What Is Malaise? 4 Ways Chronic Fatigue Syndrome Can Affect Your Mental Health

People commonly report fatigue. In fact, as many as one in five people seeking medical help say they have it.¹ 

Chronic fatigue syndrome or “myalgic encephalomyelitis” (ME/CFS) is more than just feeling a bit tired. It causes extreme exhaustion.² This fatigue is so pronounced that it can stop people from doing the things they normally would every day, like going to work or school, or even performing basic self-care like showering.³

The CDC estimates that chronic fatigue syndrome affects more than three million people in the United States.³ But it is an invisible illness, meaning it doesn’t obviously reveal itself to others. So people often feel they have to justify themselves to those around them.⁴ Additionally, those with chronic fatigue syndrome also often develop mental health conditions such as anxiety and depression. 

In this blog, we will explore the link between chronic fatigue syndrome and mental health, as well as discuss some of the possible treatments available.

The Truth About Chronic Fatigue Syndrome and Mental Health

Chronic fatigue syndrome is a long-term (chronic) condition that can affect different parts of your body over a long time. Yet no one knows exactly what causes it.² However, some people are more likely to develop it than others, for instance, if you have a family member with the condition. 

Additionally, there may be a link between trauma and chronic fatigue syndrome, as people who have experienced childhood trauma are more likely to develop chronic fatigue syndrome.⁵ Further, it is linked with post-traumatic stress disorder, which means it’s likely associated with the way the body manages stress.⁶

In general, chronic fatigue syndrome is a physical health condition rather than a psychological one.⁷ Plus, symptoms fluctuate – sometimes they are worse than others. Chronic fatigue syndrome can also affect children and adolescents, but it does so at a lower rate than in adults.¹

Yet just because CFS is predominantly a physical condition, it’s still known to seriously impact mental health. And we’ll discuss how shortly. First, it may help to be able to identify the symptoms. 

What Are the Symptoms?

The main symptom of chronic fatigue syndrome, unsurprisingly, is intense, long-lasting fatigue. But this kind of fatigue does not get better with rest. It can’t be explained by circumstances or other medical diagnoses (for instance, anemia).¹ 

People with chronic fatigue syndrome also report other physical symptoms, such as:²

• Sleep problems (not being able to sleep, sleeping too much, or not feeling exhausted when you wake up)
• Brain fog (concentration, thinking, and memory problems)
• Symptoms worsening after physical or mental activity (post-exertional malaise).
• Pain or flu-like symptoms, including high temperature or headaches (only in some people)

How Is It Diagnosed?

Unlike many other disorders, chronic fatigue syndrome is usually diagnosed by ruling out other conditions. As such, it can take some time and several blood and urine tests before you receive a diagnosis.²

An additional complication of diagnosis is that the symptoms of chronic fatigue syndrome are similar to those of other disorders. Fatigue is a key symptom of many ailments, including vitamin B deficiency, anemia, thyroid disease, and, of course, depression. In fact, chronic fatigue syndrome shares many common symptoms with depression, such as headaches, sleep problems, brain fog, and, of course, extreme tiredness.⁸

As CFS is associated with chronic pain, poor sleep, difficulties concentrating, and problems achieving a diagnosis, it’s known to impact mental health in a variety of ways. Not only can it lead to isolation and frustration, but feeling constantly misunderstood can create psychological distress and emotional regulation issues. Next, we look at four ways this form of chronic illness and mental health are linked. 

4 Ways Chronic Fatigue Syndrome Affects Your Mental Health

It’s important to clarify that, while symptoms might overlap, chronic fatigue syndrome IS NOT depression. People with chronic fatigue syndrome can, like everyone else, become depressed, and people with depression can develop chronic fatigue syndrome.⁹ In fact, mental health conditions are more likely to develop in people living with a long-term illness, with some estimating that they are more than twice as likely.^10-12 Chronic fatigue syndrome is no exception, so anxiety and depression can be common in those with it.⁴

Below, we consider four ways chronic fatigue syndrome and mental health are linked. 

1. Chronic Fatigue Syndrome Can Lead to Feelings of Low Self-Worth and Low Self-Esteem

People with long-term conditions face many challenges, for instance, feelings of self-consciousness and a lack of self-worth.¹³ Similarly, chronic fatigue syndrome can lead to low self-esteem.¹² Plus, it can lead to depression or make it worse. Depression can also exacerbate the feelings of fatigue in someone with chronic fatigue syndrome, creating a vicious cycle.¹⁴ Essentially, this is increased depression from chronic fatigue. 

