Depression often linked with pain
Like the famous question, "Which comes first, the chicken or the egg?" both depression and pain can be the other's cause or effect. While depression can generate and amplify pain due to an imbalance in neurotransmitters, extended pain, in turn, can cause a person to become depressed.
Over 75 percent of patients with depression complain of physical pains and most are unaware that its chemical effects can aggravate chronic physical conditions and increase pain. Depression can precede and even predispose a patient to developing chronic pain because of the chemical imbalance it creates along with its hindrance of the usual pain threshold and coping mechanisms.
Neurotransmitters -- chemical substances called serotonin and norepinephrine -- are produced and regulated within our brain to keep everyday pain sensations in sync by blocking or decreasing pain signals. However, when levels of serotonin or norepinephrine are decreased and unbalanced, which occurs with depression, the brain becomes incapable of processing the transmitted pain signals properly. Pain signals can be exaggerated and distorted.
Common symptoms of depression are feelings of gloom, decreased interest and pleasure, loss of or excessive appetite, excessive or decreased sleep, agitation, loss of energy, feelings of worthlessness, decreased concentration, memory loss, anxiety, irritability and thoughts of death or suicide. Moreover, people with chronic pain and depression often show signs of irritability and anxiety rather than sadness.
On the other hand, people with a chronic condition such as chronic back pain, osteoarthritis, rheumatoid arthritis or fibromyalgia can become depressed because of increasing pain severity interference with daily activity, lack of response to treatment and stress. Being in pain can be very frustrating and discouraging. The prognosis of combined depression and pain is poor compared to that for individuals with depression or pain alone.
Fortunately, research has shown that by increasing levels of either serotonin or norepinephrine in the brain with the use of antidepressants, pain signals can be decreased and even blocked. Tricyclic anti-depressants such as Elavil, selective serotonin reuptake inhibitors (SSRIs) such as Prozac or Lexapro, and especially serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Effexor or Cymbalta, which are dual-acting antidepressants that can increase both serotonin and norepinephrine, have proven capable of decreasing pain while treating both depression and chronic pain. Because pain can induce depression and vice versa, these new dual-acting agents can provide physicians with safe and convenient treatments for these connected conditions.
While depression and pain seem to have the ability to create an unbreakable vicious cycle, there is hope and there are ways to prevent and treat their reciprocal effects. Combined analgesics, antidepressants with relaxation training, positive expectation, healthy attitude and even cognitive behavior therapy can break the cycle.
A seminar on "Fibromyalgia, Depression and Chronic Pain" will be presented at 5 p.m. March 2, classrooms A, B and C, Florida Hospital Memorial Ormond Beach, 875 Sterthaus Ave., Ormond Beach. (from ER entrance, second floor.)
Dr. Yong H. Tsai is board-certified in rheumatology, allergy and clinical immunology and has been practicing in this area since 1993. Send questions to Dr. Tsai in care of accent@news-jrnl.com. You also can check his Web site: arthritis-allergy.net.
