bailey, Esther Crawley, Maria Loades

Research output: Contribution to journalReview articlepeer-review

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Objectives Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings. Design A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis. Participants Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety. Interventions Observational studies or randomised controlled trials. Comparison Any or none. Outcomes Studies with outcome measures of anxiety, depression or fatigue. Results The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive-behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated. Conclusion Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME. PROSPERO registration numbers CRD42016043488 and CRD42015016813.

Original languageEnglish
Article numbere051358
JournalBMJ Open
Issue number1
Early online date31 Jan 2022
Publication statusPublished - 31 Jan 2022


  • Anxiety disorders
  • Child & adolescent psychiatry
  • Depression & mood disorders
  • Mental health
  • Paediatrics

ASJC Scopus subject areas

  • Medicine(all)


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