2. It Can Make You Feel Isolated

Chronic fatigue syndrome can lead to social isolation. Missing out on typical life events can make you feel worried, irritable, and stressed, and that’s on top of feeling tired and potentially being in pain.^12,13 When you add a mental health condition to the mix, it can make life exponentially more difficult and worsen the symptoms of both conditions.¹⁵ Plus, the combination of ongoing pain, financial difficulty, and social isolation can start feeding into a mental health condition, explaining the psychological impact of chronic fatigue¹³

3. Chronic Fatigue Syndrome Can Make Stress Even More Challenging

For most people, “normal” levels of stress (the daily levels that encourage you to get up in the morning and get to work) can be useful. Yet, everyone has a different threshold for stress, and for many, ongoing challenges can create levels that are uncomfortable, or even overwhelming.¹⁶ 

Some people who have experienced chronic stress (continual high levels of stress over a long period) at the time of having an acute infection might go on to develop chronic fatigue syndrome.¹⁶ Plus, when people have a long-term condition, such as chronic fatigue syndrome, they might find it more difficult to manage stress that they could have handled easily previously. Clearly, this relationship is a two-way street, as people with chronic fatigue syndrome often report worse symptoms after mental stress.⁹ 

Stress comes in different forms. But the same body systems are activated whether stress is internal (for instance, because of an infection or increased inflammation) or external (like when up against a tight deadline). Interestingly, the hypothalamic-pituitary-adrenal axis, which regulates the body’s stress response, goes wrong in both chronic fatigue syndrome and depression.¹⁴ However, while in depression, the activity of the HPA axis tends to be increased, in people with chronic fatigue syndrome, it tends to be reduced.¹⁵

4. Its Unpredictable Nature Can Lead to Increased Anxiety

Symptoms of chronic fatigue syndrome might come and go. While this gives people some respite from the condition, it can also add to internal stress. In this way, the link between anxiety and chronic fatigue syndrome is clear. 

Worrying about what people think when one day you might be OK, and the next you might not be able to get out of bed, can be challenging. It can also lead to people questioning themselves about their condition and make their feelings of inadequacy even worse. Open communication with friends, family, and work can help to manage this by helping the people around you to understand the condition. 

Is There Therapy for Chronic Fatigue Syndrome?

As mentioned, CFS is not a mental health condition, but it is associated with conditions like anxiety and depression. Coping with invisible illness is never easy; it can cause people to feel misunderstood, ashamed of their condition, and hopeless that it won’t go away. 

Mental and physical illnesses, especially when they feed into one another, shouldn’t be considered in isolation. Therefore, a holistic approach to treatment is typically the best course of action. While there are no specific therapy for chronic fatigue syndrome, there are still approaches that might help.

The following could provide some physical and mental health support for CFS:

Cognitive Behavioural Therapy

Cognitive behavioural therapy is a talking therapy that has been shown to be effective for people with chronic fatigue syndrome.⁹ It is a talking therapy that can help with many mental and physical health problems by changing our thoughts and behaviors.²

Energy Management

Energy management provides advice about making the best use of your energy while managing your symptoms.² This could lead to a reduction in the mental health costs of chronic fatigue.

Medicines

Medications can help manage pain and problems sleeping.² While none of these are FDA-approved for chronic fatigue as of yet, a health provider can talk to you about their suitability for your needs. 

If ME/CFS and depression are moderate or severe, you may be prescribed an antidepressant. There are many types of antidepressants, but they all take time to be effective. They also often come with some side effects, including dry mouth and fatigue. Plus, they are often most effective in conjunction with a talking therapy.²

Graded Exercise Therapy

Graded exercise therapy can gradually increase the intensity and duration of physical exercise.⁹

Talking Therapies

When it comes to the mental health effects of CFS, there are several types of talking therapies that could help. These include:^2,17,18

• Cognitive behavioral therapy: Reframes thoughts to change behavior
• Mindfulness-based cognitive therapy: Helps people notice what’s happening around them in the moment rather than fixating on past or future worries
• Interpersonal therapy: Concentrates on your relationships with others
• Behavioral activation: Focuses on links between your mood and activities
• Counselling: Helps you find new solutions to problems. 

