About 20% of people with chronic pain also have depression or anxiety. And 30-40% with fibromyalgia have depression at some time.
Depression and pain have always gone hand in hand for me. Before I was diagnosed with fibromyalgia but was symptomatic, I had a hard time coping with it all and university at the same time… and it led to depression. Years later when I was trying to hold onto my career with fibromyalgia and migraines it led to a very dark and long depression that ultimately I ended up on medication for.
I blamed the pain. Who wouldn’t be depressed? Am I right? Pain sucks. Sucks a whole boatload of suck. Raining sucks with a forecast of a lot more suck to come. So depression seemed inevitable. And so I ignored it. If it is just the pain then it is normal for chronic pain. And I felt if I could cope with the pain then the depression would be resolved. But nothing is easy.
Yet in some ways, I think depression with fibromyalgia, and pain altogether, comes from us exceeding our limits and the thoughts we have about pain. That the situation of chronic pain, plus our thoughts, plus exceeding our limits all the time is the perfect storm for depression. We often do not think about our emotional wellbeing so when confronted with a problem and adversity we cannot resolve we can find ourselves thinking some horrible things. Guilt. Blame. Loathing. And it affects our self-esteem and self-worth. And eventually morphs into depression which ones you are in it is a self-feeding loop of feedback to the brain that is hard to break.
Because our physical experiences are intertwined with our emotional experiences (and vice versa), it is not difficult to understand that it is beneficial to seek treatment for both your physical and emotional self. Certain things that can be part of the fibromyalgia experience can cause you to become frustrated and even depressed. For example, experiencing a prolonged pre-diagnosis period, poor or limited support from the medical community, lack of understanding by family members and friends, severe chronic pain and fatigue that can last for weeks and even months at a time, changes that disrupt your lifestyle, and the inability to do the things that you used to do can all affect your emotional health. Even the most optimistic person can become emotionally challenged when it comes to the symptoms and life-altering challenges that can result from fibromyalgia. -NFA
How much of depression are our environment and situation and how much are neurotransmitters going nutbars?
To be honest, I think it starts as one and then we train our brain to feel it and it becomes the other. The thoughts just become embedded in there. And as such we do not always need medication. I think often those of us with depression and fibromyalgia likely were predisposed genetically to it and the FM combo helps it manifest. I feel I am predisposed to depressive thinking myself and I have had two depressive episodes that lasted for a while that seem to have been triggered by the pain. Pain is depressing. It is isolating. It is relentless. It is difficult to cope with. And if we are predisposed to depressive thinking I think we are more at risk for developing depression when we have chronic pain. Just a theory. Not that it matters. Once you have depression it has to be managed in of itself.
I want to read Lost Connections to explore how much of depression is a neurotransmitter imbalance and how much is not… but due to society as a whole. But although I want to read that for depression… depression and pain and depression and fibromyalgia, specifically, is more complex.
And the reason I am so interested in that is that with chronic pain it just seems like depression is at a high risk. I feel that in some ways the struggle to cope with adversity that never ends may lead to depression in some people such as myself.
As such I do not think medication should be the first line of attack. I think cognitive therapy should be. Actually, I think for chronic pain we should all have some therapy to help us think about pain and live with it before depression even develops. To boost our resiliency. Because once we have depression tangled with pain it is so much harder to unravel. And if with fibromyalgia we are predisposed to depression having therapy before would help us recognize it for what it is and help us seek treatment faster and we would already have some tools to cope with it better than we would otherwise.
All I know for sure, is that depression and pain feed off of each other. And being lost in that dark hole is horrific. I endured it for some time until I just couldn’t anymore. I had reached my breaking point with unmanaged pain and Major Depressive Disorder. I wouldn’t wish that hell on anyone. And I needed medication at the point I got to… because I was very suicidal. Therapy helped me a lot. A great deal. But not quite enough to give me back that desire to live. And they had to treat the pain and the depression together because they fed into each other. If they tried to treat the depression without managing the pain… wouldn’t have worked at all.
Because it isn’t Just the pain that leads to depression with fibromyalgia. If it was, therapy would be sufficient all the time. “Depression and fibromyalgia often occur together, and that’s not just because being tired and in pain is depressing. Both are diseases of the nervous system involving dysregulation of some of the same neurotransmitters.” NFA
Both depression and fibromyalgia involve problems with the neurotransmitters in the central nervous system. In fibromyalgia the nerves of the brain and spinal cord are too sensitive to stimuli, a condition called “central sensitization.” For example, research has shown that fibromyalgia patients have too much of a neurotransmitter called Substance P, which tells nerves to transmit pain signals to the brain. In contrast, depression occurs when signals to “feel good” are lost because there aren’t enough of the monoamine neurotransmitters (like serotonin) around to deliver the message.
Sometimes, upregulating a parallel pathway can compensate for one defective pathway. That is, an excess of “feel good” signals from serotonin could cancel out the pain signals transmitted by Substance P. But when the two pathways malfunction simultaneously, the unfortunate owner of that nervous system feels very poorly indeed. Luckily, there are many ways to positively affect the balance of neurotransmitters in the brain, such as exercise, proper nutrition, and medication. -NFA
So with fibromyalgia in particular given its neurological origins can knock our neurotransmitters out of whack. So, yes, pain can be a risk factor to depression. And, yes, we can be predisposed to depression with fibromyalgia. It is both. Or one or the other. It is the pain. It is also the brain on fibromyalgia.
All I know is that for some of us therapy is beneficial by itself. For some of us, therapy and medication are needed. And I am one that needed medication to give me a boost. And it makes a massive difference in how I cope with pain.
One plain fact is our mental and emotional wellbeing must be considered in our pain management strategy. The pain, the fatigue, the lack of sleep, the social issues with stigma… all affect us with fibromyalgia. And we have to cope with the emotional fallout all the time. And sometimes depression can result from the way fibromyalgia affects our brains compounding all the problems we are coping with. Tangling them together. And for me treating the depression with medication saved my life. And therapy helped me deal with the negative thought processes that come with living with and trying to cope with pain.
I want you to know if you have both fibromyalgia and depression:
- You are not alone
- Needing help is Not a weakness
- Therapy can help
- Taking medication is ALSO Not a weakness
- Medication can help in addition to therapy
I also want you to know you can get through it. Although, we are at risk always for another bout of it. So we have to be aware.
And if you are dealing with depression that like me you thought must just be a normal state of affairs for chronic pain and fibromyalgia I want you to know depression is dangerous. And that if you talk to your doctor they can help point you in the direction of getting help with it. If I had done so earlier, I wouldn’t have tried to kill myself… and that is what I mean by dangerous. When pain and depression mix it increases our risk factor for suicidal ideation and suicide immensely. And I don’t want anyone to go through that.
No matter the origin of depression it is something we have to treat. I don’t care what caused it, only that for a long time I was lost in it (I am curious as to what causes it and what is FM and what is other). It is there, regardless of what caused it. And once it is there it is hard to get through. Treatment for it be it therapy or medication is important for our quality of life and overall wellbeing. We deserve it. We are worth it. I don’t think I’d be alive without treatment. And I want to want to live. Treatment isn’t easy. It isn’t quick. And sometimes it is very difficult to find a medication that works for you if you need it (Like how I cannot take antidepressants so I am on Abilify instead)… but it is worth it because you are worth it.