Understanding the Effects of Pain and Depression
When you have a great deal of pain, depression is often not far away. Conversely, the very presence of depression can cause you to have aches and pains that may have no other known cause. To make matters worse, medications taken for pain, such as opiates, can help to relieve symptoms of depression due to the manipulation of neurotransmitters in the brain. Although this doesn’t sound like a bad thing, necessarily, it can lead to dependence as the patient uses the drug not for pain but to treat the depression.
That’s why it is vitally important to properly diagnose cases of depression before medicating pain. If the depression is controlled by medications, such as SSRIs, a patient will be less likely to use opiates to self-medicate. Knowing what depression is, how it interfaces with pain, and how to break the cycle can help to eliminate dependence on pain medications due to mood problems.
Constant pain causes an emotional state of constant stress. You worry that your pain won’t go away, that the medications won’t work, or that you won’t be able to function with the pain that is driving your need for medications. Symptoms of uncomplicated depression without pain can include hopelessness, feelings of guilt, and suicidal ideation. However, with the added pressure of pain, the symptoms are a bit more subtle to diagnose.
Pain patients with depression may exhibit an altered mood, such as chronic sadness, helplessness, hopelessness, and thoughts of hurting themselves, but they are not always present. Constant anxiety is a symptom often seen in this type of depression, and anger, justified or unjustified, is another mood that may present. The patient may feel a lack of self-esteem, fatigue, irritability, and isolation. Financial, legal, and family issues are often present with the depression, and loss of muscle tone, sleep disturbances, and lack of interest in sex are other common manifestations.
How Depression Causes Pain
Pain and depression are often seen together because they share some of the same biology. For instance, both depression and pain are regulated by some of the same neurotransmitters in the brain. This is why SSRI medications that affect the neurotransmitter serotonin are now showing some evidence for treating chronic pain. In addition, pain and depression use some of the same neural pathways, and one can actually activate another.
Depression can magnify pain, making it seem worse than it really is. It also keeps you from pursuing coping skills that would help with both conditions. For instance, meditation is a common alternative treatment for both conditions, but untreated depression can lead you to abandon these activities as useless. This will make the pain worse because you aren’t using a treatment that could lessen your pain. Research has shown that those who have depression and pain experience more pain, have poorer coping skills, and feel less in control of their lives.
Treating Pain and Depression Together
Treating pain often decreases depression, and treating depression often decreases pain. For this reason, it is important to get a definitive diagnosis of your depressive symptoms. For some people, it is easier to admit they are in pain than that they are depressed. If you are feeling sad, hopeless, and isolated, these feelings will only serve to make your pain worse. What’s more, the depression is treatable through a host of non-opiate medications that can make you feel better.
The first type of drug for depression is the SSRIs, such as Prozac and Lexapro. These are the drugs that most people are familiar with for dealing with depression. They have shown some promise for treating chronic pain, but not as much promise as the SNRIs. These medications, such as Cymbalta, help increase the neurotransmitter norepinephrine in the brain. They are the first antidepressant medications that the FDA approved for chronic pain. Older medications, such as tricyclic antidepressants, are also being studied for their use in chronic pain. The newer medications are often used, though, due to side effects with this class of drugs.
If you have chronic pain and depression it is important to get a professional diagnose, since one can easily be mistaken for another and you may seek to self-medicate with opiates to treat both conditions. This can lead to dependence and is not recommended. Only by treating the depression with the proper medications and therapy can you gain control of your life again.