Mission Connection: Support for People With Chronic Fatigue Syndrome

Life can feel like an uphill battle with chronic fatigue syndrome, with everyday activities being almost impossible. Therefore, it’s unsurprising that depression all too often develops as a result of CFS. By the time someone gets a diagnosis, they might feel they’ve been coping alone for months. 

Being open and honest about symptoms with your loved ones, but most importantly yourself, can help. Keeping a journal of them might be a good way to track how you’ve been feeling. And it can also be useful for detecting when signs of mental health issues creep in – allowing you to seek help earlier rather than later. 

Mission Connection is here to help if you’re dealing with chronic fatigue syndrome and mental health. We offer a variety of specialized evidence-based mental health therapies that can support the mind and body, helping you to breathe a little easier. 

Reach out to our team today if you’re ready to start supporting your mental health. Relief often starts with a simple phone call. 

References

1. Afari, N., Buchwald, D. (2003). Chronic fatigue syndrome: a review. The American Journal of Psychiatry, 160(2). https://pubmed.ncbi.nlm.nih.gov/12562565/
2. NHS. (May, 2024). Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/
3. CDC. (May, 2024). ME/CFS basics. https://www.cdc.gov/me-cfs/about/index.html.
4. Daniels, J., Brigden, A., Kacorova, A. (2017). Anxiety and depression in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): Examining the incidence of health anxiety in CFS/ME. Psychology and Psychotherapy, 90(3): 502 – 509. https://doi.org/10.1111/papt.12118. https://purehost.bath.ac.uk/ws/portalfiles/portal/185716061/Final_accepted_Health_anxiety_in_CFSME.pdf). 
5. Heim, C., Nater, U., M. Maloney, E., Boneva, R., Jones, J., F., Reeves, W. C. (2009). Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Archives of General Psychiatry, 66(1): 72 – 80. https://doi.org.10.1001/archgenpsychiatry.2008.508.
6. Carter, E. (February, 2025). Can chronic fatigue syndrome be secondary to PTSD? Advance Study. https://advancestudy.org/can-chronic-fatigue-syndrome-be-secondary-to-ptsd/
7. Geraghty, K.  (2016). The ‘all in the mind’ myth of myalgic encephalomyelitis/chronic fatigue syndrome. ME Association. https://meassociation.org.uk/2016/06/the-all-in-the-mind-myth-of-myalgic-encephalomyelitischronic-fatigue-syndrome-nursing-in-practice-27-june-2016/
8. Bernstein, S. (September, 2024). Is it chronic fatigue syndrome or depression? WebMD. https://www.webmd.com/depression/cfs-vs-depression
9. Nall, R., Matysiak, S. (June, 2025).  Fatigue and depression: are they connected? Healthline. https://www.healthline.com/health/depression/fatigue 
10. National Institute of Mental Health. (2024). Understanding the link between chronic disease and depression. https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health.
11. Huang, Y., Loux, T., Huang, X., Feng, F. (2023). The relationship between chronic diseases and mental health: A cross-sectional study. Mental Health & Prevention, 32, 200307. https://doi.org/10.1016/j.mhp.2023.200307.
12. Mental Health Foundation. (February, 2022). Long-term physical conditions and mental health. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/long-term-physical-conditions-and-mental-health 
13. Rao, A. (2023). The complex relationship between chronic diseases and mental health. Research on Chronic Diseases 7(4):087 – 089. https://doi.org.10.37532/rcd.2023.7(4).087-089. 
14. Biology Insights. (August, 2025). Chronic fatigue and depression: the connection explained. https://biologyinsights.com/chronic-fatigue-and-depression-the-connection-explained/.
15. Leone, S. S. (2010). A disabling combination: fatigue and depression. The British Journal of Psychiatry. 197,(2):86 – 87. https://doi.org/10.1192/bjp.bp.109.076604.
16. ME Association. (2020). Stress and how to handle it. https://meassociation.org.uk/literature/items/stress-how-to-handle-it/ 
17. Mission Connection. (September 2025). Mindfulness-based cognitive therapy: MCBT benefits & applications for mental health treatment. https://missionconnectionhealthcare.com/our-approach/mindfulness-based-cogntive-therapy/.
18. Mind. (April, 2023). Depression. https://www.mind.org.uk/information-support/types-of-mental-health-problems/depression/self-care/