Depression and Fibromyalgia
Depression is often described as feeling sad, down, blue, unhappy, or miserable. It is a common condition and will likely affect most people for brief periods throughout their life. Clinical depression is a type of mood disorder that is characterized by feelings of sadness, loss, anger, or frustration that interferes with everyday activities for weeks, months, or even longer.
No one knows what exactly causes depression, but a majority of researchers think it is caused by an imbalance of chemicals in the brain. Depression may also be related to genetics or “triggered” by a certain stressful event. Depression has been known to run in families, lending support to the theory that depression has a genetic link, although a family history is not necessary. Substance abuse, certain medical conditions, medications (in particular steroid use), sleep disturbances, and stressful events may all play a role in the development of depression.
Symptoms of depression include agitation, irritability, difficulty concentrating, fatigue, feelings of hopelessness and worthlessness, self-imposed isolation, loss of interest in activities that one once enjoyed, thoughts of death and suicide, and difficulty sleeping. Traditionally, medications called antidepressants are used to treat depression. Examples of common antidepressants include Prozac, Zoloft, Paxil, and Wellbutrin, however there are many different kinds. Cognitive behavioral therapy is a type of talk therapy that is commonly used as well. It helps patients understand how their thoughts and feelings influence their behaviors. In addition, certain natural therapies have also shown promising results for treating depression, including lithium (available by prescription), SAMe, St. John’s Wort, and yoga (Natural Medicines Comprehensive Database).
Depression and Fibromyalgia
The pain and disability that accompany Fibromyalgia, along with other Fibromyalgia symptoms such as headache, sleep disturbances, and muscle pain, all make it difficult to live with Fibromyalgia, and the difficulties patients often face in adequately managing their symptoms can make people feel alone and hopeless. For many Fibromyalgia sufferers, this all culminates in depression. In fact, an estimated 30% of all Fibromyalgia patients have major depression at the time they are diagnosed, and as many as 20% have generalized anxiety disorder.
A number of causes have been suggested to explain how depression occurs in Fibromyalgia patients. As previously mentioned, a chemical imbalance in the brain is often cited as the cause for most depression. Researchers believe that low levels of chemicals in the brain called neurotransmitters – in particular serotonin – may be to blame. Neurotransmitters send signals to different parts of the brain in order to regulate mood, pain, and bodily functions. When levels of these neurotransmitters are low, an individual may feel depressed. Fibromyalgia related disability is frequently associated with low levels of neurotransmitters, as is depression. Many antidepressant medications work by regulating the amount of serotonin in the brain.
Having to deal with the chronic pain and tenderness associated with Fibromyalgia may also play a role in the development of depression for Fibromyalgia sufferers. Furthermore, the role of depression may also have a genetic link in Fibromyalgia. Many individuals who have both depression and Fibromyalgia also have a family history of depression.
Sleep disturbances have also been shown to be associated with depression and anxiety in Fibromyalgia. A 2011 study by Miro et al. compared 104 women with Fibromyalgia to 86 healthy control subjects to determine the relationship between pain, emotional distress, and daily functioning. The researchers found that sleep quality, among other variables studied, was significantly associated with anxiety and depression.
Impact of Depression on Fibromyalgia Patients
Individuals who suffer from depression and Fibromyalgia often modify their behaviors as a result of the depression, such as self-imposed isolation and inactivity. In fact, non-depressed Fibromyalgia patients are more likely to be active, and physical activity is well-documented as a means of providing relief from the pain and fatigue of Fibromyalgia.
One way to better understand the role of depression in Fibromyalgia is to view it through the lens of a phenomenon known as negative feedback. Negative feedback is a cycle in which an event leads to another event, which leads to another and so on. The cycle continues until something terminates it. For example, an individual with both Fibromyalgia and depression may discontinue an exercise regimen that was providing some relief from the pain of Fibromyalgia. As the period of inactivity lengthens, their pain becomes worse, which causes the individual’s depression to worsen as well. This cycle continues until something occurs to stop it, such as the individual seeking treatment for their depression or resuming the physical activity regimen (which provides relief from the pain).
Therefore, depression can indirectly modify the course of Fibromyalgia if it is not treated appropriately, perpetuating the cycle of pain and fatigue and leading people with Fibromyalgia to lead less active and fulfilling lives.
Research on Depression and Fibromyalgia
A recently published study from Ross et al. observed 76 patients with Fibromyalgia to determine the prevalence of various types of depression. The researchers evaluated each patient for depression, and patients also completed a series of questionnaires to assess depression severity, depression type, overall Fibromyalgia symptom severity, pain severity, functional impairment, quality of life, and sleep quality. The researchers found that 40 patients had major depression with “atypical features,” meaning that they could experience improved mood in response to positive events. Twenty-seven patients had major depression with “melancholic features,” meaning that they could not experience positive moods even when good events occurred. With regard to symptoms, the study showed that those with atypical features and those who were not depressed tended to have a longer duration of Fibromyalgia symptoms, however the two depressed groups experienced far greater severity for all clinical features when compared to those who were not depressed.
A 2009 review article by Maletic and Raison evaluated recent data examining the high rates of comorbidity seen between major depressive illnesses, Fibromyalgia, and neuropathic pain (chronic pain resulting from never damage). Overall, the researchers found substantial evidence to support an association between depression and pain in general, citing that 30%-60% of all individuals with depression also suffer from a painful condition, and that pain is a major predictor of both depression and generalized anxiety disorder. The authors assert that a common genetic basis may be to blame for the frequent co-existence of depression and pain disorders, suggesting that genes involved in pain transmission and signaling may be involved. In addition, the researchers discuss how pain and depression have been observed to stimulate similar regions in the brain. The authors conclude their lengthy review by stating that environmental influences (such as stress and illness) may promote chemical changes within the body that stimulate (or fail to adequately stimulate) various areas of the brain that control mood and pain sensitivity.