Chronic Pain and Depression

Screen Shot 2015-10-22 at 10.02.35 PMDo you have depression as well as chronic pain? I just read that 50% of people with depression and physical problems never mention to their doctor that they are depressed. If that is you, here is information to help you re-consider:

“Pain slows recovery from depression, and depression makes pain more difficult to treat… Worse, both pain and depression feed on themselves, by changing both brain function and behavior. Depression leads to isolation and isolation leads to further depression; pain causes fear of movement, and immobility creates the conditions for further pain. When depression is treated, pain often fades into the background, and when pain goes away, so does much of the suffering that causes depression.”

The article on the Havard website goes on to describe how a pain treatment program will deal with depression and pain at the same time. The problem is, few of us will have access to such a program. However there is a lot that can be done to help.

As a psychotherapist/counselor I know that things change, and can get better, even when they look very bleak. My preferred way of addressing depression is through a combination of counseling and self-management. Both address all parts of person’s life, and help people gain new skills that make them more resilient in the future. Medication alone cannot do that.

However, if depression is severe, antidepressants have been shown to help. They may also help against the pain, usually at lower doses. Here is the theory: “Brain pathways that handle the reception of pain signals, including the seat of emotions in the limbic region, use some of the same neurotransmitters involved in the regulation of mood, especially serotonin and norepinephrine. When regulation fails, pain is intensified along with sadness, hopelessness, and anxiety. And chronic pain, like chronic depression, can alter the functioning of the nervous system and perpetuate itself.” (Harvard website)

 Do I have depression?

Depression is actually quite common, 20- 25 % of women have an episode during their lives.  There are the regular checklists that help you start to look at this question. Major depression is defined as a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. There are many milder forms of depression as well. Depressed people tend to feel helpless, hopeless, worthless and that their lives are out of control.

It is easy to think that these symptoms do not quite fit, “I am not that badly off, it’s just the pain that is laying me low”, “I am so stressed that I am too tired for anything”. The question is really about quality of life, do you enjoy things and people and activities in your life? Do you look forward to something this coming week? Do you have hope and goals for the future? How hard is it to get out of bed in the morning? Do you usually see the negative side of new things you encounter?

These questions could point to a possible depression or mind habits that can lead to depression. There are many articles on CBT, cognitive behavioral therapy techniques that can help. I am not myself trained in CBT, but find these helpful.

What can I try?

There is excellent research on integrative medicine suggestions. Exercise can be as helpful as medication with far less side effects. Mindfulness, walking in nature, keeping a gratefulness journal, volunteering to help someone else, and maintaining other social and spiritual connections can all be effective ways to approach depression and pain at the same time. The key to any of these: do them often and regularly. That way the inertia of “I don’t feel like it today” is more easy to overcome. This website has many resources to get you started. Take any positive action to help yourself, even if you doubt it will work. Doubt and feelings of helplessness may be symptoms of depression. Do something that might make you feel better and observe how you feel afterwards.

If you find it difficult to engage in any self-care or activities you have enjoyed in the past, or don’t find them helpful, talking to your doctor is in order. Ask for a referral for counseling or other local resources such as a NAMI support group first, especially if you are concerned about medications (which may take several weeks to take effect anyway, and don’t work for everybody). The referral could be for chronic pain, rather than depression, if stigma concerns you. Insurances these days have to cover counseling as well as physical care. Change is possible, as is feeling better. I know it is.

Image Golden Rainbow Road courtesy of: John McSporran