The country was shocked when, on Monday, August 11th, 2014, Robin Williams lost his long battle against depression and committed suicide. His wife has since announced that Mr. Williams had recently been diagnosed with Parkinson’s Disease, but his death still brought to the forefront an issue that is still often overlooked in today’s society: depression.
Unfortunately, many of the same myths about chronic pain—that it’s all in the sufferer’s head or that it’s simply a bid for attention—are also prevalent in relation to depression. These myths are not only incorrect, but they can severely and negatively impact people who suffer from chronic pain or depression.
Depression is a recognized mental illness.
The stigma around mental illnesses like depression is slowly fading as more people recognize that these conditions are actual illnesses. There are now widely accepted symptoms and treatments for conditions like clinical depression.
According to the National Alliance on Mental Illness (NAMI), some of the symptoms of clinical depression include:
- Changes in sleep and appetite
- Loss of energy
- Lack of interest
- Low self-esteem
- Poor concentration
- Feelings of hopelessness or guilt
These symptoms can range from mild to severe. In severe cases of depression, thoughts of suicide may also occur. Depression is often the result of a combination of factors. Genetics, age, gender, substance abuse, or life experiences can all impact a person’s likelihood of developing clinical depression. Additionally, chronic pain is often linked to depression.
In fact, in an article at Everyday Health, Dr. Michael Moskowitz of the University of California in Davis stated that:
“If you look at the nine places in the brain where pain occurs, six of them are where we experience mood disorders like depression and anxiety.”
The connections between chronic pain and depression may be because of similar modes of function.
Chronic pain is so closely associated with depression that it is sometimes considered a presenting symptom, or a factor in the diagnosis of depression. Indeed, pain can sometimes be the first—or even the only—symptom of depression. Often, the more severe a person’s depression is, the more intensely he or she will experience pain.
An article published in the Primary Care Companion to The Journal of Clinical Psychiatry found that both pain and depression use the same neuro-pathways. Specifically, the neurotransmitters serotonin and norepinephrine influence both pain and mood. If these neurotransmitters are dysfunctional, it can interfere with the reception of pain and the perception of mood. In other words, dysfunctional neurotransmitters can potentially cause both chronic pain and clinical depression. This is one potential explanation for why the two conditions are so often seen together.
The article also emphasizes the importance of treating both depression and pain, because the improvement of pain symptoms often results in the improvement of other symptoms of depression. At the same time, residual pain symptoms can make it more difficult for people with depression to achieve and maintain depression remission.
Current research is always finding more links between chronic pain and depression.
According to the National Institutes of Mental Health (NIMH), the links between chronic pain and depression may be because people with depression have an increased amount of proteins called cytokines. Cytokines are involved in telling the body’s immune system how to respond to disease or infection. An immune response often involves inflammation, which is usually a healthy bodily response. When a broken ankle swells or an infected cut puffs up, it’s the body’s way of encouraging healing.
However, inflammation can cause pain. If a depressed individual has a higher-than-normal amount of cytokines, he or she might be more likely to experience excess inflammation. The resultant pain can worsen depression symptoms, which makes pain more intense, which further worsens depression symptoms. Eventually, the two conditions are so tangled that it’s difficult to tell which came first.
Some physicians believe that chronic inflammation may actually be the root cause of both chronic pain and depression.
Gary Kaplan, an osteopathic physician based in Virginia, believes that chronic inflammation in the brain causes chronic pain and depression. The chemicals and cells that are released during an inflammatory immune response can, according to Dr. Kaplan, travel around the body even after the reason for the immune response has been dealt with. This lingering inflammation is called chronic inflammation, and it’s thought to be potentially responsible for a host of conditions from depression to heart disease.
Chronic inflammation can be exacerbated by a number of factors, such as poor diet, sedentary behavior, alcohol, stress, and smoking. Additionally, Dr. Kaplan believes that past trauma can impact an individual’s likelihood for chronic inflammation. For example, childhood abuse or the loss of a parent at a young age can cause stress that triggers internal inflammation.
This inflammation can stick around for a long time, potentially even years. Chronic inflammation brought on by childhood trauma can make an individual more likely to develop inflammation-related conditions, like depression or pain, later on. Dr. Kaplan believes that by treating this underlying chronic inflammation, physicians can treat the cause of depression and pain, rather than simply the symptoms.
Because of the varied possible causes of chronic pain and depression, people with these conditions have several potential treatment options.
Antidepressants that affect the uptake of neurotransmitters have been proven to treat both depression and chronic pain. Additionally, Dr. Kaplan’s patients have seen success with medications in combination with anti-inflammatory diets and alternative treatments, like acupuncture.
The more links are identified between chronic pain and depression, the more potential treatments can be identified. Most important in the treatment of individuals who have both chronic pain and depression is that they discuss all symptoms with their physicians and pursue treatment for both conditions.
Have you ever experienced depression with your chronic pain?
Image by Agustín Ruiz via Flickr